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ATI ASSESSMENT EXAMS TEST BANK - OVER 800 QUESTIONS FROM DIFFERENT EXAM LATEST (2022)
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ATI - Capstone Mental health assessment
Capstone Mental health assessment victoria final 1. A nurse is discussing discipline techniques with the parent of a preschooler. Which of the following s... [Show More] tatements by the parent indicates an understanding of time-out as a form of discipline? "I place my child in time-out for 15 minutes when they misbehave." "I send my child to their room for the time-out period." "I make use of time-out after giving three warnings." "I use a kitchen timer to mark the end of the time-out period." 2. A nurse in a well-child clinic receives a phone call from the parent of an adolescent client. The parent states, "I think my son might try to kill himself." Which of the following statements by the parent is the priority for the nurse to investigate further? "I can hear him crying in the middle of the night." "He spends most of his time locked in his room." "He refuses to go to the movies with his friends." "I noticed several cutting marks on both of his arms." 3. A nurse is caring for an adult client who is receiving treatment for alcohol use disorder. The client is upset because his partner has refused to visit him in the treatment facility. Which of the following actions by the client should indicate to the nurse that the client is using regression as a defense mechanism? The client states that he has developed sudden hearing loss. The client states that his partner will not visit because they are too busy with their job. The client yells obscenities at the nurse. The client stomps his feet and throws objects o his bedside table 4. A nurse is admitting a client who has posttraumatic stress disorder (PTSD) to a community mental health facility. Which of the following manifestations should the nurse expect when completing the admission assessment? Decreased startle response to loud noises Reports uninterrupted sleep of 10 to 12 hr each night Reluctance to discuss the event that precipitated the distress Reports feelings of acute distress that began 1 to 2 weeks ago 5. A nurse is conducting a child maltreatment screening of a family who has a toddler. Which of the following findings should the nurse identify as an indicator of possible child neglect? The child has a history of jaw factures. The child seems frightened of their parent. The child has had no immunizations since birth. The child rocks back and forth continually. 6. A nurse in an urgent-care clinic is caring for a school-age child who has several visible bruises. The child's parent states, "My partner got red today and came home angry. I don't think this will happen again." Which of the following responses should the nurse make? "I agree with you. I'm sure this will never happen again." "This is awful. You should le charges against your partner." "This is clearly child endangerment. I will have to call the police." "I'd like to know more about what happened. Let's sit and talk." 7. A nurse is caring for a client who has dementia and insists a doll is her infant child. Which of the following behavioral management techniques should the nurse use when interacting with the client? Cognitive reframing Thought stopping Validation therapy Operant conditioning 8. A nurse is planning care for a client who has major depressive disorder and is being admitted following a suicide attempt. Which of the following interventions is the nurse's priority? Initiate one-to-one observation. Encourage the client to participate in group activities. Administer an antidepressant. Set up a time for individual meetings with the client. 9. A nurse is caring for a client who is aggressive toward other clients and has been placed in wrist restraints. After obtaining a prescription for restraints from the provider, which of the following actions should the nurse take? Document the client's behavior once every hour. Keep the client in restraints until the prescription expires. Conduct a debrieng regarding the client with the unit staff. Request an evaluation of the client within 12 hr of application of restraints. 10. A nurse is providing teaching to a client who has a prescription for disulram. Which of the following client statements indicates an understanding of the teaching? "If I drink alcohol, I will become very sick." "If I drink alcohol, I will not be able to fall asleep." "If I drink alcohol, I will lose control of my inhibitions and say something I don't mean." "If I drink alcohol, I will have severe mood swings and exhibit belligerent behavior." 11. A nurse is reviewing the medical record of a newly admitted client who has major depressive disorder. Which of the following findings should the nurse identify as a risk factor for this condition? The client has a serotonin deficiency. The client has acute bronchitis. The client has an elevated calcium level. The client is an only child 12. A nurse on a medical-surgical unit is caring for a client who tells the nurse about their intentions to harm an ex-partner. Which of the following actions is a legal duty of the nurse? Keep the client hospitalized until there is no longer a threat. Ensure the client's ex-partner is notified of the threat. Ask a friend or family member to monitor the client. Transfer the client to a mental health facility. 13. A nurse is providing teaching to the caretakers of a client who has Alzheimer's disease with mild cognitive decline. The client is beginning to experience sleep disturbances. Which of the following instructions should the nurse include? Give the client a cup of hot black tea before bed. Wake the client at the same time each morning. Take the client for a walk 2 hr before bedtime each night. Allow the client to take a 90-min nap immediately after lunch. 14. A nurse on a mental health unit is planning a group therapy session about assertiveness training. For which of the following clients should the nurse recommend the training? A client who has new-onset delirium A client who is experiencing auditory hallucinations A client who is experiencing mania A client who has somatic symptom disorder 15. A nurse is caring for a client who has bipolar disorder. The client says to the nurse, "Give me your pen to cut the pain out of my chest." The nurse should identify that the client is at risk for which of the following? Illusion Hallucination Attention-seeking behavior Self-mutilation 16. A charge nurse in a community mental health clinic is discussing ethical concepts of client care with a newly licensed nurse. The charge nurse should use which of the following situations as an example of fidelity? Spending equal time with clients regardless of their insurance status. Explaining possible adverse effects to clients receiving new prescriptions. Respecting the decision of clients to refuse to participate in group therapy. Attending an educational conference on identifying clients at risk for suicide. 17. A nurse is using de-escalation techniques with a client who has become verbally aggressive with a staff member. Which of the following actions should the nurse take? Remain 15 cm (6 in) away from the client Use a raised voice when speaking to the client Determine the cause of the client's feelings Ask the client short, close-ended questions 18. A nurse is discharging a client who was admitted for the treatment of alcohol withdrawal. Which of the following resources should the nurse recommend to the client? Reach to Recovery A 12-step program Al-Anon Light therapy 19. A charge nurse is planning an in-service for newly licensed nurses on tort law in mental health care. Which of the following scenarios should the charge nurse provide as an example of an unintentional tort? A nurse did not clarify a client's prescription that was difficult to read resulting in a medication error. A nurse posted private information on social media about a client who has substance use disorder. A nurse placed a client in mechanical restraints without obtaining a prescription, resulting in injury. A nurse threatened a client with physical harm after the client became verbally abusive to staff members. 