ATI Terminology #5

A nurse is providing education to a school-age child who has a new diagnosis of asthma. Which of the following statements should the nurse include in the teaching?

"Avoid triggers that cause an attack.

A nurse is assessing a client who is to undergo a left lobectomy to treat lung cancer. The client tells the nurse that she is scared and wishes she had never smoked. Which of the following responses should the nurse make?

"It's okay to feel scared. Let's talk about what you are afraid of."

A nurse is caring for a newborn whose mother voices concerns about sudden infant death syndrome (SIDS). The nurse should include which of the following statements in a discussion with the mother?

"Placing your child on her back when sleeping will decrease the risk of SIDS."

A nurse is caring for a client who has a new diagnosis of lung cancer. The client states they do not want to tell their partner their diagnosis. Which of the following statements should the nurse make?

"Would you like to talk about your concerns?"

Which of the following assessment findings require additional action by the nurse? Click to highlight the assessment findings which require additional action by the nurse? To deselect a finding, click on the finding again.

-Child uncooperative and agitated -Child reports chest pain and joint pain as a 4 on the Faces Scale -Nasal flaring and moderate subcostal and substernal retractions are noted -Bilateral, moderate inspiratory and expiratory wheezes noted upon auscultation

A nurse is caring for a school-age child who has mild persistent asthma. Which of the following is an expected finding? (Select all that apply.)

-Daytime symptoms occur more than twice a week. -Minor limitations occur with normal activity. -Peak expiratory flow (PEF) is greater than or equal to 80% of the predicted value.

A nurse is assessing a newborn 1 hr after birth. Which of the following respiratory rates is within the expected reference range for a newborn?

48/min

A community clinic recently added a bilingual nurse to their staff to provide better health teaching with their Hispanic and Latino clients. Which of the following is an indication of improved client health outcomes?

A client has stabilized their blood glucose levels

A nurse is prioritizing client care after receiving change-of-shift report. Which of the following clients should the nurse plan to see first?

A client who told an assistive personnel he is short of breath

A nurse is caring for a client who develops an airway obstruction from a foreign body but remains conscious. Which of the following actions should the nurse take first?

Administer the abdominal thrust maneuver.

A home health nurse is interviewing a client and asks the client, "Have you or your family been exposed to any chemical liquids, fumes, lead, or unusual smells?" Which type of assessment is the nurse conducting?

An environmental health assessment

A school nurse is preparing a presentation for students about racism. Which of the following examples should the nurse use to best describe racism?

Assigning value based on physical characteristics and skin color

A nurse is assessing the respiratory pattern of an older adult client who is receiving end-of-life care. Which of the following assessment findings should the nurse identify as Cheyne-Stokes respirations?

Breathing ranging from very deep to very shallow with periods of apnea

A home health nurse cares for a neighborhood of diverse clients. Which of the following aspects of cultural diversity should the nurse remember when caring for the clients?

Caring for diverse clients will require balancing differences and needs

A nurse is assessing a client who has chronic respiratory insufficiency. Which of the following findings should the nurse expect as result of the long-term inadequate oxygenation?

Clubbing of the fingers

A nurse in a provider's office is assessing an older adult client whose son reports that the client has been sick with a respiratory illness for the past 6 days. Which of the following assessment findings is a manifestation of pneumonia in the older adult client?

Confusion

A community health nurse is making efforts to expand their cultural competence when working with clients. To develop cultural competence, the nurse must appreciate understand which of the following characteristics of their clients?

Diversity

A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions?

Encourage the client to increase fluid intake.

A school nurse receives a call that some children and teachers report being exposed to an undetermined noxious gas odor presenting in the classrooms and are experiencing dizziness. Which of the following actions should the nurse take?

Have students evacuated from the school and establish a triage area in the school parking lot.

A community health nurse is reflecting on unconscious feelings they may have toward some of the clients they care for. The nurse should identify this as which of the following concepts of cultural competence?

Implicit bias

A nurse manager of a community clinic is planning ways to increase the culturally competent care within the facility. The manager knows that which of the following benefits occur from providing culturally competent health care?

Improved health outcomes for clients

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?

Increased anteroposterior diameter of the chest

A nurse is assessing a client who has developed atelectasis postoperatively. Which of the following findings should the nurse expect?

Increasing dyspnea

A nurse is providing care to a client from a different culture during a health fair. Which action by the nurse indicates cultural competence?

Interacts effectively in a multicultural context

A nurse is assessing a client who has postoperative atelectasis and is hypoxic. Which of the following manifestations should the nurse expect?

Intercostal retractions

A nurse manager is preparing a presentation on components of cultural competence. Which of the following definitions should the manager provide for the concept of cultural awareness?

Knowledge of one's own thoughts and feelings about diversity

A nurse is auscultating the lungs of a client who has pleurisy. Which of the following adventitious breath sounds should the nurse expect to hear?

Loud, scratchy sounds

A nurse is auscultating a client's lung sounds and identifies crackles in the left lower lobe. Which of the following interventions should the nurse take?

Repeat auscultation after asking the client to breathe deeply and cough.

A nurse is assessing a client who has hypoxia. Which of the following findings should the nurse expect?

Tachycardia

A school nurse is partnering with the local hospital system's tobacco cessation program to give a presentation focused on discouraging tobacco use in high school students. According to the Health Belief Model, which of the following might be included in the presentation?

The benefits to not smoking when engaging in sports and other activities

A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?

Wheezes

A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

agitation

A community health nurse is conducting an educational program on various environmental pollutants. The nurse should emphasize that clients who have which of the following disorders are especially vulnerable to ozone effects?

asthma

A nurse is caring for a client who practices the Muslim faith. Which of the following should the nurse identify as an acceptable dietary option for this client?

chicken

A nurse in the emergency department is assessing an older adult client who has community-acquired pneumonia. Which of the following findings should the nurse expect?

confusion

A nurse is caring for a client whose partner has end-stage lung cancer. The client states, "The doctors say they only have a few months to live, but I know that with treatment they will get better." The nurse should identify that the client is exhibiting which of the following defense mechanisms?

denial

A nurse is preparing to measure a client's level of oxygen saturation and observes edema of both hands and thickened toe nails. The nurse should apply the pulse oximeter probe to which of the following locations?

earlobe

A nurse is caring for a client who has asthma and allergies. The client asks the nurse about environmental influences they should avoid. The nurse should inform the client to avoid which of the following?

mold

A nurse is caring for a pre-school-age child who has epiglottitis with a barking cough. Which of the following actions should the nurse take?

monitor oxygen saturation

A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

oral mucosa