Ati exam 2

A brief thump felt near the fourth or fifth intercostal space near the left midclavicular line.

A nurse is performing a cardiovascular assesment on a client which of the following should a nurse expect

e is wearing gloves while caring for a client. In which of the following situations should the nurse obtain a new pair of glove

After changing a dressing on the client and before documenting on the computer

A nurse is assisting with teaching a newly licensed nurse about infection control. The nurse should include in the teaching that which of the ng types of precautions requires the use of an N95 mask?

Airborne

A nurse is assisting with teaching a newly licensed nurse about hand hygiene for surgical asepsis. Which of the following ins

Apply chlorhexidine and ethanol to the hands

A nurse is assisting with teaching a group of nurses on processes that can trigger an inflammatory response in the body. The nurs that which of the following is an infectious trigger?

Bacteria

A nurse is preparing to conduct a Romberg test on a client. The nurse should explain to the client that the Romberg test is used to asses the following characteristics?

Balance

A nurse is assisting with teaching a newly licensed nurse about laboratory tests that can indicate generalized inflammation. The nurse should include which of the following laboratory tests?

C-reactive protein

A nurse is admitting a client who has vancomycin-resistant enterococcus (VRE) of the urine. The nurse should place following precautions?

Contact

I nurse is planning to admit a client who has respiratory syncytial virus (RSV). Which of the following trans nurse plan to implement?

Contact

nurse is caring for a client who states, "I am feeling so much better. My fever is gone, and I have a good appetite." The nurse st ent is likely in which of the following stages of infection?

Convalescense

A nurse is performing a respiratory assessment on a client the nurse auscultares a wet, popping sound upon inspiration of the client breathing, the nurse should identify this observation as which of the following finding

Crackles

A nurse is caring for a client who had a stroke and is immobile. The nurse should identify that the client is at risk for which of the following

Deep vein thrombosis

A nurse is preparing to perform a comprehensive physical assessment on a client. Which of the following actions should the nurse plan to take first

Develop a plan care

nurse is preparing to perform a comprehensive physical assessment on a client. Which of the following actions should the nurse plan to take first

Develop a plan of care The first action the nurse should take using the nursing process is to assess the client and develop a plan of care. The nursing process follows the steps of assessment, analysis, planning, implementation, and evaluation.

A nurse is assessing a clients peripheral vascular status of the lower extremities the nurse should place their fingertips on the top of the clients foot, between the tendons of the great toe and those of the toe next to it, in order to palpate which of the following pulses

Dorsalis pedís

A nurse is assisting with teaching a newly licensed nurse about infectious agents. The nurse should include in th ted by which of the following modes of transmission?

Droplet

A nurse is caring for a client who has influenza. The client asks how they acquired the infectious agent. The influenza is transmitted by which of the following modes?

Droplet

A nurse is assisting with teaching a newly licensed nurse about removing personal protective equipment (PPE). should the nurse instruct to remove first?

Gloves

A nurse is assisting with teaching about personal protective equipment with a newly licensed nurse. Which of the following in the nurse include?

Gloves should be removed from inside out

teaching a newly licensed nurse about using a stethoscope. Which of the following instructions should the nurse include?

Insert the earpieces at a downward angle towards your nose

A nurse is performing a complete head to toe physical examination for a client which of the following physical assessment techniques should the nurse perform first?

Inspection

A nurse is performing a complete, head-to-toe physical examination for a client. Which of the following physical asses. nurse perform first?

Inspection

A nurse is performing a physical examination of the spine for an older adult client. The nurse should identify that which if the following findings is common with aging

Kyphosis

I nurse is performing a physical examination of the spine for an older adult client. The nurse should identify that which of the ommon with aging?

Kyphosis

A nurse is preparing a presentation about muscle function for a group of newly licensed nurses. Which of the following nurse plan to include?

Muscles assist with thermoregulation in the body

A nurse is assisting with teaching a newly licensed nurse about surgical asepsis. Which of the following statement should the nurse make

Nail polish if worn should not be chipped because those areas can harbor bacteria

A nurse is setting up a sterile field to perform a dressing change on a client. Which of the following actions should the nurse take?

Open the first flap on the sterile package away from body

A nurse is caring for a client who is on contact precautions. Which of the following actions should the nurse

Place client in a private room

A nurse in a clinic is caring for a client who reports generalized aches and fever for the past 12 hr. The nurse suspects the client has acquired an . Which of the following stages of infection is the client likely experiencing?

Prodromal

A nurse is palpating a tender area of a client's abdomen. The nurse slowly applies pressure over the area with their fingertips, ases it. The client reports increased pain on the release of pressure. Which of the following findings should the nurse document?

Rebound tenderness

A nurse is palpating a tender area of a client's abdomen. The nurse slowly applies pressure over the area with their fingertips, then quickly releases it. The client reports increased pain on the release of pressure. Which of the following findings should the nurse document?

Rebound tenderness The nurse should document that the client is experiencing rebound tenderness, which is an increase in pain when deep palpation over a tender area is released. Rebound tenderness in the right lower quadrant at McBurney's point (one third the distance from the anterior iliac crest to the umbilicus) is an indication of acute appendicitis.

nurse is caring for a client who is at risk for developing atelectasis. Which of the following actions should the nurse take?

Remind the client to use incentive spirometer

A nurse is assisting with teaching a newly licensed nurse about needlestick injuries. Which of the following instruction:

Report needle stick to nursing supervisor

A nurse is caring for a client who acquired an infection after touching a faucet that an infected person had touched. Which of the folle hain of infection does the faucet represent?

Reservoir

A nurse is performing an abdominal assessment on a client over which of the following areas of the client abdomen should the nurse attempt to auscultate activate bowel sounds first

Right lower quadrant

is performing an abdominal assessment on a client. Over which of the following areas of the client's abdome ultate active bowel sounds first?

Right lower quadrant

nurse is performing hand hygiene after caring for a client who has Clostridium difficile. Which of the following hand hygiene methods should the nurse use ?

Soap and water

irse is preparing to lift a heavy object off the floor. In which order should the nurse perform the following steps to demonstral ody mechanics? (Move the steps into the box on the right, placing them in the selected order of performance. Use all the step

Stand as close to the objective Keep abdominal muscles contracted Look straight up ahead with shoulders Bend hips slightly Push up from knees

A nurse is caring for a client who has acquired an infection from a visitor. The client is an example of which of the following link in the chain of infection

Susceptible host

A nurse is assessing a client's cranial nerves. Which of the following client actions is an indication that cranial nerve I is intact?

The client can identify a misty scent

A nurse is performing a general client survey and finds that the clients body mass index BMI of 23 which of the following should the nurse document

The client has a BMI within the expected reference range

A nurse is assisting with teaching a newly licensed nurse about airborne infection isolation rooms (AIIR). Which of the following should the nurse include

The door to the AIR should remain closed

A nurse is supervising a newly licensed nurse perform hand hygiene. Which of the following actions by the newly licer understanding of the procedure?

Turn off the faucet with a towel

A nurse is performing a cardiovascular assessment on a client. Which of the following findings should the nurse expec

• A brief thump felt near the fourth or fifth intercostal space near the left midclavicular line.