20. A nurse is preparing to teach a client who has major depressive disorder and is scheduled to undergo electroconvulsive therapy (ECT). Which of the following statements should the nurse include in the teaching? "ECT is contraindicated in clients who have psychotic symptoms." "ECT is delivered through electrodes attached to the head." "ECT cannot be administered to clients who have suicidal ideation." "ECT is conducted under regional anesthesia." 21. A nurse is caring for a client who exhibits excessive attention-seeking behaviors, including acting irtatious and seductive. The nurse should identify these behaviors as manifestations of which of the following personality disorders? Paranoid Histrionic Narcissistic Antisocial 22. A nurse is caring for a client who is taking a tricyclic antidepressant. For which of the following findings should the nurse monitor as an adverse effect of tricyclic antidepressants? Orthostatic hypotension Diarrhea Hyperactivity Increased urinary output 23. A mental health nurse is providing preventive care for a group of clients in the community. Which of the following actions by the nurse demonstrates a secondary prevention strategy? Leading a group discussion with several clients who have schizophrenia and are dealing with tardive dyskinesia. Screening college students who demonstrate manifestations of depressive disorder. Training volunteers in an adult day care facility to communicate effectively with clients who have cognitive impairments. Teaching personal coping skills to a group of adults whose parents have Alzheimer's disease. 24. A nurse is caring for a client who has posttraumatic stress disorder (PTSD) after being physically assaulted. The client is unable to recall any details of the event. Which of the following defense mechanisms should the nurse recognize that the client is displaying? Dissociation Rationalization Undoing Reaction formation 25. A charge nurse is providing education to a group of newly-licensed nurses about the rights of clients who are involuntarily admitted. Which of the following responses by a newly-licensed nurse indicates understanding of the teaching? "These clients can receive packages after they are privately inspected by security." "These clients cannot be considered for a research study." "These clients can vote in local and federal elections." "These clients cannot refuse their prescribed antipsychotic medications." 26. A home health nurse is caring for a client who reports feeling tired and being unable to grocery shop. Which of the following responses by the nurse is an example of therapeutic communication? "Have you thought about taking a sleeping pill?" "Your fatigue will pass, and everything will be just ne." "Do you have a family member who can assist you?" "Let's discuss how to get you the help you need." 27. A charge nurse on a mental health unit is preparing an in-service for staff members about client rights. Which of the following information should the nurse include? A client who is a voluntary admission does not have the right to request to be discharged. A client who is admitted involuntarily has the right to refuse to participate in therapy. A client who is admitted involuntarily cannot refuse to take prescribed psychotropic medications. A client who is a voluntary admission cannot withdraw consent after it has been given. 28. A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate in the plan of care? Provide additional attention to the client. Apply mechanical restraints before administering medication. Obtain a verbal contract from the client. Limit staff members who work with the client 29. A nurse is caring for a client who reports a history of frequent alcohol consumption. Which of the following questions should the nurse ask when screening for alcohol use disorder? "Has a family member indicated that you should cut down on your drinking?" "Have you had a glass of wine in the last week?" "Do you drink alcohol with your friends?" "Do you enjoy drinking alcohol?" 30. A nurse is caring for a client who has just learned that her partner has died by suicide. Which of the following actions should the nurse take first? Refer the client to a support group for survivors of suicide. Offer to contact the client's family or support system. Inform the client that feelings of guilt are often felt by survivors of suicide. Determine the client's understanding of the suicide events. 31. A nurse is caring for a client who has become violent and is threatening self-harm following a crisis. After ensuring enough staff are available, which of the following actions should the nurse take first? Administer a sedative medication. Perform a debrieng with the sta. Acknowledge the client's emotions. Place the client in restraints. 32. A nurse is assessing a client who reports using cocaine 1 hr ago. Which of the following findings should the nurse expect? Polyphagia Fever Bradycardia Oliguria [Show Less]
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ATI Pharmacology Assessment 1, Assessment 2, And Pharmacology Post - Assessment Assignment 1
PHARMACOLOGY ASSESSMENT 1 1. The first action the nurse should take is to assess the client for injury due to medication error. Assess the client 2.... [Show More] A nurse is reviewing the medical record of a client who received medications 1 hr ago and reports having chest pain. The nurse should recognize that chest pain can be an adverse effect of which of the following medication? Albuterol Furosemide Digoxin Atenolol 3. A nurse is providing teaching to a client who has a new prescription for ranitidine for the treatment of Zollinger-Ellison syndrome. The nurse should explain to the client that ranitidine treats ulcers through which of the following actions? It decreases stomach motility It reduces gastric acid production It forms a protective barrier in the stomach lining. It neutralizes gastric acid. 4. A nurse is caring for a client who has open-angle glaucoma and a new prescription for acetazolamide. Prior to administering the first dose, the nurse should ask the client if they have allergy to which of the following medication classifications? Nitrates Sulfa-based medications Antilipemic agents Proton pump inhibitors 5. A nurse is caring for a client who has HIV and is starting therapy with ritonavir and zidovudine. The client asks why they must take both medications. Which of the following response should the nurse make? If you take the two medications together, it will shorten the duration of you…. Taking the two medications together keeps you from becoming resistant to either of them. Taking the two medication together keeps you from developing toxicity from either of them Zidovudine will help protect you from the possible adverse effects of ritonavir 6. A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting to take immediate release exenatide. Which of the following client statements indicates an understanding of the teaching? I will discard the open injector pen after two months I will inject the medication into the muscle of my thigh I will store open injector pens at room temperature I will take this medication one hour before morning and evening meals. 7. A nurse is providing teaching to a client who has a new prescription for folic acid. The client states I thought that was only given during pregnancy. Which of the following statements should the nurse make? Folic acid is important for stimulating the immune system Folic acid is given to increase the absorption of the medication Folic acid is administered to minimize the manifestations of benign prostatic hyperplasia Folic acid important for the building of blood cells. 