ATI GENERAL NURSING 2023/2024 LATEST QUESTIONS
AND ANSWERS WITH RATIONALES| A+ GRADED|
1-The nurse understands that which of these body substances are modes of transmission for hepatitis
B? Select all that apply.
1. Blood
2. Feces
3. Semen
4. Urine
5. Vaginal secretions
Explanation:
Viral hepatitis is a disease of the liver characterized by inflammation, necrosis, and cirrhosis. One of
the most common viral strains that causes hepatitis is hepatitis B. The transmission of hepatitis B is
primarily through contact with blood, semen, and vaginal secretions (mnemonic: B for body fluids),
commonly through unprotected sexual intercourse and intravenous illicit drug use (Options 1, 3,
and 5). Infants born to infected mothers are also at risk for vertical transmission of hepatitis
B. Although kissing, sneezing, sharing drinks/utensils, and breastfeeding are not known routes of
transmission, hepatitis B could possibly be transmitted through saliva entering the bloodstream via
sharing a toothbrush or receiving a bite.
Hepatitis B has an insidious onset of illness, and clients may be asymptomatic carriers. Early
symptoms are often nonspecific (eg, malaise, nausea, vomiting, abdominal pain). Hepatitis B may
produce jaundice, weight loss, clay-colored stools, and thrombocytopenia in late stages of illness. An
effective vaccine is widely available for hepatitis B.
,(Option 2) The transmission of hepatitis A occurs through the fecal-oral route via poor hand hygiene
and improper food handling. Therefore, this infection is seen primarily in developing countries.
Hepatitis B is not transmitted through feces.
(Option 4) Urine is not known to be a mode of transmission for any form of hepatitis.
Educational objective:
The transmission of hepatitis B occurs through parenteral or sexual contact with body fluids such as
blood, semen, or vaginal secretions (mnemonic: B for body fluids).
2-At 8 AM, medications are prescribed for assigned clients. Which medication should the nurse
administer first?
1. Acetylsalicylic acid for a client with a history of coronary artery disease and ischemic
stroke
2. Metformin for a client with serum glucose of 285 mg/dL (15.8 mmol/L) who is scheduled
for a CT scan with contrast
3. Morphine sulfate for a client with terminal lung cancer who has chronic bone pain
4. Pyridostigmine for a client with myasthenia gravis exacerbation who reports
difficulty swallowing
Explanation:
Myasthenia gravis (MG) is a chronic, neurologic autoimmune disorder that involves damage to
acetylcholine receptors at the neuromuscular junctions, which results in skeletal muscle weakness.
The ocular (ptosis) and facial muscles, along with those responsible for chewing and swallowing,
are affected initially; however, weakness can progress to the respiratory muscles (eg, intercostal,
diaphragm).
,Pyridostigmine (Mestinon) is a first-line drug that inhibits acetylcholine breakdown and is prescribed
to temporarily increase muscle strength in clients with MG. It is the priority medication as difficulty
swallowing indicates weakness of the muscles involved in swallowing and increases aspiration risk.
(Option 1) Acetylsalicylic acid (Aspirin) is prescribed daily to prevent ischemic attacks and
myocardial infarction in clients with coronary artery disease and ischemic stroke; it is not the priority
medication.
(Option 2) Metformin (Glucophage) is an anti-hyperglycemic drug that can cause lactic acidosis in
clients with kidney disease. Contrast used for CT scan can cause kidney injury. It is recommended
that the drug be held before and resumed 48 hours after the CT scan (if renal function [creatinine] is
normal).
(Option 3) Analgesia with opioids is appropriate to treat chronic pain associated with terminal
cancer. However, decreasing the aspiration risk is more urgent than providing pain relief.
Educational objective:
Pyridostigmine (Mestinon) inhibits acetylcholine breakdown and is prescribed to temporarily increase
muscle strength in clients with myasthenia gravis. The ocular and facial muscles, along with those
responsible for chewing and swallowing, are affected initially; this can increase the client's aspiration
risk.
3-The nurse reviews prescriptions for assigned adult clients. Which prescription should the nurse
question?
