Fundamentals ATI

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A nurse is performing an abdominal assessment of a client. Which of the following positions should the nurse tell the client to assume for this examination?

supine

A nurse is providing preoperative teaching to a client who is scheduled for arthroplasty in the next month and may require a blood transfusion. The client expresses concern about the risk of acquiring an infection from the blood transfusion. Which of the following statements should the nurse share with the client?

"donate autologous blood before the surgery"

A nurse is planning an in-service training session about nutrition. Which of the following statements should the nurse include in the teaching?

"fats provide energy"

A nurse is teaching a client about how to remove a soiled dressing. Which of the following statements by the client indicates an understanding of the teaching?

I'll wear nonsterile gloves

A nurse is teaching range-of-motion exercises to a client who has osteoarthritis. Which of the following client positions demonstrates an understanding of supination of the hand?

the client holds the hand with the palm up

A nurse is preparing to administer an afternoon dose of ampicillin to a client. The client appears upset and refuses to take the medication before throwing the pill on the floor. Which of the following entries should the nurse enter into the client's medical record?

the client threw the medication on the floor

A nurse is developing a plan of care for a client. Which of the following pieces of information should the nurse consider when planning care that is culturally congruent?

the meaning of disease can vary widely across cultures

A client is being discharged home with oxygen therapy delivered through a nasal cannula. Which of the following instructions should the nurse provide to the client and family members?

wear cotton clothing to avoid static electricity

A nurse is teaching a client who has low back pain about heat therapy. Which of the following statements by the client indicates an understanding of the teaching?

"I need to place a towel between the heating pad and my skin"

A nurse is measuring the blood pressure of several clients. Which of the following results is within the expected reference range for blood pressure?

116/70

A nurse is planning weight-loss strategies for a group of clients who are obese. Which of the following actions by the nurse will improve the clients' commitment to a long-term goal of weight loss?

Attempt to increase the clients' self-motivation

A nurse is caring for a client who has a stage III pressure ulcer on the heel. When preparing to irrigate the wound, which of the following actions should the nurse take first?

check the client's pain level

A nurse is examining a client for signs of costovertebral angle tenderness. The nurse should place the client in which of the following positions for evaluation?

Sitting

A nurse is caring for a client who is receiving IV fluid replacement. Which of the following findings should the nurse identify as infiltration of the IV infusion site?

Taut skin around the IV catheter that is cool to the touch

A nurse is providing nutritional teaching to a group of clients. Which of the following definitions for the recommended dietary allowance (RDA) should the nurse include in the teaching?

The RDA defines the level of nutrient intake that meets the needs of healthy people in various groups

A nurse is teaching a client who is postoperative following a knee arthroplasty about the muscles he will need to strengthen in physical therapy. Which of the following muscle groups is responsible for movement at the knee joint?

antagonistic

A nurse in an emergency department is caring for a client who reports developing severe right eye pain with a gritty sensation while sawing wood. Which of the following actions should the nurse take first?

ask the client about first aid-performed at the scene

A nurse is caring for a client who has a terminal illness. The client is restless and reports severe pain but refuses the prescribed opioid pain medication. Which of the following actions should the nurse take first?

ask why the client is refusing the pain medication

A nurse in a provider's office is assessing a client who has heart failure. The client has gained weight since her last visit, and her ankles are edematous. Which of the following findings is another clinical manifestation of fluid volume excess?

bounding pulse

A nurse is measuring a client's vital signs and notices an irregularity in the pulse. Which of the following actions should the nurse take?

count the apical pulse rate for 1 full min and describe the rhythm in the chart

A nurse is planning care for a young adult client who has a terminal illness. Which of the following concepts of death should the nurse consider for this client?

death is viewed as an interruption of what might have been

A nurse is caring for a client who has terminal cancer. The client is proceeding with plans to build a new home. The nurse should identify that this behavior typically indicates which of the following stages of grief?

denial

A nurse is assessing a client who has a total calcium level of 12.7 mg/dL. Which of the following findings should the nurse expect?

depressed deep-tendon reflexes

A nurse is replacing the surgical dressings on a client who had abdominal surgery. Which of the following actions should the nurse take?

don clean gloves to remove the old dressing

A nurse is preparing to administer eye drops to a client following surgery. Which of the following actions should the nurse take when instilling the eye drops?