8. A nurse in the PACU is caring for a client who has received general anesthesia and has manifestation of malignant hyperthermia. Which of the following medications should the nurse expect to administer? Diazepam Dantrolene Cyclobenzaprine Metaxalone 9. A nurse is caring for a client who refuses a prescribed influenza immunization. Which of the following actions should the nurse take first? Contact the provider who prescribed the immunization Ask the client to describe their concerns Provide the client with education about the immunization Document the client refusal of the immunization 10. A nurse is caring for a client who has a prescription for a hypotonic Iv fluid. Which of the following solution the nurse expects to administer? 0.45% sodium chloride 0.9% sodium chloride 3% sodium chloride Lactated ringers 11. A nurse in an emergency department is caring for a client who has a new prescription for acetylcysteine. For which of the following condition should the nurse expect to administer this medication? Gastrointestinal bleed Acute bronchospasm Morphine toxicity Acetaminophen toxicity 12. A nurse is obtaining vital signs for a client who has been taking propranolol. Which of the following finding should the nurse identify as an adverse effect of the medication? Respiratory rate 20/min Oral temperature 37.8 Blood pressure 118/78 mm Apical pulse 50 /min 13. A nurse is providing teaching to a client who has neuropathic pain and a new prescription for amitriptyline once per day. Which of the following information should the nurse include in the teaching? Increase fluids while taking the medication Expect an elevation in blood pressure with initial doses of the medication Stop the medication immediately if urine becomes orange in color Take the medication in the morning 14. A nurse is providing teaching to a client who has a new prescription for oral extended-release potassium chloride tablets. Which of the following instructions should the nurse include in the teaching? Do not crush this medication Dissolve the tablet in your mouth Take this medication on an empty stomach Take this medication every other day 15. A nurse is providing teaching to a client who has a new prescription for levothyroxine. Which of the following statements by the client indications an understanding of the teaching? I should take this medication with food I will take three doses each day I might not realize the full effect of the medication for several weeks I might gain weight while taking this medication if I do not exercise 16. While assessing a client at the beginning of the shift a nurse notes that the client received a medication in error from the nurse on the previous shift. At which of the following times should the nurse plan to complete an incident report about the error? After the end of the current shift After contacting risk management As soon as the assessment is complete As soon as the nurse from the previous shift has been informed 17. A nurse is preparing to administer a second unit of packed RBCs to a client who is experiencing hemorrhagic shock. The nurse should monitor the client for which of the following manifestation as an indication of circulatory overload? Chills Wheezing Dyspnea Flushing 18. A nurse is planning care for a client who has neutropenia. Which of the following medication should the nurse expect to administer? Epoetin Filgastrim Enoxaparin Oprelvekin 19. A nurse is teaching a client who has a new prescription for brimonidine to treat open-angle glaucoma. Which of the following client statement indicate an understanding of the teaching? It’s ok to put the drops in my eyes while I’m wearing my contacts I can expect to feel some irritation when I put these drops in my eyes I should expect to stop taking the medication after 3 weeks At least these drops will help clear up the redness I get in my eyes sometimes [Show Less]
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ATI ASSESSMENT LEADERSHIP AND COMMUNITY HEALTH - NURS 406 / NURS406
ASSESSMENT LEADERSHIP AND COMMUNITY HEALTH 1. An occupational health nurse is preparing to teach a health promotion class for workers at a warehou... [Show More] se. Which of the following statements should the nurse include? "Rub your hands together for at least 10 seconds when washing them." "Keep your abdominal muscles tightened when lifting objects." "Ensure that 20 percent or less of calories are from saturated fats." "Engage in aerobic exercise 2 to 4 days per week for 20 min." 2. A nurse is preparing an in-service about family violence for a group of newly licensed nurses. Which of the following statements should the nurse include in the teaching? "Perpetrators of family-directed violence recognize their behavior as abnormal." "Female clients who experience partner violence are at greater risk for acute diseases." "The victim's risk for homicide is greatest when they decide to leave the relationship." "The level of violence of the events decreases over time." 3. A community health nurse is reviewing primary prevention strategies for West Nile virus with a group of clients in a rural health clinic. Which of the following instructions should the nurse include? Avoid exposure to deer ticks. Eliminate areas of standing water. Use a respiratory mask when cleaning bird coops. Plan outdoor activities after dusk 4. A school nurse is providing care for students in an elementary education facility. Which of the following interventions by the nurse addresses the primary level of prevention? Design interventions for a student's individual education plan (IEP). Teach students about healthy food choices. Perform first aid for minor injuries. Perform scoliosis screenings for students. 5. A nurse is conducting a home visit with an older adult client. Which of the following observations should the nurse address to promote a safe environment? Loud volume of the television set Wall-to-wall carpet in the living room Low chairs without armrests Use of indirect lighting 6. A case manager completes a history and physical assessment for a client who has COPD. Which of the following actions should the case manager take next? Identify the client's current health needs. Call the provider with a list of client concerns. Compile a list of community resources for the client. Refer the client to a COPD support group 7. A nurse manager is implementing a quality improvement project to reduce the number of methicillinresistant Staphylococcus aureus (MRSA) infections at the facility. Which of the following actions should the nurse manager take first? Develop a MRSA protocol for implementation. Provide educational in-service for staff. Evaluate outcomes resulting from interventions. Conduct a chart review to evaluate precipitating factors of clients who develop MRSA. 8. A nurse manager is teaching a group of employees about standards for Quality and Safety Education for Nurses (QSEN). Which of the following statements by an employee should the nurse manager identify as an example of the QSEN concept of quality improvement? "We should start tracking how soon clients are discharged after laparoscopic versus open surgery." "We should be sure to log out of the computers immediately following documentation." "We should involve our clients' partners in care planning as much as possible." "We should provide change-of-shift report as a team, including the assistive personnel who assisted with care. 9. A hospice nurse is providing teaching to a client who has a new diagnosis of a terminal illness and her family. Which of the following statements should the nurse include in the teaching? "Hospice care focuses on disease treatment and rehabilitation." "The provider will coordinate your health care needs while in hospice." "You must choose a family caregiver before being admitted into a hospice facility." "Hospice care continues to help families with grief after a death occurs." 