ATI Custom MED SURG II Exam
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Free ATI Custom MED SURG II Exam Questions
A patient with systemic lupus erythematosus (SLE) is prescribed methotrexate. What nursing instructions regarding pregnancy are essential?
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Advise the patient to consult a fertility specialist before starting methotrexate
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Methotrexate usage does not influence pregnancy outcomes
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Ensure the patient begins folic acid supplementation to support fetal development
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Methotrexate may cause severe fetal malformations; pregnancy must be avoided while on treatment
Explanation
Methotrexate is a known teratogen classified as Pregnancy Category X. It is a folic acid antagonist that inhibits cell division and can cause severe fetal malformations, spontaneous abortion, and fetal death. Patients of childbearing age must be counseled explicitly to avoid pregnancy during treatment and for a period of time after discontinuation. Reliable contraception is mandatory while on methotrexate therapy, and this education is a critical nursing responsibility.
Why the other options are incorrect:
A. Advise the patient to consult a fertility specialist before starting methotrexate — While future fertility planning is a valid discussion, it is not the essential or most urgent nursing instruction. The immediate priority is warning the patient about the severe teratogenic risk and the absolute requirement to avoid pregnancy during treatment.
B. Methotrexate usage does not influence pregnancy outcomes — This is factually incorrect and dangerous. Methotrexate has well-documented, serious adverse effects on fetal development and pregnancy outcomes. Providing this information to a patient could result in catastrophic harm.
C. Ensure the patient begins folic acid supplementation to support fetal development — While folic acid supplementation is sometimes recommended alongside methotrexate to reduce side effects such as mucositis and liver toxicity in the patient, it does not make methotrexate safe during pregnancy. Folic acid supplementation is not a substitute for pregnancy avoidance while on this medication.
5 oz × 30 mL/oz = 15 mL
The nurse will administer 15 mL of apple juice along with the furosemide dose.
Why Other Options are Incorrect:
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Complete Blood Count (CBC)
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Western blot assay
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Prothrombin Time (PT)
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Liver Function Test
Explanation
Correct Answer: (B) Western blot assay
The Western blot assay is the confirmatory test used to diagnose HIV infection. The standard HIV diagnostic algorithm involves an initial screening test such as the enzyme-linked immunosorbent assay (ELISA) or a fourth-generation antigen/antibody combination test. If the initial screen is reactive, the Western blot assay is performed to confirm the diagnosis by detecting specific antibodies against HIV proteins. A positive Western blot in a symptomatic patient confirms HIV infection.
Why Other Options are Incorrect:
A. Complete Blood Count (CBC) — A CBC provides information about red blood cells, white blood cells, and platelets and may show abnormalities in an HIV-positive patient such as anemia or lymphopenia, but it cannot diagnose HIV infection and is not a confirmatory test.
C. Prothrombin Time (PT) — PT measures how long blood takes to clot and is used to assess coagulation function and monitor anticoagulation therapy. It has no role in the diagnosis of HIV.
D. Liver Function Test — Liver function tests assess hepatic enzymes and markers of liver health. While HIV and antiretroviral medications can affect liver function, these tests do not diagnose HIV infection and are not used for confirmation.
A nurse is caring for a patient experiencing unexplained weight loss and requiring nutritional support.
Nurse's Notes: At 1000 — Patient appears fatigued and reports difficulty maintaining weight. Skin dry and flaking, especially on arms and legs. Intake over the last 24 hours reported to be less than 50% of meals attempted. At 1400 — Patient reports mild nausea and early satiety after small meals. Muscle wasting noted in upper arms. Patient appears lethargic but responsive to verbal cues.
Vital Signs: Temperature: 36.4°C (97.5°F) → 36.6°C (97.9°F) Heart Rate: 95/min → 98/min Respiratory Rate: 20/min → 22/min Blood Pressure: 100/65 mmHg → 98/62 mmHg Oxygen Saturation: 98% on room air → 97% on room air
Intake and Output: 0800: Oral Input 60mL, IV Input 500mL, Medication Input 250mL 1200: Oral Input 80mL, Urine Output 300mL 1400: Oral Input —, Urine Output 200mL, Emesis Output 50mL
Laboratory Results: Albumin: 2.9 mg/dL (Reference: 3.5–5.0 g/dL) — LOW Creatinine: 0.9 mg/dL (Reference: 0.6–1.5 mg/dL) — Normal Glucose: 82 mg/dL (Reference: 70–100 mg/dL) — Normal Electrolytes: Within normal limits
Which 3 factors should the nurse prioritize to support nutritional management for this patient?
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Review vaccination history
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Monitor changes in weight and muscle mass
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Assess medication interactions affecting appetite
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Evaluate calorie and protein intake
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Determine hydration status
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Check vitamin C levels
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Monitor skin condition
Explanation
Correct Answer: (B), (C), and (D)
Monitor changes in weight and muscle mass — The patient presents with visible muscle wasting in the upper arms and difficulty maintaining weight, making tracking of weight and muscle mass essential to evaluating the effectiveness of any nutritional intervention and detecting further deterioration.
