ATI Health P/M

A nurse is teaching a middle-age client about hypertension. Which of the following information should the nurse include in the teaching?

"Diuretics are the first type of medication to control hypertension." The nurse should include in the teaching that diuretic medication is the first type of medication to control hypertension, by decreasing blood volume and lowering blood pressure.

A nurse is teaching a client how to follow a low-purine diet as prescribed by the provider for the management of gout. Which of the following statements indicates the client understands the teaching?

"I should avoid eating liver and other organ meats." The nurse should encourage the client who has gout to avoid organ meats, such as liver, due to high levels of purine.

A nurse is caring for a 4-year-old child who has croup and wet the bed overnight. When the parents visit the next day, the nurse explains the situation and one of the parents says, "She never wets the bed at home. I am so embarrassed." Which of the following responses should the nurse make?

"It is expected for children who are hospitalized to regress. The toileting skills will return when your child is feeling better." A recently learned skill, such as toilet training, is often temporarily lost due to the stress of hospitalization. The nurse should reassure the parents that regression is an expected behavior in children who are hospitalized and that her child will regain bladder control when she is feeling better.

A nurse is providing teaching about Kegel exercises to a group of clients who are in the third trimester of pregnancy. Which of the following statements by a client indicates understanding of the teaching?

"These exercises help pelvic muscles to stretch during birth." Kegel exercises improve the strength of perineal muscles, facilitating stretching and contracting during childbirth.

A nurse in a family planning clinic is caring for a 17-year-old female client who is requesting oral contraceptives. The client states that she is nervous because she has never had a pelvic examination. Which of the following responses should the nurse make?

"What part of the exam makes you most nervous?" This therapeutic response recognizes the client's feelings. It also uses the therapeutic technique of clarification to encourage the client to tell the nurse more about her concerns.

A nurse is providing teaching to the parents of a newborn. Which of the following information should the nurse include?

"Your baby will receive a hepatitis B vaccine prior to discharge." An infant should receive three doses of the hepatitis B (HepB) vaccine over the first 6 months of life. The first dose is given at birth, the second dose between 1 and 2 months of age, and the third dose between 6 and 18 months of age. If the mother is hepatitis B surface antigen positive, the newborn should receive the HepB vaccine within 12 hr of birth.

A nurse is providing teaching about nutrition to a group of clients. The nurse should include that which of the following foods contains the highest level of thiamine per serving?

1 cup whole grain wheat flour Whole or enriched grains contain 0.981 mg thiamine, which is the highest level of thiamine.

A nurse is teaching an adult client who has a low literacy level about self administration of a subcutaneous medication. Which of the following strategies should the nurse use to promote the client's understanding?

Ask the client to demonstrate the skill. The nurse should give the client essential information first, repeating as necessary, and reinforce the instructions with demonstrations. The nurse can ask the client to restate, review, and demonstrate skills to promote and evaluate client understanding.

A nurse is assisting with the admission of a client to an inpatient unit. Which of the following sources of information should the nurse rely on for accurate information about the client?

Client concerns Information the nurse obtains directly from the client is generally the most accurate and provides the best information available. The client is a primary source of information.

A nurse is providing health promotion teaching to the parents of an infant. Which of the following conditions should the nurse identify as the leading cause of death among this age group?

Congenital anomalies Congenital anomalies are the leading cause of infant mortality in the U.S.

A nurse is developing a health program for the parents of school-age boys. Which of the following information about pubescent changes should the nurse include in the program?

Growth spurts in height occur toward the end of midpuberty. Growth spurts in height occur toward the end of midpuberty. Boys grow an average of 10 to 30 cm (4 to 12 inches) during this period.

A nurse is assessing a client's abdomen who reports stomach pain. Which of the following actions should the nurse take first?

Inspect Evidence-based practice indicates the nurse should first inspect the abdomen for external abnormal conditions first.

A nurse is providing teaching to the parent of an infant about introducing solid foods. The nurse should recommend that which of the following foods be introduced first?

Iron-fortified cereal Iron-fortified cereal should be the first solid food introduced to the infant.

A nurse is developing an education program about skin cancer for a community center. Which of the following instructions should the nurse plan to include?

Keep a body map of skin lesions. A body map of scars, spots and lesions will help clients monitor for new growth and changes to lesions to help detect skin cancer.

A nurse is preparing to administer vaccines to a 1-year-old child. Which of the following vaccines should the nurse give? (Select all that apply.)

Measles, mumps rubella (MMR) Varicella (VAR) Measles, mumps rubella (MMR) is correct. A 1-year-old child should receive the first of two doses of the MMR vaccine. Diphtheria, tetanus and acellular pertussis (DTaP) is incorrect. By 1 year of age, the child should have already received three doses of DTaP: at 2 months, 4 months, and 6 months. The child should receive a fourth dose at 15 months of age. Varicella (VAR) is correct. A 1-year-old child should receive the first of two doses of the VAR vaccine. Rotavirus (RV) is incorrect. A 1-year-old child should have received the RV vaccine in a two or three dose series starting at 2 months of age. Human papillomavirus (HPV4) is incorrect. A child should receive a three dose series of the HPV4 vaccine at 11 or 12 years of age.

A nurse is providing teaching for a client who has a recent diagnosis of depression. Which of the following should the nurse identify as a primary risk factor for this disorder?

Past history of childhood trauma A history of trauma in childhood is a primary risk factor for depression.

A nurse is providing teaching about a low-FODMAP diet for a client who has irritable bowel syndrome (IBS). The nurse should instruct the client to avoid which of the following foods?

Raisins A low-FODMAP diet limits the intake of foods that contain high amounts of fructose and other short-chain carbohydrates, which have been found to decrease the incidence and severity of symptoms in clients who have IBS. Dried fruits, such as raisins, have an increased amount of fructose, which can increase the severity and incidence of symptoms in clients who have IBS.

A nurse is planning care for a client who is confined to bed. Which of the following actions should the nurse include in the plan?

Reposition the client every 2 hr. The nurse should change the client's position every 2 hr to stimulate circulation and prevent pressure ulcers.

A nurse is reinforcing teaching about contraceptive methods with a client. Which of the following should the nurse recognize as a contraindication for diaphragm use?

The client has pelvic relaxation. Pelvic relaxation and large cystocele are contraindications for diaphragm use.