10. A nurse manager is discussing electronic medical records with a newly licensed nurse. Which of the following actions should the nurse take to maintain client confidentiality? (Select all that apply.) Log out of the computer terminal before leaving. Share passwords for computer access with colleagues. Change computer access passwords on a regular basis. Avoid accessing information about clients admitted to other units. Shred computer-generated client worksheets after use. 11. A nurse is completing an assessment of a recently widowed older adult client. He states he is unable to drive and is afraid to cook on the stove. Which of the following community resources should the nurse recommend? Hospice care Meals on Wheels Home health services American Association of Retired Persons 12. A charge nurse is discussing HIPAA with a newly licensed nurse. Which of the following actions should the charge nurse include in the teaching as an example of a HIPAA violation? Posting the name of the nurse providing care on a client's communication board Discussing the client's new medication with a hospital pharmacist Faxing requested medical information for a client who is transferring to another facility Emailing the client's positive hepatitis results from an unencrypted serve 13. A nurse manager is preparing to complete staff performance appraisals. Which of the following principles should the nurse manager consider when completing the appraisals? Performance appraisals should be written in measurable terms. Appraisal objectives should be applicable to staff at every level. Performance appraisals should be based on the nurse manager's preferences. Completed appraisals should be approved by a provider. 14. A nurse is caring for a client and realizes they have administered the wrong medication. Which of the following actions should the nurse take first? Notify the provider. Check the condition of the client. Document the occurrence in the electronic medical record. Complete an incident report. 15. A nurse is caring for a newborn in the nursery following a circumcision. The newborn's grandparent, who does not have an identication bracelet, requests to take the newborn to his parent's room. Which of the following actions should the nurse take? Check the newborn's identication bracelet with the chart. Obtain permission from the newborn's mother. Respectfully deny the grandparent's request. Review the newborn's footprint record 16. A nurse enters a client's room and finds the client pulseless. The client's living will requests no resuscitation be performed, but the provider has not written the prescription. Which of the following actions should the nurse take? Administer emergency medications without performing CPR. Begin CPR. Call the provider for a do-not-resuscitate (DNR) order. Respect the client's wishes, and do not attempt CPR. 17. A staff nurse is challenging a shift assignment with the charge nurse. Which of the following statements made by the charge nurse is an example of smoothing as a strategy to resolve conflict? "If you accept this assignment today, I will let you choose your assignment tomorrow." "If you don't agree with the assignment, I will have to report your decision to the nursing supervisor." “Let’s just focus on giving our client medications on time.” "You have a lot of experience, so I'm sure you're capable of these tasks." 18. A community nurse is instructing a group of newly licensed nurses about diseases that require airborne precautions. Which of the following diseases should the nurse include? Rubella Pertussis Influenza Varicella 19. A nurse is receiving change-of-shift report on a group of clients. Which of the following clients should the nurse assess first? A client who has urolithiasis and reports severe ankle pain extending toward the abdomen A client who has acute cholecystitis and reports abdominal pain radiating to the right shoulder A client who has had a total knee arthroplasty, is 1 day postoperative, and reports a pain level of 8 on a 0 to 10 pain scale A client who has a fractured femur and reports sudden sharp chest pain 20. An occupational health nurse in a factory is planning interventions to reduce environmental stressors for employees. Which of the following interventions should the nurse use to aect physical agents in the environment? (Select all that apply.) Teach workers to choose personal strategies to cope with work stress. Limit the amount of time workers spend in temperatures over 43.3° C (110° F). Provide ear plugs for use at workstations throughout the factory. Obtain dosimeters for employees to wear when using new machinery that emits radiation. Require more frequent disinfection of work surfaces during inuenza season. 21. A nurse is using the ecologic model for population health to develop interventions to address HIV in a community. Which of the following interventions should the nurse include to address financial factors affecting community health? Have adolescents lead peer discussions in schools about safe sexual practices. Distribute condoms through remote community clinics. Create commercial advertisements describing the long-term eects of HIV. Include information about perinatal HIV transmission at prenatal education classes. 22. A nurse is planning a staff education program to review nursing interventions for clients who have kidney failure. Which of the following sources should the nurse identify as the best resource for obtaining evidence-based information? The advice of an expert nephrology nurse Retrospective chart reviews Facility critical pathway A recent peer-reviewed nursing research article [Show Less]
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ATI Maternal Newborn Assessment - NURS 406 / NURS406
Maternal Newborn Assessment 1. A nurse is performing a vaginal exam on a client who is in active labor. The nurse notes the umbilical cord protruding th... [Show More] rough the cervix. Which of the following actions should the nurse take? Administer oxytocin to the client via intravenous infusion. Apply oxygen at 2 L/min via nasal cannula. Prepare for insertion of an intrauterine pressure catheter. Assist the client into the knee-chest position. 2. A nurse is assessing a newborn who is 48 hr old and is experiencing opioid withdrawals. Which of the following findings should the nurse expect? Hypotonicity Moderate tremors of the extremities Axillary temperature 36.1° C (96.9° F) Excessive sleeping 3. A nurse is reviewing a client's medical record and notes that the client is taking tamoxifen. The nurse should identify that tamoxifen is used to treat which of the following conditions? Non-Hodgkin's lymphoma Endometriosis Breast cancer Polycystic ovary syndrome 4. A nurse is caring for a client who is receiving oxytocin to augment labor. The client has an intrauterine pressure catheter and an internal fetal scalp electrode for monitoring. Which of the following is an indication that the nurse should discontinue the infusion? Contraction frequency every 3 min Contraction duration of 100 seconds Fetal heart rate with moderate variability Fetal heart rate of 118/min 5. A nurse providing dietary teaching for a client who is at 29 weeks of gestation and has phenylketonuria. Which of the following suggested foods should the nurse include in the teaching? A peanut butter sandwich on wheat bread A sliced apple and red grapes A chocolate chip cookie with a glass of skim milk A scrambled egg with cheddar cheese 6. A nurse is reviewing a laboratory report for a client who is at 33 weeks of gestation and has preeclampsia. Which of the following laboratory results should the nurse report to the provider? BUN 35 mg/dL Hgb 15 mg/dL Bilirubin 0.6 mg/dL Hct 37% 7. A nurse is providing teaching about newborn safety to a client who is being admitted for induction of labor. Which of the following client statements indicate an understanding of the teaching? "I will check the identication badge of anyone who removes my baby from our room." "I should include a photo of my baby along with any public birth announcements to social media." "I will allow my baby to sleep on the bed in my room when I am in the shower." "I should expect the nurses to carry my baby in their arms to the nursery." 