1. 0.45% sodium chloride (NaCl) solution prescribed for a client with syndrome of
inappropriate antidiuretic hormone secretion who has a sodium level of 120 mEq/L
(120 mmol/L)
2. 0.9% NaCl solution prescribed for a client with gastrointestinal bleeding who has a
, hemoglobin level of 8.9 g/dL (89 g/L)
3. 1,000 mL bolus of 0.9% NaCl solution prescribed for a client with septic shock who has
a
white blood cell count of 18,000/mm3 (18.0 × 109/L)
4. Lactated Ringer's solution prescribed for a male client with hypovolemic shock and a
thermal burn who has a hematocrit level of 56% (0.56)
Explanation:
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is associated with increased water
reabsorption and excessive intra- and extracellular fluid, which result in hypervolemia from fluid
retention and dilutional hyponatremia. In the setting of SIADH, the nurse should question a
prescription for a hypotonic solution (eg, 0.45% NaCl; or dextrose water) as it would worsen the fluid
and electrolyte imbalance. A prescription for fluid restriction and a hypertonic IV solution (eg, 3%
NaCl) administered in small quantities would be appropriate to shift fluid back into the vascular
compartment and correct hyponatremia.
(Option 2) Isotonic fluids (eg, normal saline) are appropriate for clients with volume deficit such as
those with gastrointestinal bleeding.
(Option 3) Septic shock involves an inflammatory response to pathogens that leads to massive
vasodilation and increased capillary permeability, resulting in intravascular hypovolemia and severe
hypotension. An isotonic solution (eg, 0.9% NaCl) bolus is prescribed to expand intravascular volume
and increase blood pressure.
(Option 4) A burn injury causes tissue damage and increased capillary permeability; this leads to
fluid and electrolyte losses related to evaporation and intravascular fluid shifts into the interstitial
tissue, which result in hypovolemia, hemoconcentration (eg, hematocrit >53% [0.53]), and
hypotension. An isotonic solution (eg, lactated Ringer's) is prescribed to replace fluid and electrolyte
losses.
AND ANSWERS WITH RATIONALES| A+ GRADED|
1-The nurse understands that which of these body substances are modes of transmission for hepatitis
B? Select all that apply.
1. Blood
2. Feces
3. Semen
4. Urine
5. Vaginal secretions
Explanation:
Viral hepatitis is a disease of the liver characterized by inflammation, necrosis, and cirrhosis. One of
the most common viral strains that causes hepatitis is hepatitis B. The transmission of hepatitis B is
primarily through contact with blood, semen, and vaginal secretions (mnemonic: B for body fluids),
commonly through unprotected sexual intercourse and intravenous illicit drug use (Options 1, 3,
and 5). Infants born to infected mothers are also at risk for vertical transmission of hepatitis
B. Although kissing, sneezing, sharing drinks/utensils, and breastfeeding are not known routes of
transmission, hepatitis B could possibly be transmitted through saliva entering the bloodstream via
sharing a toothbrush or receiving a bite.
Hepatitis B has an insidious onset of illness, and clients may be asymptomatic carriers. Early
symptoms are often nonspecific (eg, malaise, nausea, vomiting, abdominal pain). Hepatitis B may
produce jaundice, weight loss, clay-colored stools, and thrombocytopenia in late stages of illness. An
effective vaccine is widely available for hepatitis B.
,(Option 2) The transmission of hepatitis A occurs through the fecal-oral route via poor hand hygiene
and improper food handling. Therefore, this infection is seen primarily in developing countries.
Hepatitis B is not transmitted through feces.
(Option 4) Urine is not known to be a mode of transmission for any form of hepatitis.
Educational objective:
The transmission of hepatitis B occurs through parenteral or sexual contact with body fluids such as
blood, semen, or vaginal secretions (mnemonic: B for body fluids).
2-At 8 AM, medications are prescribed for assigned clients. Which medication should the nurse
administer first?
