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BUNDLE FOR ATI PN MED SURGE EXAM 2023
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PN Adult Medical Surgical Practice A with NGN Questions and Answers 2023
A nurse is caring for a client who is scheduled for surgery and is experiencing anxiety. Which of the following interventions should the nurse identify as ... [Show More] the priority? Determine the client's understanding of the procedure. A nurse is contributing to the plan of care for a client who has peripheral arterial disease of the lower extremities. Which of the following interventions should the nurse include? Dangle the extremities off the side of the bed. A nurse is assisting in the plan of care for a client who had a recent left hemispheric stroke. Which of the following actions should the nurse include in the plan? Use simple verbal cues when directing tasks. A nurse is reinforcing teaching with the caregiver of a client who is terminally ill about manifestations of impending death. Which of the following manifestations should the nurse include? Incontinence of the bowel and bladder A nurse is preparing to remove a client's NG tube. Which of the following interventions should the nurse take to decrease the risk for aspiration? Pinch the NG tube. A nurse is caring for a client who is preoperative and is receiving an IV infusion of cefazolin. Ten minutes after beginning the infusion, the client reports intense itching. Which of the following actions should the nurse take first? Stop the medication infusion. A nurse is reinforcing discharge teaching with a client who has cirrhosis. Which of the following instructions should the nurse include? "Consume foods that are low in sodium." A nurse is reinforcing teaching with a client who is scheduled for a guaiac fecal occult blood test. Which of the following instructions should the nurse include in the teaching? Avoid eating red meat for 3 days prior to the test. A nurse is preparing to administer phytonadione 7 mg subcutaneously to a client who has an INR of 4. Available is phytonadione 10 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) 0.7 mL A nurse is reinforcing teaching with a client who is taking insulin glargine. Which of the following information should the nurse include in the teaching? "This type of insulin should be given at the same time every day." A nurse is caring for a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection in a surgical wound. Which of the following information should the nurse plan to share with visitors? Visitors must don a gown and gloves prior to entering the client's room. A nurse is collecting data from a 55-year-old female client who reports vaginal dryness and hot flashes. The client is interested in trying hormone replacement therapy (HRT). Which of the following should the nurse recognize as a contraindication to HRT? History of treatment for blood clots A nurse is reinforcing teaching about management of constipation with a client who has hypothyroidism. Which of the following instructions should the nurse include in the teaching? Increase intake of fiber-rich foods. A nurse is reinforcing teaching with a client who has multiple sclerosis and a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? Avoid stopping this medication suddenly. A nurse is caring for a client who has an area indicating potential breakdown over the sacrum. Which of the following actions should the nurse take? Minimize the time the head of the bed is elevated. A nurse is assisting with the care of a client who is receiving 0.9% sodium chloride by continuous IV infusion. The client reports pain and swelling at the IV site. In which order should the nurse perform the following steps? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) Check IV site Stop the infusion Withdraw the IV catheter Elevate the affected arm Notify the charge nurse Drag words from the choices below to fill in each blank in the following sentence. During the emergent phase of burn care, the client is at risk for developing____________ and _____________. Hypovolemia Respiratory failure A nurse in an oncology clinic is reinforcing teaching about Mohs surgery with a client who has skin cancer. Which of the following information should the nurse include in the teaching? Mohs surgery is a horizontal shaving of thin layers of the tumor. A nurse is contributing to the plan of care for a client who is postoperative following a total knee arthroplasty. The client is using a continuous passive motion (CPM) machine. Which of the following interventions should the nurse recommend for the plan of care? Keep a sheepskin pad between the client's extremity and the CPM machine. A nurse is reinforcing teaching about joint protection with a client who has an acute exacerbation of rheumatoid arthritis. Which of the following information should the nurse include in the teaching? Apply cold packs to the inflamed joints. A nurse is caring for a client who has difficulty swallowing. Which of the following actions should the nurse implement to prevent aspiration? Give the client liquids with increased viscosity. A nurse is discussing health screening guidelines with an older adult client. Which of the following statements should the nurse include? "You should have a pneumococcal immunization every 10 years." A nurse is planning to implement droplet precautions for a client who has manifestations of pertussis. Which of the following interventions should the nurse include when contributing to the plan of care? Apply a mask on the client if transport is needed. A nurse is contributing to the plan of care for a client who was admitted to the neurological unit following a stroke 3 hr ago. Which of the following interventions should the nurse identify as the priority? Keep the client in a side-lying position. A nurse is caring for a client who has a compound fracture of the femur and