8. A nurse is assessing a client who is at 31 weeks of gestation. Which of the following findings should the nurse identify as an indication of a potential prenatal complication? Periodic tingling of fingers Absence of clonus Leg cramps Blurred vision 9. A nurse is reviewing the laboratory results of a newborn who is 24 hr old. Which of the following findings should the nurse report to the provider? Hemoglobin 12 g/dL Glucose 50 mg/dL Bilirubin 4 mg/dL Platelets 200,000/mm 10. A nurse is caring for a client who is in labor and has an epidural for pain control. Which of the following clinical manifestations is an adverse effect of epidural anesthesia? Polyuria Hypertension Pruritus Dry mouth 11. A nurse is teaching a client about using an intrauterine device (IUD) for contraception. Which of the following client statements indicate an understanding of the teaching? "I will need to have the IUD replaced each year." "I will need to apply a spermicide prior to intercourse." "I should expect my periods to stop while I have the IUD." "I should check for the string each month after menstruation." 12. A nurse is assessing a newborn who is 10 hr old. Which of the following findings should the nurse report to the provider? Axillary temperature 36.5° C (97.7° F) Nasal faring Heart rate 158/min One void since birth 13. A nurse is assessing a client who gave birth 1 week ago. The client states, "I don't know what's wrong. I love my baby, but I feel so let down and I seem to cry for no reason." The nurse should identify that the client is experiencing which of the following emotional responses to birth? Postpartum depression Taking-in phase Postpartum blues Taking-hold phase 14. A nurse is providing teaching to a group of women about risk factors for ovarian cancer. Which of the following risk factors should the nurse include? (Select all that apply.) Nulliparity History of breastfeeding Previous use of oral contraceptives History of breast cancer Hormone replacement therapy 15. A nurse is caring for a client who is at 38 weeks of gestation and is experiencing continuous abdominal pain and vaginal bleeding. The client has a history of cocaine use. The nurse should identify that the client is likely experiencing which of the following complications? Abruptio placentae Hydatidiform mole Preterm labor Placenta previa 16. A nurse is caring for a client who is postpartum, has a deep-vein thrombosis, and is receiving heparin therapy via subcutaneous injections. Which of the following actions should the nurse take? Request a prescription for PRN aspirin from the provider. Massage the injection site thoroughly following administration. Instruct the client that they cannot breastfeed while receiving heparin. Administer the injection in the client's abdomen. 17. A nurse is caring for a newborn whose father voices concerns about his ability to bond with his baby. Which of the following actions should the nurse take to facilitate bonding? (Select all that apply.) Point out to the father that the newborn turns toward his voice. Ask the father why he is concerned about bonding with the newborn. Encourage the father to touch and stroke the newborn's skin. Demonstrate diapering and swaddling techniques for the father. Encourage the father to lay the newborn beside him while both are sleeping. 18. A nurse is providing teaching to a client who has fibrocystic breast changes and is experiencing breast discomfort during menstruation. Which of the following instructions should the nurse include? "Increase potassium intake." "Increase fluid intake to 3 liters per day." "Decrease sodium intake before menstruation." "Decrease daily fiber intake." 19. A nurse is admitting a client who is at 35 weeks of gestation and is experiencing mild vaginal bleeding due to placenta previa. Which of the following actions should the nurse plan to take? Initiate continuous monitoring of the FHR. Administer a dose of betamethasone. Check the cervix for dilation every 8 hr. Request that the provider prescribe misoprostol PRN 20. A nurse is providing teaching to a client who is at 32 weeks of gestation and is experiencing stress incontinence. Which of the following information should the nurse include in the teaching? (Select all that apply.) Decrease dietary fiber. Practice Kegel exercises. Restrict daily fluid intake. Reduce caffeine intake. Avoid daily exercise. 21. A nurse is caring for a client who is receiving oxytocin to augment labor. The nurse notes recurrent variable decelerations of the FHR. Which of the following actions should the nurse take first? Prepare the equipment necessary to initiate an amnioinfusion. Administer oxygen at 10 L/min via nonrebreather face mask. Discontinue the infusion of oxytocin. Place the client in a left lateral position. 22. A nurse is admitting a client who is at 33 weeks of gestation and has preeclampsia with severe features. Which of the following actions should the nurse take? Restrict protein intake to less than 40 g/day. Initiate seizure precautions for the client. Initiate an infusion of 0.9% sodium chloride at 150 mL/hr. Encourage the client to ambulate twice per day 23. A nurse is caring for a client who is in the transition phase of labor. Which of the following actions should the nurse take? Assist the client to void every 3 hr. Monitor contractions every 30 min. Place the client into a lithotomy position. Encourage the client to use a pant-blow breathing pattern 24. A nurse is assessing a newborn who was born vaginally with vacuum extractor assistance. The nurse notes swelling over the newborn's head that crosses the suture line. The nurse should identify the swelling as which of the following findings? Nevus ammeus Caput succedaneum Cephalohematoma Erythema toxicum 25. A nurse is caring for a newborn who has a blood glucose level of 45 mg/dL. Which of the following actions should the nurse take? Encourage the mother to breastfeed the newborn. Gavage feed 60 mL (2 oz) of glucose water. Administer 10 mL of D W via IV. 10 Recheck the glucose level in 2 hr 26. A nurse is assessing a newborn who is 48 hr old and has a maternal history of methadone use during pregnancy. Which of the following manifestations should the nurse identify as an indication of neonatal abstinence syndrome? Hyporeactivity [Show Less]
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ATI - Nursing Care of Children Assessment - NURS 406 / NURS406
Nursing Care of Children Assessment 1. A home health nurse is providing teaching about post seizure management to the parents of a school age child wh... [Show More] o has epilepsy and experiences tonic-clonic seizures. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) "Hyperextend your child's head for 5 minutes following a seizure." "Immediately following a seizure, give your child 6 ounces of water." "Following a seizure, record the length and characteristics of your child's seizure." "Administer rectal diazepam to your child following a seizure." "Call for emergency medical services if the size of your child's pupils are unequal after a seizure." 2. A nurse in a pediatric clinic is discussing the pathophysiology of Reye syndrome with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicate an understanding of the disorder? "Reye syndrome causes fatty changes in the liver." "Reye syndrome leads to venous thrombus formation." "Reye syndrome is associated with misuse of acetaminophen." "Reye syndrome is linked to decreased serum ammonia levels 3. A nurse is teaching the parents of a toddler about strategies to manage temper tantrums. Which of the following instructions should the nurse include in the teaching? "Honor the child's request if she holds her breath." "Establish a structured daily routine for the child." "Place the child in her room alone until the temper tantrum ends." "Comfort the child during the temper tantrum." 4. A nurse is completing an assessment following suctioning of a child who has a tracheostomy. Which of the following findings should the nurse identify as an indication that the procedure has been effective? Increased respiratory rate Decreased oxygen saturation Clear breath sounds Increased oral secretions 5. A nurse is developing a plan of care for a 4-year-old child who has hemophilia and is experiencing acute hemarthrosis. Which of the following interventions should the nurse include in the plan? Have the child perform passive range-of-motion exercises. Administer aspirin as needed for pain. Place ice packs on the affected joints. Position the lower extremities below the level of the heart. 