ATI NURS 202 EXAM 2 Review

A nurse is caring for a client whose I&O flow sheet for 0700 to 1500 indicates the following: voided x3: 350mL, 200mL, 150mL; wound drainage 2tsp; and emesis 2oz. What total output in mL should the nurse document for this 8 hour period? (Nearest whole number)

770 mL

A nurse is administering a medication to a client who asks the nurse to leave the medication at the bedside to be take at a later time. Which of the following responses should the nurse make? A. "Call me when you are ready, and I will return with the medication. B. "Since you were taking this medication at home, I will leave it for you to take." C. "I will come back in 30 mins to check that you took the medication so I can chart the time." D. "If you refuse to take the medication now, I cannot give it again until your next scheduled time."

A. "Call me when you are ready, and I will return with the medication.

A newly licensed nurse is preparing to administer medications to a client. The nurse notes that the provider has prescribed a medication that is unfamiliar to them. Which of the following actions should the nurse take? A. Consult the medication reference book available on the unit. B. Ask a more experienced nurse for information about the medication. C. Call the client's provider and verify the prescription. D. Ask the client if they take this medication at home.

A. Consult the medication reference book available on the unit.

A nurse is preparing to change the bed linens of a client who has AIDS and is incontinent of stool. Which of the following PPE items should the nurse don prior to providing client care? (Select all that apply.) A. Gown B. Gloves C. Mask D. Hair cover E. Goggles

A. Gown B. Gloves

A nurse is preparing to administer an otic antibiotic to an adult client who has otitis media. Which of the following actions should the nurse plan to take? A. Hold the dropper 1cm (0.5 in) above the ear canal during administration. B. Apply pressure to the nasolacrimal duct following administration. C. Place a cotton ball into the inner ear canal for 30 minutes following administration. D. Straighten the ear canal by pulling the auricle down and back prior to administration.

A. Hold the dropper 1cm (0.5 in) above the ear canal during administration.

A nurse is planning care for a client who had a stroke. The client has hemiplegia and occasional urinary incontinence. Which of the following actions should the nurse include in the client's plan of care? A. Offer the client a bedpan every 2 hours. B. Limit the client's daily fluid intake until he is no longer incontinent. C. Request a prescription for an indwelling urinary catheter from the client's provider. D. Ambulate the client to the bathroom every 30 minutes.

A. Offer the client a bedpan every 2 hours.

A nurse is demonstrating colostomy care to a client who has anew colostomy. Which of the following actions should the nurse teach the client to perform? (Select all that apply.) A. Use antimicrobial ointment on the peristomal site. B. Empty the bag when it is one-third to one-half full. C. Cut the skin barrier opening a little larger than the ostomy. D. Was the peristomal skin with mild soap and water. E. Apply the skin barrier while the skin is slightly moist.

B. Empty the bag when it is one-third to one-half full. C. Cut the skin barrier opening a little larger than the ostomy. D. Was the peristomal skin with mild soap and water.

A nurse in a long-term care facility is admitting a client who is incontinent and smells strongly of urine. His partner, who has been caring for him at home, is embarrassed and apologizes for the smell. Which of the following responses should the nurse make? A. "A lot of clients who are care for at home have the same problem." B. "Don't worry about it. He will get a bath, and that will take care of the odor." C. "It must be difficult to care for someone who is confined to bed." D. "When was the last time he has a bath?"

C. "It must be difficult to care for someone who is confined to bed."

A nurse if providing teaching to a client who has constipation. Which of the following instructions should the nurse include? A. Use bismuth subsalicylate regularly. B. Consume a low-fiber diet. C. Eat yogurt with live cultures. D. Use bisacodyl suppositories regularly.

C. Eat yogurt with live cultures.

An assistive personnel (AP) us helping a nurse care for a female client who has an indwelling urinary catheter. Which of the following actions by the AP indicates a need for further teaching? A. The AP uses soap and water to clean the perineal area. B. The AP tapes the catheter to the client's inner thigh. C. The AP hangs the collection bag at the level of the bladder. D. The AP ensures there are no kinks in the drainage tubing.

C. The AP hangs the collection bag at the level of the bladder.

A nurse is acting for a client who has major fecal incontinence and reports irritation in the perianal area. Which of the following actions should the nurse take first? A. Apply a fecal collection system. B. Apply a barrier cream. C. Cleanse and dry the area. D. Check the client's perineum.

D. Check the client's perineum.