Nursing Concept Advanced Test ATI
A nurse working in a hospice facility is talking to a client's son who is distressed because his mother cries frequently & says she wants to die. Which of the following responses by the nurse is appropriate?
"Let's discuss some strategies you can use when this happens again."
A nurse is reinforcing teaching with the caregiver of a client who has aphasia. The nurse should include which of the following communication strategies in the teaching?
Cue client by providing cards that portray common needs. -Using picture cards that portray common needs provides cues for the client and enhances communication
A nurse is caring for a client who has an UTI & is prescribed ciprofloxacin (Cipro). The client exhibits urticaria & angioedema following administration of the medication. Which of the following is the first action the nurse should take?
Determine respiratory rate (Think of ABC)
A nurse is caring for a client who has an acid-base imbalance. For which of the following manifestations is metabolic alkalosis a possible complication?
Excessive vomiting -Metabolic alkalosis is a potential complication of excessive vomiting bc of the loss of acid from the body.
A nurse is reinforcing teaching about client consent to treatment with a group of newly licensed nurses. Which of the following statements by a newly licensed nurse indicates further teaching?
It is the responsibility of the provider to obtain express consent.
A nurse is caring for a client who had a cerebrovascular accident 2 days ago. Which of the following is the first sign of increased intracranial pressure (ICP)?
Lethargy -It occurs when pressure is placed on the reticular activating system within the brainstem. Lethargy is the 1st sign of increased ICP.
A nurse is caring for a child who is 24 hr postoperative following a supratentorial craniotomy. The nurse should maintain the child in which of the following positions?
Supine with head of the bed 30 degrees -Prevents hemorrhage by reducing blood flow to the brain
A nurse has assigned 4 tasks to an assistive personnel (AP). Which of the following should the nurse instruct the AP to perform first?
Take ABG specimen to the lab -ABG specimen are kept in ice so it should be transported immediately.