6. A nurse in the emergency department is caring for a preschooler who has epiglottitis. Which of the following actions should the nurse take? Place the child in a left lateral position. Obtain a specimen from the child's throat for a culture. Inspect the child's throat with a padded tongue depressor. Initiate droplet precautions for the child. 7. A nurse is providing teaching to the parent of a child about home care following a cardiac catheterization. Which of the following statements should the nurse include? "You should give your child aspirin if they report pain at the site." "You can remove the pressure dressing 8 hours after the procedure." "Your child can soak in the bathtub 24 hours after the procedure." "Your child should avoid strenuous physical activities for several days." 8. A nurse is admitting a child who has pertussis. Which of the following isolation precautions should the nurse initiate? Droplet Contact Airborne Protective environment 9. A nurse on a pediatric unit is receiving change-of-shift report for a group of clients. Which of the following clients should the nurse see first? A child who is postoperative following a tonsillectomy and reports moderate throat pain A child who had a cardiac catheterization using the femoral artery and has blanching of the toes A child who has bacterial pneumonia and is due for their initial dose of IV antibiotics A child who has juvenile idiopathic arthritis and needs assistance with application of prescribed splints 10. A nurse in a pediatric clinic is performing a history and physical for a toddler who is scheduled to receive a measles, mumps, and rubella (MMR) immunization. Which of the following findings indicate that the immunization should be withheld? Temperature of 38° C (100.4° F) Family history of sudden infant death syndrome (SIDS) Taking an antihistamine for seasonal allergies Receiving prednisone for nephrotic syndrome 11. A nurse is instilling optic drops into an 18-month-old child's ears. Which of the following methods should the nurse use? Pull the pinna down and back. Insert the dropper into the ear canal. Administer the ear drops at 5.5° C (42° F). Massage the area behind the ear. 12. A nurse is providing teaching to an adolescent who has a new prescription for cefazolin. For which of the following adverse effects should the nurse instruct the adolescent to monitor and report to the provider? Dry mouth Constipation Back pain Urticaria 13. A nurse is providing discharge teaching to the parents of a child who has sickle cell anemia and was hospitalized after experiencing a vasoocclusive crisis. Which of the following instructions should the nurse include in the teaching? "Avoid immunizing your child with the meningococcal vaccine." "Restrict the time your child spends playing outdoors." "Increase your child's intake of oral fluids." "Provide your child with a high-protein diet." 14. A nurse is providing teaching to the parent of a school-age child who has pediculosis capitis. Which of the following instructions should the nurse include in the teaching? "Seal no washable items in a plastic bag for 2 days." "Soak hair brushes in boiling water for 10 minutes." "Apply permethrin 1 percent cream rinse every day for 5 days." "After washing bed linens, place them in a dryer on a cool setting for 30 minutes." 15. A nurse is admitting a childs who has bacterial meningitis. Which of the following actions should the nurse take first? Initiate antibiotic therapy for the child. Minimize the child's environmental stimuli. Place the child in a side-lying position. Administer pain medication to the child 16. A nurse is assessing a 12-month-old infant who is immediately postoperative following hernia repair surgery. Which of the following pain measurement tools should the nurse use to determine if the infant is experiencing pain? FACES COMFORT CRIES FLACC 17. A nurse is caring for a school-age child who has metastatic osteosarcoma. The child asks the nurse, "Am I going to die?" Which of the following responses should the nurse make? "What is your pain level right now?" "Your doctor will be able to answer your questions tomorrow." "It sounds like you are worried. Tell me what you have been told." "It's natural to worry about death, but you should focus your energy on getting better." 18. A nurse is caring for a toddler who drinks 946 mL (32 oz) of whole milk per day and has a poor appetite. The nurse should identify the toddler as being at risk for which of the following conditions? Iron deciency anemia Vitamin A toxicity Impaired carbohydrate metabolism Lactose intolerance 19. A nurse is providing teaching to the parent of a child who has a new prescription for methylphenidate. Which of the following instructions should the nurse include? "Monitor your child for excessive sleepiness." "Administer the medication with a caffeinated beverage." "Administer the second dose of the medication at lunch time." "Monitor your child for weight gain." 20. A nurse is planning care for an infant who has congenital talipes equinovarus. Which of the following referrals should the nurse expect the provider to make? Ophthalmologist Nutrition counselor Speech therapist Orthopedic specialist 21. A nurse is caring for a child who has acute glomerulonephritis. Which of the following actions should the nurse take? Obtain a daily weight. Strain the urine. Monitor blood glucose level every 4 hr. Recommend strict bed rest. 22. A nurse is teaching a school-age child and their parents about managing diabetes mellitus during illness. The nurse should determine that the teaching has been effective when the parents indicate they will provide which of the following when the child is ill? Decreased calories Increased fluids Blood glucose monitoring every 8 hr Urine testing for leukocytes 23. A nurse is assessing a toddler who is toilet-trained and has a temperature of 38.5° C (101.3° F). Which of the following findings should the nurse recognize as an indication of a urinary tract infection (UTI)? Steatorrhea Jaundice Incontinence Rebound tenderness 24. A nurse on a pediatric unit is reviewing the laboratory results for a group of clients. Which of the following results should the nurse identify as the priority? An adolescent who has iron-deciency anemia and an Hgb level of 11 mg/dL A school-age child who has diabetes mellitus and an HbA1c of 8% A toddler who has moderate dehydration and an RBC count of 5.6/mm3 A preschooler who has cystic fibrosis-related diabetes and a WBC count of 15,000/mm3 25. A nurse is assessing a child who has received the first 50 mL of a blood transfusion. Which of the following findings indicates that the child might be experiencing an air embolism? Sharp pain in middle of the chest Severe itching of the hands Distended neck veins Decreased temperature 26. A nurse is assessing a child who has sickle cell anemia and is experiencing a vasoocclusive crisis. Which of the following clinical manifestations should the nurse expect? Weight gain Bradypnea Pain Diarrhea 27. A charge nurse is assisting a newly licensed nurse with the preoperative assessment of a 2-year-old child who has a Wilms' tumor. Which of the following actions by the newly licensed nurse indicates an understanding of the needed care? Measuring the child's abdominal circumference Palpating the child's abdomen Providing clear liquids up to 1 hr prior to surgery Continuously monitoring the child's oxygen saturation 28. A nurse is creating a plan of care for a child who is awake and responsive following an acute head injury. Which of the following interventions should the nurse include? Place the child in a room with bright uorescent lighting. Initiate seizure precautions for the child. Use the COMFORT scale to rate the child's pain. Suction the child's nares to determine the presence of fluid. 