Assess medication interactions affecting appetite — The patient reports nausea and early satiety after small meals, which are common side effects of certain medications. Identifying whether any current medications are suppressing appetite or causing GI disturbance is critical to addressing the root cause of inadequate intake.
Evaluate calorie and protein intake — With albumin significantly below the reference range at 2.9 g/dL, less than 50% of meals being consumed, and documented emesis, evaluating the actual caloric and protein intake is fundamental to designing an appropriate nutritional support plan.
Why the other options are incorrect:
A. Review vaccination history — Vaccination status is not relevant to the immediate nutritional management of this patient and does not address the presenting clinical concerns of weight loss and malnutrition.
E. Determine hydration status — While oral intake is low and there is some emesis noted, electrolytes are within normal limits and IV fluids are running, making hydration a secondary concern at this time rather than one of the top three nutritional priorities.
F. Check vitamin C levels — There is no specific clinical indication in the presented data to prioritize vitamin C assessment over the more pressing concerns of overall caloric intake, protein status, and appetite-affecting medications.
G. Monitor skin condition — While the patient has dry, flaking skin, this is a symptom of the underlying nutritional deficit rather than a primary management priority. Addressing nutritional intake directly will have a greater impact than monitoring skin condition alone.
A nurse is reinforcing teaching with a group of clients at a community health clinic about HIV testing. Which of the following populations should the nurse explain is at an increased risk for HIV infection?
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Children who have low socioeconomic status
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People who have alcohol use disorder
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People who use an insulin pump
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People who are pregnant
Explanation
People with alcohol use disorder are at increased risk for HIV infection because alcohol impairs judgment and lowers inhibitions, leading to higher rates of unprotected sexual intercourse and other high-risk behaviors. Alcohol use disorder is also associated with increased likelihood of engaging with multiple sexual partners and reduced consistent use of barrier protection, all of which are established behavioral risk factors for HIV transmission.
Why the other options are incorrect:
A. Children who have low socioeconomic status — Low socioeconomic status alone does not place children at increased risk for HIV infection. HIV transmission requires specific routes of exposure such as sexual contact, sharing needles, or perinatal transmission, none of which are inherent to socioeconomic status in children.
C. People who use an insulin pump — Insulin pump use involves a subcutaneous catheter changed by the patient in a controlled, sterile manner. This does not constitute a risk factor for HIV transmission. HIV risk from needles relates to sharing contaminated needles for intravenous drug use, which is entirely different from insulin delivery devices.
D. People who are pregnant — Pregnancy itself does not increase the risk of acquiring HIV. However, an HIV-positive pregnant person does carry the risk of transmitting the virus to their unborn child. Being pregnant is a consideration for HIV screening and prevention of mother-to-child transmission, but it is not an independent risk factor for HIV acquisition.
A nurse is providing care for multiple clients diagnosed with infections. Which of the following clients is at the greatest risk of sepsis?
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A client who is lactating
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A 55-year-old client
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A 3-year-old client
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A client who has AIDS
Explanation
A client with AIDS has severely compromised immune function due to profound CD4 T-lymphocyte depletion. This advanced immunosuppression leaves the patient virtually unable to mount an effective immune response against pathogens, making them highly susceptible to sepsis when an infection occurs. Sepsis occurs when the immune response to infection becomes dysregulated and begins causing systemic organ damage, a risk that is dramatically elevated in immunocompromised individuals such as those with AIDS.
Why the other options are incorrect:
A. A client who is lactating — Lactation is a normal physiological state and does not significantly compromise immune function or increase the risk of sepsis beyond what is typical for a postpartum woman.
B. A 55-year-old client — While aging is associated with mild immunosenescence, a 55-year-old does not have the degree of immune compromise seen in AIDS. Without other significant comorbidities, this patient is at a substantially lower risk of sepsis than a patient with AIDS.
C. A 3-year-old client — Young children have developing immune systems and are more susceptible to infections than healthy adults, but their immune function is not nearly as impaired as that of a patient with AIDS. A 3-year-old with an intact immune system has far greater capacity to respond to infection than an AIDS patient.
A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and is prescribed to receive 40 mL of fluid replacement every 4 hr for each 100 mL of output. The client's output over the last 4 hr was 250 mL. How much water should the nurse administer to the client? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Explanation
Correct Answer: 100 mL
Using the prescribed replacement formula:
For every 100 mL of output → replace with 40 mL
Step 1: Determine how many 100 mL units are in 250 mL of output: 250 mL ÷ 100 mL = 2.5 units
Step 2: Multiply by the replacement rate: 2.5 × 40 mL = 100 mL
The nurse should administer 100 mL of water to the client over the next 4-hour period.
A nurse is contributing to the plan of care for a client who has a terminal illness. Which of the following interventions should the nurse identify as the priority?
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Encourage the client to recall positive life events
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Suggest ways the client can continue interacting with social contacts
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Schedule pain medication on a routine basis
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Promote the client's expression of feelings about loss of self-care ability
Explanation
In terminal illness, the priority of care shifts to comfort and symptom management. Pain is one of the most distressing and prevalent symptoms at end of life, and scheduling pain medication on a routine basis ensures consistent therapeutic drug levels that prevent pain from breaking through. Reactive or as-needed dosing alone is inadequate for terminal pain management. Proactive, scheduled analgesia is a foundational principle of palliative and hospice care and directly addresses the patient's most immediate physiological need.
