nur 242 Med Surg Exam

ATI nur 242 Med Surg Exam

Total Questions : 49

Showing 10 questions Sign up for more
Question 1: View

A nurse is creating the plan of care for a client who is immunosuppressed.Which of the following precautions should the nurse include in the plan? (Select all that apply)

Explanation

Choice A rationale
Immunosuppressed clients are at increased risk for infections from foodborne pathogens. Eating only cooked foods helps to kill potentially harmful bacteria, reducing the risk of infection. Raw foods can harbor bacteria and parasites that cooked foods do not.
Choice B rationale
Wearing a mask, gloves, and gown protects both the immunosuppressed client and the healthcare provider from the transmission of pathogens. This personal protective equipment (PPE) barrier reduces the likelihood of infection by preventing the transfer of pathogens.
Choice C rationale
Visitors with active infections pose a high risk to immunosuppressed clients due to their weakened immune systems. Restricting such visitors helps in minimizing the exposure to infectious agents and therefore decreases the risk of infections.
Choice D rationale
Incorrect, as disposing of linen in the trash is not a standard infection control practice. Linens should be handled according to hospital protocols, typically involving proper laundering to prevent contamination and spread of infections.
Choice E rationale
Limiting bathing is not recommended. Regular bathing helps in maintaining skin integrity and preventing skin infections. However, excessive bathing might lead to dry skin, so balanced hygiene practices should be maintained.


Question 2: View

A nurse is planning to assign tasks for a group of clients.Which of the following tasks should the nurse plan to assign to an assistive personnel (AP)? (Select all that apply)

Explanation

Choice A rationale
Weighing a client with heart failure is a non-invasive and routine task that can be performed by an assistive personnel (AP). Accurate daily weights are essential for monitoring fluid balance in these clients.
Choice B rationale
Incorrect, as providing discharge instructions for a client requires professional nursing judgment and assessment, tasks outside the scope of practice for APs.
Choice C rationale
Incorrect, as performing an admission assessment requires critical thinking and clinical judgment, which are responsibilities of a licensed nurse.
Choice D rationale
Ambulating an older adult client with hypertension can be safely done by an AP. This helps in maintaining the client's mobility and preventing complications such as blood clots and muscle atrophy.
Choice E rationale
Incorrect, as checking a blood product with another nurse prior to administration involves a critical safety check that must be performed by licensed nurses to ensure the right blood is given to the right patient.


Question 3: View

A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings is the highest priority for the nurse to report to the provider?

Explanation

Choice A rationale
Joint pain in hands and knees is a common symptom of SLE due to inflammation but is not immediately life-threatening. It requires management but is not the highest priority.
Choice B rationale
A dry, raised rash on the face, such as a malar rash, is common in SLE and should be monitored and treated, but it is not immediately life-threatening.
Choice C rationale
Feelings of depression are serious and need addressing but are not an immediate threat to physical health. Depression is often associated with chronic illnesses and requires comprehensive mental health support.
Choice D rationale
Presence of peripheral edema could indicate renal involvement or cardiac issues in SLE, which can be life-threatening. It is crucial to address this finding urgently to prevent complications such as renal failure or severe cardiovascular events.


Question 4: View

A nurse is caring for an older client on a medical-surgical unit.Which of the following interventions should be included in the plan of care?

Explanation

Choice A rationale
Monitoring the client’s hydration status is critical for older adults, especially those on a medical-surgical unit, to prevent dehydration, which can lead to serious complications such as renal impairment, confusion, and electrolyte imbalance.
Choice B rationale
Encouraging physical activities is beneficial but is not always feasible or safe for all older clients, especially those with certain medical conditions or mobility limitations.
Choice C rationale
Administering medications as prescribed is essential but is a standard practice for all clients and not specific to older adults' unique needs.
Choice D rationale
Educating the client on dietary needs is important but secondary to monitoring hydration, which addresses more immediate physiological needs and complications.


Question 5: View

A nurse is teaching a group of middle adult clients about early detection of cancer.

The nurse should include the American Cancer Society recommendation that men and women at average risk should have which of the following screening tests?

Explanation

Choice A rationale
Cervical cancer screening is recommended for individuals with a cervix starting at age 21, not necessarily for detecting colorectal cancer. It's an essential screening but irrelevant to middle-aged clients discussing colorectal cancer risk.
Choice B rationale
Lung cancer screening is mainly for people with a history of heavy smoking. Discussing lung cancer screening with a doctor is vital, but it does not address the early detection of colorectal cancer for average-risk individuals.
Choice C rationale
The previous recommendation was to start colorectal cancer screening at age 50. However, guidelines have updated, and this age is now considered outdated for average-risk individuals.
Choice D rationale
Colorectal cancer screening for everyone beginning at age 45 aligns with the latest American Cancer Society guidelines. This change reflects evidence showing the benefit of earlier screening to detect and prevent colorectal cancer in average-risk adults.


