ATI RN
ATI SP 250 Exam 3 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse in an emergency department is caring for a client who has burns on the front and back of both his legs and arms. Using the rule of nines the nurse should document burns to which percentage of the client's total body surface area (TBSA)?
Correct Answer: D
Rationale: This is because according to the rule of nines, each arm accounts for 9 percent and each leg accounts for 18 percent of the TBSA.
Therefore, burns on both arms and both legs equal (9+9+18+18) = 54%.
Question 2 of 5
A nurse is developing a plan of care for a client who is rehabilitating from major burns. Which of the following interventions should the nurse include to provide emotional support?
Correct Answer: C
Rationale: This is because talking with the client can help reduce anxiety, pain, and isolation, as well as build trust and rapport between the nurse and the client. Talking with the client can also provide an opportunity for education, feedback, and encouragement.
Question 3 of 5
A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?
Correct Answer: D
Rationale: CD4-T-cell count 180 cells/mm3 is the nurse's priority.
Rationale: This is because a low CD4-T-cell count indicates a high risk of opportunistic infections and impaired immune function. The nurse should implement infection prevention measures and monitor the client for signs of infection. The other values are not as critical as the CD4-T-cell count.
Question 4 of 5
A nurse is admitting a client who has sustained severe burn injuries in a grease fire. The nurse shades in a diagram indicating the burned surface areas. Using the Rule of Nines, the nurse should estimate that the client has burned what percentage of body surface area? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 31.5
Rationale: The anterior chest wall and abdomen accounts for 18%, the left upper limb 9% (4.5% anteriorly and 4.5% posteriorly), and the right upper limb 4.5% (2.25% anteriorly and 2.25% posteriorly). (18+9+4.5) = 31.5%.
Question 5 of 5
A nurse is caring for a client who has a history of exposure to TB and symptoms of night sweats and hemoptysis. Which of the following tests should the nurse realize is the most reliable to confirm the diagnosis of active pulmonary TB?
Correct Answer: B
Rationale: This is because sputum culture can identify the presence and type of mycobacteria that cause TB, while other tests can only indicate exposure or infection. Sputum culture results may take several weeks, so treatment should be initiated based on clinical suspicion and other tests.