was placed in balanced suspension skeletal traction 4 days ago. Which of the following actions should the nurse take? Perform pin site care daily. A nurse is reinforcing discharge teaching about wound care with the caregiver of a client who is postoperative. Which of the following instructions should the nurse include in the teaching? Report purulent drainage to the provider. A nurse is collecting data from a client who has hypokalemia. Which of the following findings should the nurse identify as the priority? Dysrhythmia Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Reduce the temperature in the clients room. Limit visitors Hyperthyroidism Increased temperature Weight daily A nurse is caring for a client who reports stomatitis. Which of the following dietary recommendations should the nurse make? "Eat soft foods." A nurse is caring for a client who has a history of breast cancer. The client asks the nurse about birth control. Which of the following methods of birth control is contraindicated for this client? Combination oral contraceptives A nurse is collecting data from a client and notices several skin lesions. Which of the following findings should the nurse report as possible melanoma? Irregular borders A nurse is contributing to the plan of care for a client who has COPD and is dyspneic. Which of the following interventions should the nurse include in the plan? Encourage abdominal breathing A nurse is assisting with the care of a client who has a newly-inserted water-seal closed chest tube. Which of the following findings should the nurse report to the provider? Chest drainage is greater than 70 mL/hr. A nurse is reinforcing teaching with a client who is to begin using an insulin pump. Which of the following instructions should the nurse include? "Use rapid-acting insulin in the infusion device." Which of the following actions should the nurse take? Select all that apply. Instruct the client to splint their abdomen with a pillow when coughing plan to ambulate the client as soon as possible report the client's urinary output to the charge nurse monitor the client's pain level A nurse is caring for a client who is in Buck's traction. Which of the following interventions should the nurse perform to reduce skin breakdown? Keep the skin dry and free of perspiration. A nurse is monitoring a client who is taking acarbose. Which of the following findings should the nurse identify as an adverse effect of the medication? Abdominal cramps A nurse is reinforcing teaching with a client who is on a low-sodium diet and asks about how to improve the taste of bland food. Which of the following foods should the nurse recommend? Lemon juice A nurse is reinforcing discharge teaching for the caregivers of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching? Remind the client to avoid watching their feet when walking. A nurse is reinforcing teaching with a client who has systemic lupus erythematosus (SLE) and is to begin taking methylprednisolone orally. Which of the following statements should the nurse include in the teaching? "Limit contact with large groups of people." A nurse is reviewing the laboratory results of a client who is scheduled for a CT scan with an IV contrast agent. Which of the following laboratory findings should the nurse report to the provider prior to the procedure? Creatinine 1.9 mg/dL Complete the following sentence by using the lists of options. After reviewing the findings in the client's medical record, the nurse should first address the client's_____________ followed by the client's ________. Abdominal distention Acute pain The nurse is collecting data on the client For each client finding, click to specify if the finding is consistent with appendicitis, diverticular disease, or Crohn's disease. Each finding may support more than 1 disease process. Blood in the stool - Diverticular disease Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client has manifestations of ___________ ; therefore, the priority finding for the nurse to report is the __________. peritonitis laboratory values The nurse is contributing to the plan of care for the client who has peritonitis and Crohn's disease. For each potential intervention, click to specify if the intervention is indicated or contraindicated for the client. Obtain blood cultures - indicated obtain the client's vital signs every 15 min - indicated Administer a hypotonic IV solution - contraindicated insert a nasogastric tube - indicated The nurse is assisting with the care of the client who is preoperative for an exploratory laparotomy. Select the 4 actions the nurse should take. Administer phenytoin with a sip of water on the day of surgery. Assist with the administration of gentamicin 100 mg IV. Assist with the administration of dextrose 5% in lactated Ringer's. Contact the wound, ostomy, and continence nurse. The nurse is reinforcing discharge teaching with the client. Which of the following client statements indicates an understanding of the teaching? Select all that apply. "I should schedule several rest periods throughout the day" "I should notify my provider if my temperature is higher than 101 degrees Fahrenheit". A home health nurse is reinforcing teaching about preventing asthma attacks with a client who has asthma. Which of the following instructions should the nurse include in the teaching? "Do not allow visitors to smoke cigarettes in your home." A nurse is caring for a client who has a new cast on their left forearm and reports severe pain in the affected arm with numbness in the fingers. The nurse finds the skin is pale and cold with sluggish capillary refill. Which of the following fracture complications should the nurse suspect? compartment syndrome A nurse is contributing to the plan of care for a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection and is on contact isolation precautions. Which of the following actions should the