1. Acetylsalicylic acid for a client with a history of coronary artery disease and ischemic
stroke
2. Metformin for a client with serum glucose of 285 mg/dL (15.8 mmol/L) who is scheduled
for a CT scan with contrast
3. Morphine sulfate for a client with terminal lung cancer who has chronic bone pain
4. Pyridostigmine for a client with myasthenia gravis exacerbation who reports
difficulty swallowing
Explanation:
Myasthenia gravis (MG) is a chronic, neurologic autoimmune disorder that involves damage to
acetylcholine receptors at the neuromuscular junctions, which results in skeletal muscle weakness.
The ocular (ptosis) and facial muscles, along with those responsible for chewing and swallowing,
are affected initially; however, weakness can progress to the respiratory muscles (eg, intercostal,
diaphragm).
,Pyridostigmine (Mestinon) is a first-line drug that inhibits acetylcholine breakdown and is prescribed
to temporarily increase muscle strength in clients with MG. It is the priority medication as difficulty
swallowing indicates weakness of the muscles involved in swallowing and increases aspiration risk.
(Option 1) Acetylsalicylic acid (Aspirin) is prescribed daily to prevent ischemic attacks and
myocardial infarction in clients with coronary artery disease and ischemic stroke; it is not the priority
medication.
(Option 2) Metformin (Glucophage) is an anti-hyperglycemic drug that can cause lactic acidosis in
clients with kidney disease. Contrast used for CT scan can cause kidney injury. It is recommended
that the drug be held before and resumed 48 hours after the CT scan (if renal function [creatinine] is
normal).
(Option 3) Analgesia with opioids is appropriate to treat chronic pain associated with terminal
cancer. However, decreasing the aspiration risk is more urgent than providing pain relief.
Educational objective:
Pyridostigmine (Mestinon) inhibits acetylcholine breakdown and is prescribed to temporarily increase
muscle strength in clients with myasthenia gravis. The ocular and facial muscles, along with those
responsible for chewing and swallowing, are affected initially; this can increase the client's aspiration
risk.
3-The nurse reviews prescriptions for assigned adult clients. Which prescription should the nurse
question?
1. 0.45% sodium chloride (NaCl) solution prescribed for a client with syndrome of
inappropriate antidiuretic hormone secretion who has a sodium level of 120 mEq/L
(120 mmol/L)
2. 0.9% NaCl solution prescribed for a client with gastrointestinal bleeding who has a
, hemoglobin level of 8.9 g/dL (89 g/L)
3. 1,000 mL bolus of 0.9% NaCl solution prescribed for a client with septic shock who has
a
white blood cell count of 18,000/mm3 (18.0 × 109/L)
4. Lactated Ringer's solution prescribed for a male client with hypovolemic shock and a
thermal burn who has a hematocrit level of 56% (0.56)
Explanation:
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is associated with increased water
reabsorption and excessive intra- and extracellular fluid, which result in hypervolemia from fluid
retention and dilutional hyponatremia. In the setting of SIADH, the nurse should question a
prescription for a hypotonic solution (eg, 0.45% NaCl; or dextrose water) as it would worsen the fluid
and electrolyte imbalance. A prescription for fluid restriction and a hypertonic IV solution (eg, 3%
NaCl) administered in small quantities would be appropriate to shift fluid back into the vascular
compartment and correct hyponatremia.
(Option 2) Isotonic fluids (eg, normal saline) are appropriate for clients with volume deficit such as
those with gastrointestinal bleeding.
(Option 3) Septic shock involves an inflammatory response to pathogens that leads to massive
vasodilation and increased capillary permeability, resulting in intravascular hypovolemia and severe
hypotension. An isotonic solution (eg, 0.9% NaCl) bolus is prescribed to expand intravascular volume
and increase blood pressure.
(Option 4) A burn injury causes tissue damage and increased capillary permeability; this leads to
fluid and electrolyte losses related to evaporation and intravascular fluid shifts into the interstitial
tissue, which result in hypovolemia, hemoconcentration (eg, hematocrit >53% [0.53]), and
hypotension. An isotonic solution (eg, lactated Ringer's) is prescribed to replace fluid and electrolyte
losses.
