ATI RN
ATI SP 250 Exam 3 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse's priority when assessing the severity of the client's burns?
Correct Answer: D
Rationale: This is because burns to the face, neck, and upper extremities can compromise the airway, circulation, and mobility of the client. The nurse should monitor for signs of respiratory distress, infection, and contractures in these areas.
Extract:
Diagnostic Results
January:
• Laboratory: CD4 cell count 200 cells/mm³ (Normal range: 600-1500 cells/mm³)
June:
• Laboratory: CD4 cell count 90 cells/mm³ (Normal range: 600-1500 cells/mm³)
• Chest x-ray: Bilateral white infiltrates consistent with pneumonia
Question 2 of 5
A nurse in a community health clinic is caring for a client who has a history of HIV. For each of the following assessment findings for the client, identify if the finding is consistent with HIV stage I or HIV stage III (AIDS). Each finding may support more than one disease process.
| Options | HIV stage I | HIV stage III |
|---|---|---|
| CD4 cell count 200 cells/mm3 (600-1500 cells/mm3) | ||
| Weight changes | ||
| Chest x-ray showing bilateral white infiltrates consistent with pneumonia | ||
| Skin condition | ||
| Latest CD4 cell count |
Correct Answer: A,C,E
Rationale: CD4 cell count 200 cells/mm³ is consistent with HIV stage II or III, as it indicates significant immunosuppression. Chest x-ray showing bilateral white infiltrates consistent with pneumonia is indicative of HIV stage III (AIDS), as opportunistic infections like pneumonia are common. Latest CD4 cell count (90 cells/mm³) is consistent with HIV stage III (AIDS), as it is below 200 cells/mm³, a threshold for AIDS diagnosis.
Extract:
Question 3 of 5
A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse's priority when assessing the severity of the client's burns?
Correct Answer: D
Rationale: This is because burns to the face, neck, and upper extremities can compromise the airway, circulation, and mobility of the client. The nurse should monitor for signs of respiratory distress, infection, and contractures in these areas.
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 teaching a client who has tuberculosis and is to start combination drug therapy. Which of the following medications should the nurse plan to administer?
Correct Answer: A,D,E
Rationale: This is because these medications are antimycobacterial agents that inhibit the growth and replication of Mycobacterium tuberculosis, the bacterium that causes tuberculosis. Acyclovir is an antiviral medication, and montelukast is used for asthma.