nurse take? Have a designated stethoscope in the client's room. A nurse is collecting data from a client who has heart failure and is taking digoxin. Which of the following outcomes from the medication should the nurse expect? Decreased shortness of breath. A nurse is contributing to the plan of care for a client who has a new prescription for nystatin suspension for oral candidiasis. Which of the following interventions should the nurse include in the plan? Instruct the client to swish the medication in their mouth. A nurse is reviewing the laboratory results of a client who has type 2 diabetes mellitus. The nurse should identify that which of the following laboratory values indicates the client is at risk for delayed wound healing? Prealbumin 12 mg/dL A nurse is caring for a client who had an acute ischemic stroke 1 day ago. Which of the following actions should the nurse take to reduce the risk for aspiration? Allow for 30 min of rest before meals. [Show Less]
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PN Med Surg 2023 A w/NGN Questions and Answers Graded A+
A nurse is assisting with the care of a client who is receiving 0.9% sodium chloride by continuous IV infusion. The client reports pain and swelling at the... [Show More] IV site. In which order should the nurse perform the following steps? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) Check the IV site. Stop the infusion. Withdraw the IV catheter. Elevate the affected arm. Notify the charge nurse. A nurse is reviewing the laboratory results of a client who is scheduled for a CT scan with an IV contrast agent. Which of the following laboratory findings should the nurse report to the provider prior to the procedure? Creatinine 1.9 mg/dL A nurse is monitoring a client who is taking acarbose. Which of the following findings should the nurse identify as an adverse effect of the medication? Abdominal cramps A nurse is contributing to the plan of care for a client who has chronic obstructive pulmonary disease (COPD) and is dyspneic. Which of the following interventions should the nurse include in the plan? Encourage abdominal breathing. A nurse is preparing to administer phytonadione 7 mg subcutaneously to a client who has an INR of 4. Available is phytonadione 10 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) 0.7 A nurse is examining a client's IV site and notes a red line up his arm. The client reports a throbbing, burning pain at the IV site. The nurse should identify that the client's manifestations indicate which of the following complications of IV therapy? Thrombophlebitis A nurse is reinforcing teaching about management of constipation with a client who has hypothyroidism. Which of the following should the nurse include in the teaching? Increase intake of fiber-rich foods. A nurse is caring for a client who has a compound fracture of the femur and was placed in balanced suspension skeletal traction 4 days ago. Which of the following actions should the nurse take? Perform pin site care daily. A nurse observes a client who is lying in bed experiencing a tonic-clonic seizure. Which of the following actions should the nurse take? Loosen clothing around the client's neck. A nurse is contributing to the plan of care for a client who has multiple sclerosis and is taking dantrolene to manage muscle spasms. Which of the following interventions should the nurse include? Encourage the client to complete ADLs. A nurse is reinforcing discharge teaching to prevent dumping syndrome for a client following a partial gastrectomy for ulcers. Which of the following information should the nurse include in the teaching? Avoid liquids at mealtimes. A nurse is collecting data from a client who has heart failure and is taking digoxin. Which of the following outcomes from the medication should the nurse expect? Decreased shortness of breath A nurse is reinforcing discharge teaching with a client who has hearing loss. Which of the following actions should the nurse take when communicating with the client? Rephrase client instructions when not understood. A nurse is preparing to remove a client's NG tube. Which of the following interventions should the nurse take to decrease the risk of aspiration? Pinch the NG tube. A nurse is contributing to the plan of care for an older adult client who is at risk for osteoporosis. Which of the following interventions should the nurse include to prevent bone loss? Encourage weight-bearing exercises. A home health nurse is reinforcing teaching with a client about preventing complications of peripheral vascular disease. Which of the following statements indicates that the client is adhering to the nurse's instructions? "I don't cross my legs anymore." A nurse is reinforcing teaching about glycosylated hemoglobin (HbA1c) testing with a client who has diabetes mellitus. Which of the following statements indicates that the client understands the teaching? "I will have my HbA1c checked twice per year." A nurse is assisting the charge nurse with developing an in-service about caring for clients who have internal sealed radiation implants. Which of the following information should the nurse include? Dispose of radiation implants in a lead container. A nurse is caring for a client who had an acute ischemic stroke 1 day ago. Which of the following actions should the nurse take to reduce the risk for aspiration? Allow for 30 min of rest before meals. A nurse is caring for a client who is 1 day postoperative following a hip arthroplasty. The client is exhibiting hypotension, tachycardia, and tachypnea. The nurse should recognize that these findings indicate which of the following complications? Pulmonary embolism A nurse is reinforcing teaching with a client who has gonorrhea. Which of the following information should the nurse include? "You are at risk for infertility with this infection, regardless of treatment." A nurse is contributing to