ATI CH 6&8 Application Exercises

A nurse is caring for a client who is 24 hr postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for "real food." The nurse tells the client that she will call the surgeon and ask. The surgeon hears the nurse's report and prescribes a full liquid diet. The nurse used which of the following levels of critical thinking? a) Basic b) Commitment c) Complex d) Integrity

a) At the basic level, thinking is concrete and based on a set of rules, such as obtaining the prescription for diet progression.

A nurse is caring for a client who has a new prescription for antihypertensive medication. Prior to administering the medication, the nurse uses an electronic database to gather information about the medication and the effects it might have on this client. Which of the following components of critical thinking is the nurse using when he reviews the medication information? a) Knowledge b) Experience c) Intuition d) Competence

a) By using the electronic database, the nurse takes the initiative to increase his knowledge

A nurse manager of a medical‑surgical unit is assigning care responsibilities for the oncoming shift. A client is awaiting transfer back to the unit from the PACU following thoracic surgery. To which of the following staff members should the nurse assign this client? a) Charge nurse b) RN c) Practical nurse (PN) d) Assistive personnel (AP)

b) A client returning from surgery requires an RN's assessment and establishment of a plan of care, especially if the client is potentially unstable.

A nurse is caring for a client who is 24 hr postoperative following abdominal surgery. The nurse suspects the client's pain management is inadequate. Which of the following data reinforce this suspicion? (Select all that apply.) a) The client seems easily agitated. b)The client is non-adherent with coughing, deep breathing, and dangling. c) The client may have pain medication every 4 to 6 hr but accepts it every 6 to 7 hr. d) The client reports tenderness in his right lower leg. e) The client's vital signs are heart rate 110/min, respiratory rate 20/min, temperature 37° C (98.6° F), and blood pressure 136/80 mm Hg

b) Refusal to perform interventions that could increase his pain level (coughing, deep breathing) supports that the client has unrelieved pain. c) Acceptance of pain medication only at or beyond the maximum interval suggests that the client has pain between the time the effects of the previous dose subside and the new dose takes effect. e) Elevated blood pressure and pulse rate without elevated temperature or other signs of distress support that the client has unrelieved pain.

A nurse receives a prescription for an antibiotic for a client who has cellulitis. The nurse checks the client's medical record, discovers that she is allergic to the antibiotic, and calls the provider to request a prescription for a different antibiotic. Which of the following critical thinking attitudes did the nurse demonstrate? a) Fairness b) Responsibility c) Risk taking d) Creativity

b) The nurse is responsible for administering medications in a safe manner and according to standards of practice. Checking the medical record for allergies helps ensure safety

A nurse is preparing an in‑service program about delegation. Which of the following elements should she identify when presenting the five rights of delegation? (Select all that apply.) a) Right client b) Right supervision and evaluation c) Right direction and communication d) Right time e) Right circumstances

b) The right supervision and evaluation is one of the five rights of delegation. They also include the right task and the right person. c) Right direction and communication is one of the five rights of delegation. They also include the right task and the right person. e) The right circumstances is one of the five rights of delegation. They also include the right task and the right person.

A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP. Which of the following information should the nurse share with the AP? (Select all that apply.) a) The roommate ambulates independently. b) The client ambulates with his slippers on over his anti-embolic stockings. c) The client uses a front‑wheeled walker when ambulating. d) The client had pain medication 30 min ago. e) The client is allergic to codeine. f) The client ate 50% of his breakfast this morning.

b) To complete this assignment safely, the AP should make sure the client wears stockings and slippers. c) To complete this assignment safely, the AP should make sure the client uses a front‑wheeled walker. d) To complete this assignment safely, the AP should know that the client should be feeling the effects of the pain medication

A nurse on a medical‑surgical unit has received change‑of‑shift report and will care for four clients. Which of the following client's needs should the nurse assign to an assistive personnel (AP)? a) Feeding a client who was admitted 24 hr ago with aspiration pneumonia b) Reinforcing teaching with a client who is learning to walk using a quad cane c) Reapplying a condom catheter for a client who has urinary incontinence d) Applying a sterile dressing to a pressure ulcer

c) The application of a condom catheter is a noninvasive, routine procedure that the nurse may delegate to an AP.

A nurse uses a head‑to‑toe approach to conduct a physical assessment of a client who will undergo surgery the following week. Which of the following critical thinking attitudes did the nurse demonstrate? a) Confidence b) Perseverance c) Integrity d) Discipline

d) Discipline is developing a systematic approach to thinking. Proceeding head to toe is a systematic approach to collecting the data a physical assessment yields.

An RN is making assignments for a practical nurse (PN) at the beginning of the shift. Which of the following assignments should the PN question? a) Assisting a client who is 24‑hr postoperative to use an incentive spirometer b) Collecting a clean‑catch urine specimen from a client who has a wound infection c) Providing nasopharyngeal suctioning for a client who has pneumonia d) Teaching a client who has asthma to use a metered‑dose inhaler

d) The RN is responsible for primary teaching. The PN may only reinforce teaching