ATI Study Guide

A nurse is assessing a client's nutritional status. The nurse determines the client is consuming 500 calories more per day than his energy level requires. If his dietary habits do not change, how long will it take the client to gain 4.5 kg (10 lb)?

10 weeks - because 1 lb of body fat is equivalent to 3,500 calories, consuming 500 extra calories each day for 7 days would lead to a total of 3,500 calories and a 1 lb gain per week. At the rate of 1 lb per week, the client would gain 10 lb in 10 weeks.

A nurse is caring for a client who requires fluid restriction and may drink only 1 oz of water with each oral medication. How many milliliters of water should the nurse document as intake for the 3 separate medication the client receives during a 12-hr night shift?

90 - 1 oz/30 mL = 3 x 1 ox/X mL 1 oz/30 mL = 3 oz/X mL x = 90

A nurse is caring for a client who has a prescription for acetaminophen 325 mg PO for an oral temperature above 38.4C. Above what Farenheit temperature should the nurse administer acetaminophen to the client?

F = (C x 9/5) + 32 F = (38.4 x 9/5) + 32 F = 69.12 + 32 F = 101.12

A nurse is preparing to administer oral phenytoin to a client who has a seizure disorder. Before administering the medication, which of the following actions should the nurse take?

check the medication dose and the client's identification - the "rights" of medication administration include verifying the right client and the right dose.

A nurse is administering a cleansing enema to a client who is scheduled for a diagnostic procedure. Which of the following actions should the nurse take?

insert the tip of the tubing 8 cm (3.1 in) - the nurse should insert the tip of the tubing 7-10 cm (3-4 in) along the rectal wall to prevent dislodging of the tube during the procedure and avoid injury to rectal mucosa. - the nurse should LUBRICATE 5-8 cm (2-3 in) of the tip. - hold the enema container a max 45 cm (18 in) ABOVE the rectum to prevent painful distention of the colon.