the plan of care for a client who was admitted to the neurological unit following a stroke 3 hr ago. Which of the following interventions should the nurse identify as the priority? Keep the client in a side-lying position. A nurse is assisting in the care of a client who has manifestations of sepsis. Which of the following provider prescriptions should the nurse implement first? Initiate oxygen at 4 L/min via nasal cannula. A nurse is reinforcing teaching with a client who is taking insulin glargine. Which of the following information should the nurse include in the teaching? "This type of insulin should be given at the same time every day." A nurse is collecting data from a client who has hypothyroidism. Which of the following manifestations should the nurse anticipate? Bradycardia A nurse is collecting data from a client who has chronic kidney disease with hyperkalemia. Which of the following findings should the nurse expect related to hyperkalemia? Bradycardia A nurse enters the room of a client whose transfusion of packed RBCs was initiated 15 min ago by the RN. The client reports dyspnea and urticaria. Which of the following actions should the nurse perform first? Stop the infusion. A nurse is collecting data from a 55-year-old female client who reports vaginal dryness and hot flashes. The client is interested in trying hormone replacement therapy (HRT). Which of the following should the nurse recognize as a contraindication to HRT? History of treatment for blood clots A nurse is reinforcing teaching with the family of a client who has a cervical injury and has a halo vest in place. Which of the following safety precautions should the nurse include in the teaching? Change the sheepskin liner weekly. A nurse is collecting data from a client who has hypokalemia. Which of the following findings should the nurse identify as the priority? Dysrhythmia A nurse in a long-term care facility is collecting data from a client who reports fullness in the rectum and abdominal cramping. Which of the following findings should indicate to the nurse that the client might have a fecal impaction? Small liquid stools A nurse is caring for a client who is preoperative and is receiving an IV infusion of cefazolin. Ten minutes after beginning the infusion, the client reports intense itching. Which of the following actions should the nurse take first? Stop the medication infusion. A nurse is planning to implement droplet precautions for a client who has manifestations of pertussis. Which of the following interventions should the nurse include when contributing to the plan of care? Apply a mask on the client if transport is needed. A nurse is reinforcing discharge instructions with a client who is postoperative following a right hip arthroplasty. Which of the following statements should the nurse make? "Avoid bending your hips more than 90 degrees." A nurse is reinforcing teaching with an adolescent client regarding testicular self-examination. Which of the following statements by the client demonstrates an understanding of the teaching? "I understand that testicular cancer is painless." A nurse is caring for a client who has acute pancreatitis. While providing care, the nurse observes ecchymosis around the umbilicus. The nurse should identify that this is a manifestation of which of the following? Intra-abdominal bleeding A nurse is contributing to the plan of care for a client who is postoperative following a total knee arthroplasty. The client is using a continuous passive motion (CPM) machine. Which of the following interventions should the nurse recommend for the plan of care? Keep a sheepskin pad between the client's extremity and the CPM. A nurse is monitoring a client who recently had a cast placed on the right lower extremity for a bone fracture. Which of the following findings should the nurse recognize as abnormal? Lack of sensation between the first and second toes A nurse is reinforcing teaching with a client who has mitral valve disease. Which of the following statements by the client indicates an understanding of the disease process? "I should call my doctor if my ankles swell." A nurse is providing discharge teaching for the family of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching? Remind the client to avoid watching her feet when walking. A nurse is caring for a client who has bacterial meningitis. Upon monitoring the client, which of the following findings should the nurse expect? Red macular rash A nurse is reinforcing teaching with a client who has systemic lupus erythematosus (SLE) and is to begin taking methylprednisolone orally. Which of the following statements should the nurse include in the teaching? "Limit contact with large groups of people." A nurse is reinforcing discharge teaching with a client who has cirrhosis. Which of the following instructions should the nurse include? "Consume foods low in sodium." A nurse is reviewing the medical record of a client who has a prescription for morphine. Which of the following findings should the nurse report to the provider? Urinary retention A nurse is caring for a client who is at risk for developing pressure ulcers. Which of the following actions should the nurse take? Position pillows between the bony prominences. A nurse is discussing health screening guidelines with an older adult client. Which of the following statements should the nurse include? "You should have a pneumococcal immunization every 10 years." A nurse is reinforcing teaching about joint protection with a client who has an acute exacerbation of rheumatoid arthritis. Which of the following information should the nurse include in the teaching? Apply cold packs to the inflamed joints. A nurse is preparing to auscultate the bowel sounds of a client who has a mechanical bowel obstruction in the descending colon. When listening in the left upper quadrant, the nurse should identify this sound as which