Why the other options are incorrect:
A. Encourage the client to recall positive life events — Life review is a valuable psychosocial and spiritual intervention in end-of-life care, but it is not the clinical priority when unmanaged pain is present. Physical comfort must be established before higher-level psychosocial interventions are addressed.
B. Suggest ways the client can continue interacting with social contacts — Maintaining social connection supports emotional wellbeing and reduces isolation, but again, this is a secondary priority compared to ensuring adequate pain control in a terminally ill patient.
D. Promote the client's expression of feelings about loss of self-care ability — Emotional support and therapeutic communication around loss of independence are important aspects of end-of-life care, but they do not take precedence over the immediate physical priority of pain management.
A nurse is reinforcing education with a client who has discoid lupus erythematosus. Which of the following statements made by the client indicates understanding of how to prevent exacerbation of skin rashes?
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"I should exercise on a regular basis."
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"I need to apply sunscreen."
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"I must wash my hands before touching my skin."
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"I need to sleep 8 hours a night."
Explanation
Discoid lupus erythematosus (DLE) is a chronic autoimmune skin condition in which UV light exposure is a well-established trigger for skin rash exacerbations. Applying broad-spectrum sunscreen daily, along with wearing protective clothing and avoiding peak sun hours, is one of the most important self-care measures to prevent flares. The client's statement about applying sunscreen directly reflects an understanding of this critical preventive strategy.
Why the other options are incorrect:
A. "I should exercise on a regular basis." — While exercise is beneficial for general health, it is not specifically related to preventing DLE skin rash exacerbations and does not reflect disease-specific education.
C. "I must wash my hands before touching my skin." — Hand hygiene is a general infection prevention measure and is not specifically targeted at preventing lupus-related skin flares. It does not demonstrate understanding of DLE management.
D. "I need to sleep 8 hours a night." — Adequate rest is important for overall immune health and fatigue management in lupus patients, but it is not a specific strategy for preventing skin rash exacerbations in DLE.
Which nursing interventions are appropriate for managing patient comfort during the dying process? (Select all that apply.)
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Ensure the patient remains in a brightly lit room
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Provide emotional support to the family
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Frequently reposition the patient to prevent skin breakdown
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Maintain a calm and quiet environment
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Encourage oral intake even when the patient is no longer able to swallow
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Offer aggressive treatments to prolong life
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Administer pain medication as prescribed
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Monitor for and manage symptoms like dyspnea and restlessness
Explanation
End-of-life comfort care, also known as palliative care, focuses on maintaining dignity, relieving suffering, and supporting both the patient and their family. Providing emotional support to the family acknowledges their grief and keeps them engaged in the care process. Frequent repositioning prevents pressure injuries in a patient who is immobile and unable to shift their own weight. Maintaining a calm and quiet environment reduces sensory overstimulation that can cause agitation in a dying patient. Administering pain medication as prescribed ensures the patient remains free from unnecessary pain and discomfort. Monitoring and managing symptoms such as dyspnea and restlessness are core components of comfort-focused end-of-life nursing care.
Why Other Options are Incorrect:
A. Ensure the patient remains in a brightly lit room — Bright lighting can be overstimulating and distressing for dying patients who are sensitive to sensory input. A softly lit, calm environment is preferred to promote comfort and peace.
E. Encourage oral intake even when the patient is no longer able to swallow — Forcing or encouraging oral intake in a patient who can no longer swallow creates a serious risk of aspiration. At end of life, reduced oral intake is a natural physiological process and should not be reversed through encouragement or artificial means.
F. Offer aggressive treatments to prolong life — The goal of end-of-life care shifts from curative or life-prolonging interventions to comfort and quality of life. Aggressive treatments are inconsistent with palliative and hospice care principles and can cause unnecessary suffering in the final stages of life.
A patient has received a vaccine for influenza. Which type of immunity does this vaccine primarily provide?
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Herd immunity
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Passive immunity
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Active immunity
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Natural immunity
Explanation
Receiving an influenza vaccine stimulates the recipient's own immune system to produce antibodies and memory cells against the influenza antigen. This is classified as active immunity because the individual's immune system actively participates in generating the protective response. It is also specifically artificial active immunity, as the antigen is introduced through a vaccine rather than through natural infection.
Why the other options are incorrect:
A. Herd immunity — Herd immunity is a population-level concept describing the indirect protection of unvaccinated individuals when a sufficient proportion of the population is immune. It is not a type of immunity that a vaccine provides to an individual patient.
B. Passive immunity — Passive immunity involves receiving pre-formed antibodies from an external source, such as immunoglobulin therapy or maternal antibodies transferred to a newborn. The individual's immune system does not actively generate its own response. A vaccine does not provide passive immunity.
D. Natural immunity — Natural immunity develops following actual infection with a pathogen, not from vaccination. A vaccine provides artificially induced immunity by mimicking the antigen without causing the disease itself.
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