Questions 85

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ATI Nur258 Med Surg 2 Final Exam Questions

Extract:


Question 1 of 5

A nurse is working with a limited staff because of a severe storm in the area. The facility incident commander has initiated disaster protocols. Which of the following actions should the nurse take first?

Correct Answer: B

Rationale: In a disaster situation, prioritizing care for clients with life-threatening emergencies is crucial to ensure that those in the most critical condition receive immediate attention. This aligns with triage principles and ensures that limited resources are used effectively.

Question 2 of 5

A nurse is planning care for a client who has leukemia and a platelet count of 60,000/mm³ (nl. 140,000-400,000/mm³). Which intervention should the nurse include in the plan of care?

Correct Answer: B

Rationale: Administering stool softeners is a key intervention for clients with thrombocytopenia, as it helps to prevent straining during bowel movements, which could cause rectal bleeding due to fragile blood vessels.

Question 3 of 5

A nurse is developing an education program about skin cancer for a community center. Which of the following instructions should the nurse plan to include?

Correct Answer: A

Rationale: Keeping a body map of skin lesions is a key strategy for monitoring changes in the skin over time. This helps individuals track any new or changing lesions, which is crucial for early detection of skin cancer.

Question 4 of 5

A nurse is providing education about levothyroxine to a client diagnosed with primary hypothyroidism. Which of the following statements should the nurse use when teaching the client?

Correct Answer: A

Rationale: Levothyroxine is used to replace thyroid hormone in hypothyroidism. Symptoms like tremors, nervousness, and insomnia can indicate that the dose is too high, suggesting possible hyperthyroidism.

Question 5 of 5

A nurse is caring for a client who has methicillin-resistant Staphylococcus aureus (MRSA) in an abdominal wound. The nurse enters the room to check the client's pulse. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: Clean gloves are appropriate for contact with the client or the wound, as MRSA is transmitted through direct contact. This prevents contamination while assessing the client.

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