drop the eye medication into the lower conjunctival sac

A nurse is caring for an older adult client who has an in-the-canal hearing aid. The client states that the hearing aid is making a whistling sound. The nurse should identify which of the following factors as the source for this sound?

excessive wax in the ear canal

A nurse is caring for a client who has a hearing impairment. Which of the following interventions should the nurse use when speaking with the client?

face the client when speaking

A nurse is caring for a client who has the head of his bed elevated to a 45degree angle with his knees slightly flexed. Which of the following positions should the nurse document for the client?

fowler's

A nurse is teaching a client about lifestyle changes to manage a chronic illness. which of the following strategies should the nurse use first to help the client make a commitment to these lifestyle changes?

help the client identify ways that these changes will result in positive personal outcomes

A nurse is caring for a client who has a gastric ulcer. The nurse should explain that prolonged exposure of the body to stress can also cause which of the following to occur?

hyperglycemia

A nurse is teaching a group of unit nurses about the experiences of clients who are having surgery. In what phase of care is the client transferred to the surgical suite table before being transferred to the PACU?

intraoperative

A nurse is providing teaching to a client regarding protein intake. Which of the following foods should the nurse include as an example of an incomplete protein?

lentils

A nurse is planning care for a client who has anorexia and nausea due to cancer treatment. Which of the following interventions should the nurse include?

limit drinking liquids with food

A nurse is measuring a client's vital signs. The client's resting radial pulse rate is 55/min. Which of the following actions should the nurse take next?

measure the client's apical pulse rate

A nurse is caring for a client who had a stroke and is at risk of falling. Which of the following actions should the nurse take?

monitor the client at least once every hour

A nurse in a long-term care facility is in the dining room while residents are eating lunch. One resident begins to choke and is coughing strongly. Which of the following actions should the nurse take?

observe the client closely

A nurse is collecting health history data from a client who is deaf and uses ASL to communicate. The nurse will be working with an ASL interpreter. Which of the following actions should the nurse take when working with the interpreter?

pace speech to allow time for the interpreter to convey the words

A hospice nurse is reviewing religious practices of a group of clients with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

people who practice Judaism stay with the body of the deceased until burial

A nurse is leading an education session about disposing of biohazardous materials. which of the following instructions should the nurse include in the teaching?

place soiled linen in a single linen bag

A nurse on a rehabilitation unit is preparing to transfer a client who is unable to walk from a bed to a wheelchair. Which of the following techniques should the nurse use?

place the wheelchair at a 45-degree angle to the bed

A nurse has received a prescription for dextran to administer to a client. The nurse should recognize that dextran belongs in which of the following functional classifications?

plasma volume expanders

A nurse is preparing to administer a cleansing enema to a client. Which of the following actions should the nurse plan to take?

position the client on his left side

A nurse is performing suctioning for a client who has a tracheostomy. Which of the following actions should the nurse take?

pull suction catheter back 1cm if the client starts coughing

A nurse is caring for an older adult client who is violent and attempting to disconnect her IV lines. The provider prescribes soft wrist restraints. Which of the following actions should the nurse take while the client is in restraints?

remove the restraints one at a time

A nurse is planning care for a client who is confused and requires a prescription for wrist restraints. Which of the following interventions should the nurse include in the plan of care?

renew the prescription for the use of restrains within 24 hrs

A nurse is preparing to administer a bolus feeding to a client through an NG tube and observes that the exit mark on the tube has moved since the last feeding. Which of the following actions should the nurse plan to take?

request an x-ray of the client's abdomen

A nurse is screening a client who has an S-shaped spinal column with unequal should heights. The nurse should identify these findings as manifestations of which of the following abnormalities?

scoliosis

A nurse is providing teaching to an older adult client who has constipation. Which of the following statements should the nurse include in the teaching?

sit on the toilet 30 min after eating a meal

A nurse is caring for a client who is hospitalized and has a new tracheostomy. Which of the following actions should the nurse take when performing tracheostomy care for the client?

soak the inner cannula of the tracheostomy tube in normal saline

A nurse is caring for a client who has peripheral edema. The nurse should identify that which of the following nutrients regulates extracellular fluid volume?

sodium

A nurse is caring for a client who has xerostomia with a lack of saliva. Which of the following nutrients will be affected by the lack of salivary amylase?

starch


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