Question 6: View

A nurse is reviewing the CBC findings for a female client who is receiving combination chemotherapy for breast cancer.

Which of the following findings should the nurse report to the provider?

Explanation

Choice A rationale
An RBC count of 5 million/mm³ is within the normal range for adult females, so this finding would not be concerning in the context of chemotherapy.
Choice B rationale
A WBC count of 2300/mm³ is significantly lower than the normal range (typically 4500 to 11000/mm³) and indicates neutropenia, which is a critical side effect of chemotherapy that needs to be reported immediately.
Choice C rationale
Hemoglobin level of 12 g/dL is within the normal range for adult females, so this would not be concerning in the context of chemotherapy.
Choice D rationale
A platelet count of 155,000/mm³ is within the normal range (150,000 to 450,000/mm³). Although on the lower end, it is not typically alarming enough to report immediately in the context of chemotherapy.


Question 7: View

A nurse is admitting a child who has a total WBC count of 1200.

Which of the following clients should the nurse place in the same room with this child?

Explanation

Choice A rationale
A child with rheumatic fever could carry infectious agents that might pose a risk to a child with severe immunocompromise such as low WBC.
Choice B rationale
A child recovering from a ruptured appendix might have residual infection or be at higher risk of infection, which could be dangerous for a child with very low WBC count.
Choice C rationale
A child with cystic fibrosis has a risk of respiratory infections, posing a threat to a child with a compromised immune system like severe neutropenia.
Choice D rationale
A child with nephrotic syndrome does not typically carry infectious risks and would be a safer roommate for a child with a compromised immune system due to low WBC count.


Question 8: View

Treatment for frostbite includes which actions? (Select all that apply.)

Explanation

Choice A rationale
Administering IV opioids can help manage the intense pain associated with frostbite, improving patient comfort during rewarming and recovery.
Choice B rationale
After rewarming, the extremity should be elevated, not lowered, to reduce edema by encouraging fluid return to the central circulation.
Choice C rationale
Immersing hands and feet in warm water is a crucial step in the rewarming process, which helps restore blood flow and prevent further tissue damage.
Choice D rationale
Elevating affected limbs after rewarming helps reduce edema and prevents further swelling and complications.
Choice E rationale
Tetanus prophylaxis is recommended in frostbite cases as frostbite injuries can break the skin, increasing the risk of tetanus infection. Hence, avoiding tetanus prophylaxis is incorrect.


Question 9: View

A nurse is providing teaching to a client who has breast cancer about the adverse effects of chemotherapy.

Which of the following client statements indicates an understanding of the teaching?

Explanation

Choice A rationale
Avoiding crowds is to prevent the client from getting infections due to immunosuppression, not to prevent spreading infection to others, thus an incorrect rationale.
Choice B rationale:
Running a toothbrush through a dishwasher may seem hygienic but is generally unnecessary. More effective measures are needed to ensure oral hygiene without excessive sterilization.
Choice C rationale
Antiemetics are typically taken prior to or at the first sign of nausea during chemotherapy, not after the infusion is complete, so this statement is incorrect regarding the timing of antiemetic use.
Choice D rationale
Calling the doctor for unusual menstrual bleeding is crucial as it can indicate thrombocytopenia, a potential side effect of chemotherapy, reflecting the client's correct understanding.


Question 10: View

A nurse is evaluating a client's laboratory results.

The nurse should recognize that an increase in the client's prostate specific antigen (PSA) laboratory value is indicative of which of the following diagnoses?

Explanation

Choice A rationale
Liver cancer is not associated with elevated prostate specific antigen (PSA) levels. PSA is a protein produced primarily by prostate cells, and its elevation is typically linked to prostate-related conditions rather than liver disorders.
Choice B rationale
Breast cancer is not associated with elevated PSA levels. PSA is specific to prostate cells, which are not present in breast tissue. Therefore, PSA is not a marker used in diagnosing or monitoring breast cancer.
Choice C rationale
Colon cancer is not linked to elevated PSA levels. PSA is not a biomarker for colon cancer, as it is specific to the prostate gland. Other markers, such as carcinoembryonic antigen (CEA), are more relevant for colon cancer.
Choice D rationale
Prostatic cancer is associated with elevated PSA levels. PSA is produced by prostate cells, and elevated levels can indicate prostate cancer, benign prostatic hyperplasia (BPH), or inflammation of the prostate.


You just viewed 10 questions out of the 49 questions on the ATI nur 242 Med Surg Exam Exam. Subscribe to our Premium Package to obtain access on all the questions and have unlimited access on all Exams.

Subscribe Now

learning

Join Naxlex Nursing for nursing questions & guides! Sign Up Now