29. A nurse is providing teaching to the parent of an infant about car seat safety. Which of the following statements by the parent indicate an understanding of the teaching? "I should place the shoulder harness above the level of my baby's shoulders." "I should place the car seat rear-facing until my baby is 2 years old." "I will place the retainer clip over my baby's abdomen." "I should position my baby at a 30-degree angle in the car seat." 30. A nurse is caring for a child who is experiencing status asthmaticus. Which of the following actions should the nurse take first? Initiate an infusion of IV fluids. Obtain a blood specimen for ABG analysis. Administer a dose of an IV corticosteroid. Apply humidified oxygen. 31. A nurse is caring for a child who has cancer and is receiving chemotherapy. The parent tells the nurse that they want to discontinue treatment and take the child home. Which of the following responses should the nurse make? "What are your reasons for making this decision today?" "You should discuss your concerns with your child's provider." "You should give the treatment a chance to work before giving up." "Do you need assistance gathering your child's belongings to return home? 32. A nurse is assessing an infant who has intussusception. Which of the following manifestations should the nurse expect? Polyuria Scaphoid abdomen Gelatinous red stool Generalized edema 33. A school nurse is assessing the visual acuity of a school-age child. Which of the following findings indicate that the child should be evaluated for strabismus? Visual acuity 20/30 bilaterally Peripheral vision 70° downward Movement of the uncovered eye during a cover test Light reflects symmetrically within each pupil during a corneal light reflex test 34. A nurse is preparing an educational program about death and dying for the guardians of children who have a terminal illness. Which of the following information should the nurse include? Preschoolers believe their illness is punishment for their misbehavior. Preschoolers are interested in what happens to the body after death. Adolescents worry more about death than the physical changes that can occur as a result of the illness. Toddlers personify death as being a type of monster 35. A nurse is assessing a child who has acute kidney injury. Which of the following clinical manifestations should the nurse expect? Decreased respiratory rate Polyuria Hyperactivity Edema 36. A nurse is assessing a 6-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? The infant does not exhibit fear of strangers. [Show Less]
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ATI Respiratory, Board Vitals EXAM REVIEW - NURS 406 / NURS406
RESPIRATORY 1- A charge nurse receives notification of the admission of a client who is coughing frequently and whose sputum is pink, frothy, and copiou... [Show More] s. The client has history of night sweats, anorexia, and weight loss. Which of the following actions should the nurse take? (SATA) -Assign the client to a private room with negative-pressure airflow -Wear an N95 respirator when entering the client’s room. 2- A nurse is assisting a provider with a comprehensive physical examination of a client. When the provider uses transillumination, the nurse should explain to the client that this technique help evaluate which of the following structures? -Maxillary sinuses 3- A nurse is caring for a client who smokes cigarettes and has a new diagnosis of emphysema. How should the nurse assist the client with smoking cessation? -Discuss ways the client can reduce the number of cigarettes smoked per day. 4- A nurse is planning care for a client who has chronic obstructive pulmonary disease (COPD) and is malnourished. Which of the following recommendations to promote nutritional intake should the nurse include in the plan? -Eat high-calorie food first. Rational: client who has COPD experience early satiety. Client should eat calorie-dense food first. 5- A nurse is preparing to administer cisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication? -Tinnitus. Rational: An adverse effect of cisplatin is ototoxicity, which can cause tinnitus. 6- A nurse in a medical-surgical unit is assessing a client. The nurse should identify that which of the following findings is a manifestation of a pulmonary embolism? -Stabbing chest pain Rational: sudden chest pain that is sharp and stabbing is a manifestation of pulmonary embolism. Other manifestations include dyspnea, coughing, hemoptysis (coughing up blood), tachypnea, tachycardia, diaphoresis, and feeling of impending doom. 7- A nurse in the PACU is assessing a newly admitted client and observes intercostal retractions and a high-pitched inspiratory sound (stridor). The nurse should identify theses findings as manifestations of which of the following complications? -Respiratory obstruction 8- A nurse is reviewing the laboratory results of a client who has metabolic alkalosis. Which of the following laboratory values should the nurse expect? -ph 7.49,HCO3-32mEq/L, PaCO2 40mmHg Rational: Metabolic alkalosis: pH and bicarbonate values are greater than the expected references range, and the PaCO2 is within the expected reference range. 9- A nurse is providing teaching to a client who has a chronic cough and is scheduled for a bronchoscopy. Which of the following client statements indicates an understanding of the teaching? -“A tissue sample might be obtained during the procedure” 10- A nurse is preparing a client for a bronchoscopy. Which of the following actions should the nurse take? (SATA) -Explain that the client will receive sedation and will not remember the procedure. -Verify that the client understands the purpose and nature of the procedure. 11- A nurse is preparing a client for discharge following a bronchoscopy. Which of the following assessment is the nurse’s monitoring priority? -Confirming the gag reflex Rational: The greater risk to the client’s safety is aspiration resulting from a depressed gag reflex. 12- A nurse is caring for a client who is postoperative following a thoracic lobectomy. The client has 2 chest tubes in place: 1 in the lower portion of the thorax and the other higher on the chest wall. When a family member asks why the client has 2 chest tubes, which of the following responses should the nurse make? -“The lower tube will drain blood, and the higher tube will remove air.” 13- A nurse is providing teaching to a client who will undergo a total laryngectomy. Which of the following statements indicate that the client understands the impact of the surgery? - “I understands that I will have a permanent tracheostomy after the surgery.” Rational: With a partial laryngectomy, the tracheostomy is temporary. With the total laryngectomy the tracheostomy will be permanent. 14- A nurse is providing discharge instructions to a client who has a new laryngectomy. The nurse tells the client to be careful while bathing to prevent which of the following complications? -Aspiration of water. Rational: This is a client with a tracheostomy, so he will need to use a shower shield over the stoma when bathing or showering to keep water out of the airway. 15- A nurse is caring for a client who is extremely anxious and is hyperventilating. The client’s ABG results are pH 7.50, PaCO2 27 mmHg, and HCO3-25 mEq/L. The nurse should identify that the client has which of the following acid-base imbalances? -Respiratory alkalosis. 16- A nurse is planning postoperative education for a client who will undergo a radical neck dissection for cancer of the larynx. The nurse should include which of the following topics? (SATA) -NPO status [Show Less]
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ATI Capstone Med Surge - NURS 406 / NURS406
