Question

The nurse is caring for a client who has HIV.

Answer 1

Correct Answers:

Tuberculosis

Rationale :

✍️ The client with HIV, elevated temperature, tachycardia, and respiratory symptoms (increased RR, low SpO₂) is at risk for opportunistic infections, particularly tuberculosis.

✍️ TB is a leading cause of death in HIV-positive clients, especially in those with low CD4 counts.

✍️ The respiratory findings and immune compromise suggest possible active TB, which should be investigated promptly.

✍️ Nurses must recognize early signs of TB in immunosuppressed clients, as it can lead to sepsis and respiratory failure if untreated.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 2

Correct Answers:

The medication should be discontinued 3 months prior to a planned pregnancy.

Rationale :

◈ Methotrexate is a teratogenic medication that can cause fetal harm and congenital anomalies.

◈ It must be discontinued at least 3 months before conception to allow drug clearance and reduce risk to the fetus.

◈ Patients planning pregnancy should be counseled about contraception and timing of medication cessation.

◈ This information is critical in preconception planning for women with autoimmune conditions like rheumatoid arthritis.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 3

Correct Answers:

Basal cell carcinoma has a low incidence of metastasis.

Rationale :

▪ Basal cell carcinoma (BCC) is the most common and least aggressive type of skin cancer.

▪ It has a low risk of metastasis, but it can cause local tissue destruction if not treated.

▪ BCC typically appears on sun-exposed skin and grows slowly over time.

▪ Educating patients on early detection and sun protection helps reduce incidence.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 4

Correct Answers:

Yellow sclera

Rationale :

🔷 The presence of yellow sclera in a client suspected of TB indicates possible hepatotoxicity, likely from TB medications such as isoniazid or rifampin.

🔷 This finding, along with elevated AST, suggests liver involvement and must be reported to the provider immediately.

🔷 TB medications are known to cause drug-induced hepatitis, which requires prompt intervention.

🔷 The nurse should also expect lab monitoring and possible adjustment of therapy.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 5

Correct Answers:

Tinnitus

Rationale :

👉 Tinnitus, or ringing in the ears, is a classic early sign of salicylate toxicity from medications like aspirin.

👉 This symptom must be reported promptly as it may progress to hearing loss or more severe toxicity if not addressed.

👉 Monitoring for auditory changes is especially important in older adults and those on high doses.

👉 Dose adjustment or drug discontinuation may be needed to prevent systemic toxicity.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 6

Correct Answers:

Difficulty swallowing

Rationale :

✳️ Facial burns, especially around the mouth, eyes, and neck, can lead to airway edema, making swallowing difficult and indicating potential airway obstruction.

✳️ This is a priority concern and must be reported immediately as it can rapidly progress to respiratory compromise.

✳️ Swelling in these regions often precedes intubation, and early intervention is critical.

✳️ Airway assessment takes precedence over all other burn-related findings.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 7

Correct Answers:

CD4-T-cell count 180 cells/mm³

Rationale :

▧ A CD4 count below 200 indicates a high risk for opportunistic infections and meets diagnostic criteria for AIDS.

▧ This value reflects significant immune suppression, requiring prophylactic medications and close monitoring.

▧ It is a priority lab value that determines treatment adjustments and infection risk.

▧ Clients with this level need enhanced surveillance for infections like PCP, candidiasis, and CMV.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 8

Correct Answers:

Instruct the client to use pursed-lip breathing.

Rationale :

✔️ Pursed-lip breathing helps COPD clients prolong exhalation, prevent air trapping, and improve oxygenation.

✔️ It is an essential non-pharmacologic technique that promotes better ventilation and reduces dyspnea.

✔️ This technique also helps keep airways open during exhalation and decreases the work of breathing.

✔️ It should be part of routine self-management education for clients with chronic respiratory conditions.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 9

Correct Answers:

Increased anteroposterior diameter of the chest

Rationale :

▲ An increased AP diameter, or barrel chest, is a hallmark physical finding in clients with emphysema, a form of COPD.

▲ It results from chronic lung hyperinflation, which expands the thoracic cavity over time.

▲ This structural change contributes to difficulty exhaling and reduces lung elasticity.

▲ It is a common clinical observation in advanced pulmonary disease.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 10

Correct Answers:

Facial rash

Rationale :

➡️ A butterfly-shaped facial rash is a hallmark feature of systemic lupus erythematosus (SLE).

➡️ This rash typically spans the cheeks and bridge of the nose and can worsen with sun exposure.

➡️ It results from immune complex deposition and inflammation of the skin.

➡️ Recognizing this sign is key in early identification and management of lupus flares.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

RN ATI MedSurg SP 250 Exam 3

No.

1 :
The nurse is caring for a client who has HIV.

Answer Options

2 :
A nurse is caring for a female client who has rheumatoid arthritis and a new prescription for methotrexate. The client tells the nurse she is planning a pregnancy. Which of the following instructions should the nurse give the client?

3 :
A nurse is planning an educational program about basal cell carcinoma. Which of the following information should the nurse plan to include?

4 :
The nurse on a medical-surgical unit is caring for a newly admitted client with a diagnosis of R/O tuberculosis.

Answer Options

5 :
A nurse is caring for a client who is taking aspirin for arthritis. The nurse should identify which of the following findings as an adverse effect of this medication?

6 :
A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of the following is the priority finding to report to the provider.

7 :
A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?

8 :
A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

9 :
A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

10 :
A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?

Connect With Us

RN ATI MedSurg SP 250 Exam 3

No.

1 : The nurse is caring for a client who has HIV.

Answer Options

2 : A nurse is caring for a female client who has rheumatoid arthritis and a new prescription for methotrexate. The client tells the nurse she is planning a pregnancy. Which of the following instructions should the nurse give the client?

3 : A nurse is planning an educational program about basal cell carcinoma. Which of the following information should the nurse plan to include?

4 : The nurse on a medical-surgical unit is caring for a newly admitted client with a diagnosis of R/O tuberculosis.

Answer Options

5 : A nurse is caring for a client who is taking aspirin for arthritis. The nurse should identify which of the following findings as an adverse effect of this medication?

6 : A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of the following is the priority finding to report to the provider.

7 : A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?

8 : A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

9 : A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

10 : A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?

1 :
The nurse is caring for a client who has HIV.

2 :
A nurse is caring for a female client who has rheumatoid arthritis and a new prescription for methotrexate. The client tells the nurse she is planning a pregnancy. Which of the following instructions should the nurse give the client?

3 :
A nurse is planning an educational program about basal cell carcinoma. Which of the following information should the nurse plan to include?

4 :
The nurse on a medical-surgical unit is caring for a newly admitted client with a diagnosis of R/O tuberculosis.

5 :
A nurse is caring for a client who is taking aspirin for arthritis. The nurse should identify which of the following findings as an adverse effect of this medication?

6 :
A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of the following is the priority finding to report to the provider.

7 :
A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?

8 :
A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

9 :
A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

10 :
A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?