Capstone Med Surg Assessment 1. A nurse is teaching a client about using a continuous positive airway pressure (CPAP) device to treat obstructive sleep ap... [Show More] nea. Which of the following information should the nurse include in the teaching? It delivers a present amount of airway pressure throughout the breathing cycle 2. A nurse is providing discharge teaching to a client following a heart transplant. Which of the following information should the nurse include in the teaching? Shortness of breath might be an indication of transplant rejection 3. A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and is receiving 3 % sodium chloride via continuous IV. Which of the following laboratory finding should the nurse identify as an indication that the SIADH is resolving? Urine specific gravity 1.020 4. A nurse is teaching a client about fecal occult blood testing (FOBT) for the screening of colorectal cancer. Which of the following statements should the nurse include in the teaching? You should avoid taking corticosteroids prior to testing 5. A nurse is preparing a client for a colonoscopy. Which of the following medications should the nurse anticipate the provider to prescribe as an anesthetic for the procedure? Propofol 6. A nurse is planning care for a client who has acute pancreatitis. Which of the following interventions should the nurse include in the clients plan? Select all that apply. Monitor blood glucose levels Maintain NPO status until pain-free Manage acute pain 7. A nurse is teaching a client who has hypertension about dietary modifications to help control blood pressure. Which of the following food choices should the nurse recommend as the client to include in their diet? 3 oz of chicken breast 8. A nurse is reviewing the medical record of a client who has unstable angina. Which of the findings should the nurse report to the provider? Breath Sounds 9. A nurse is providing discharge instructions to a client who has GERD. Which of the following statements by the client demonstrates an understanding of the teaching? I will limit activities that require bending at the waist. 10. A nurse at a provide office is interviewing a client who has multiple sclerosis and has been taking dantrolone for several months. Which of the following client statements should the nurse identify as an indication that the medication is effective? I don’t have muscle spasms as frequently 11. A nurse is assessing a client who reports a possible exposure to HIV. Which of the following finding should the nurse identify as an early manifestation of HIV infection? Fatigue 12. A nurse is teaching a client who has type 1 diabetes mellitus about hypoglycemia .which of the following statements by the client indicates an understanding of the teaching? I can drink 4 ounces of soda if my blood sugar is low 13. A nurse is providing discharge teaching to a client who has heart failure and a prescription for furosemide 20 mg PO two times daily. Which of the following instructions should the nurse include in the teaching? Increase intake of high-potassium foods 14. A nurse is caring for a client who has burn injuries covering their upper body and is concerned about their altered appearance .Which of the following statements should the nurse make? It could be helpful for you to attend a support group for people who have burn injuries. 15. A nurse is developing a plan of care for a client who will be placed in halo traction following surgical repair of the cervical spine .Which of the following interventions should the nurse include in the plan? Monitor the client skin under the halo vest. 16. A nurse is caring for a client who has a traumatic brain injury. Which of the following finding should indicate to the nurse the need for immediate intervention? Respiratory rate 30/min 17. A nurse is assessing a client who has meningitis. The nurse should identify which of the following finding as a positive Kerning s sign? After stroking the lateral area of the foot, the client’s toes contract and draw together. After hip flexion, the client is unable to extend their leg completely without pain 18. A nurse is teaching a group of assistive personnel (AP) about caring for client who have Alzheimer’s disease. Which of the following information should the nurse include in the teaching? Provide supervision to prevent a client from becoming injured or lost. 19. A home health nurse is providing teaching to the family of a client who has a seizure disorder. Which of the following interventions should the nurse include in the teaching? Keep a padded tongue blade near the bedside. Place a pillow under the client's head while in bed during a seizure. Administer diazepam orally at the onset of seizures. Position the client on their side during a seizure. 20. A nurse is contributing to the plan of care for a client who has pyelonephritis. Which of the following interventions should the nurse include? Encourage the client to consume caffeinated beverages Avoid the use of acetaminophen for discomfort Monitor the clients the urine for color changes Begin antibiotic therapy after culture and sensitivity results are obtained 21. Nurse is assessing a client who has a herniated lumbar disc. Which of the following findings should the nurse expect? The client reports relief from pain when lying in the prone position. The client reports that her low-back pain radiates upward toward one scapula. The client reports tingling and a burning sensation in one foot. The client reports decreased pain when the affected leg is raised and straightened 22. A nurse is caring for a client who has acute gastritis and is NPO. The client has a new prescription to resume oral intake. Which of the following items should the nurse offered the client? Lemonade Tomato soup Gelatin Black coffee 23. A triage nurse nds a school-age child lying in the road following a school bus crash with multiple casualties. The child has a respiratory rate of 8/min, is unresponsive to verbal commands, and groans to painful stimuli. The nurse should assign the client which of the following triage tags? Red Yellow Green Black 24. A nurse is teaching a client who has a new diagnosis of polycystic kidney disease. Which of the following statements should the nurse include in the teaching? "Take aspirin as needed to reduce your pain." "Reduce your dietary beer intake." "Apply dry heat to your abdomen when needed." "Check your weight once per week." 25. A nurse is assessing a client who has right lower lobe pneumonia. Which of the following findings should the nurse expect? Dull percussion sounds Increased anterior posterior chest diameter Distended neck veins Pitting edema 26. A nurse is providing teaching to the caregivers of a client who has Alzheimer's disease. Which of the following instructions should the nurse give? (Select all that apply.) Install safety locks and alarm systems. Place nightlights throughout the home. Replace carpeted flooring with tile. Establish a predictable daily routine for the client. Remind the client of scheduled activities 1 day in advance. 27. A nurse is caring for a client who is hyperventilating and has the following ABG results: pH 7.50, PaCO 29 mm Hg, and HCO 25 mEq/L. The nurse should recognize that the client has which of the following acid-base imbalances? 2 3 – Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis 28. A nurse is providing discharge teaching for a client who has COPD about nutrition. Which of the following instructions should the nurse include? Eat three large meals daily. Consume high-calorie foods. Limit caffeinated drinks to two per day. Drink fluids during mealtime 29. A nurse is caring for a client who has a right-sided pneumothorax. Following chest tube insertion, which of the following findings indicates that the chest drainage system is functioning correctly? Gentle bubbling in the suction chamber Crepitus around the insertion site Constant bubbling in the water seal chamber Absence of breath sounds on the right side 30. A nurse is caring for client who has a new diagnosis of tuberculosis. Which of the following precautions should the nurse initiate to present transmission of the disease? Contact precautions Airborne precautions Droplet precautions Protective environment 31. A nurse is planning care for a client who has Ménière's disease and is experiencing episodes of vertigo. Which of the following interventions should the nurse include in the plan? Maintain strict bed rest. Restrict uid intake to the morning hours. Administer aspirin. Provide a low-sodium diet. 32. A nurse reviewing laboratory reports for client who is taking NSAISs for rheumatoid arthritis. Which of the following results should the nurse [Show Less]
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