of the following? (Click on the audio button to listen to the clip.) Hyperactive bowel sounds A nurse is reinforcing teaching with a client who is on a low-sodium diet and asks about how to improve the taste of bland food. Which of the following should the nurse recommend? Lemon juice A nurse is caring for a client who is postoperative and has an epidural infusion. Which of the following findings should the nurse recognize as the priority? Dyspnea A nurse is caring for a client who is 3 days postoperative following a total right hip arthroplasty. Which of the following actions should the nurse take? Maintain abduction of the client's right leg while in bed. A nurse is caring for a client who is 24 hr postoperative following abdominal surgery and has an NG tube. Which of the following actions should the nurse plan to take to decrease the risk of postoperative complications? Encourage the client to use an incentive spirometer every hour while awake. A nurse is contributing to the plan of care for a client who is having difficulty eating following a stroke. Which of the following interventions should the nurse plan to implement first? Recommend a referral for a speech language pathologist. A nurse is caring for a client who is in Buck's traction. Which of the following interventions should the nurse perform to reduce skin breakdown? Keep the skin dry and free of perspiration. A nurse is reviewing the laboratory results of a client who has chronic kidney failure and is receiving epoetin alfa. The nurse should identify that which of the following laboratory values indicates the treatment is effective? Hgb 11 g/dL A nurse is reinforcing teaching with a client who has multiple sclerosis and a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? Avoid stopping this medication suddenly. A nurse is performing an ECG on a client who is scheduled for surgery the following morning. In which of the following locations should the nurse place the V1 electrode? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.) c A nurse in an oncology clinic is reinforcing teaching about Mohs surgery with a client who has skin cancer. Which of the following information should the nurse include in the teaching? Mohs surgery is a horizontal shaving of thin layers of the tumor. A nurse is caring for a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection in a surgical wound. Which of the following information should the nurse plan to share with visitors? Visitors must don a gown and gloves prior to entering the client's room. A nurse is reinforcing teaching about dietary changes with a client who has cardiovascular disease. Which of the following images indicates the type of cooking fat the nurse should recommend the client use when preparing meals? olive oil A nurse is contributing to the plan of care for a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection and is on contact isolation precautions. Which of the following actions should the nurse take? Have a designated stethoscope in the client's room. [Show Less]
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ATI Med Surg Practice B 2023 Questions Answered 100% correct
A nurse is providing teaching to a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching? "I s... [Show More] hould clean my toothbrush in the dishwasher once a month." "I should eat more fresh fruit and vegetables." "I will avoid drinking a glass of cold liquid that has been standing for 30 minutes." "I will take my temperature once a day." I will take my temperature once a day. A nurse is providing teaching to a client who has asthma about the use of a metered-dose inhaler. The nurse should identify that which of the following client actions indicates an understanding of the teaching? Breathing in rapidly while administering the medication Washing the plastic case and cap of the inhaler in the dishwasher Holding breath for 10 seconds after inhaling Waiting 15 seconds between puffs, if two puffs are required Holding breathe 10 secs after inhaling A nurse is reviewing the laboratory findings of a client who developed chest pain 6 hr ago. The nurse should identify which of the following findings as an indication of a myocardial infarction (MI)? Creatine kinase (CK-MB) 85 units/L High-density lipoprotein (HDL) 65 mg/dL Alanine aminotransferase (ALT) 28 units/L Troponin I 8 ng/mL Troponin 18 A nurse is caring for a client who had a nephrostomy tube inserted 12 hr ago. Which of the following findings should the nurse report to the provider? The client's urinary output has increased. The client reports back pain. The client's urine color is red tinged. The client's BUN is 18 mg/dL. The client reports back pain A nurse is providing discharge teaching about infection prevention to a client who has AIDS. Which of the following statements by the client indicates understanding of the teaching? "I will eat a salad at least once each day to increase my intake of vitamin K." "I can work in my flower garden as long as I wear gardening gloves to cover my skin." "I will no longer floss my teeth after brushing my teeth." "I can sip on a glass of juice for at least 2 hours before I should discard it." I will no longer floss my teeth after brushing A nurse is providing discharge teaching to a client who is postoperative following a modified radical mastectomy. Which of the following instructions should the nurse include? Flex the affected arm when ambulating. Numbness can occur along the inside of the affected arm. Begin active range-of-motion exercises 1 day after surgery. Dress in clothing that fits snugly. numbness can occur along the inside of the affected arm A nurse is providing postoperative teaching for a client who had a total knee arthroplasty. Which of the following instructions should the nurse include? Flex the foot every hour when awake. Place a pillow under the knee when lying in bed. Lower the leg when sitting in a chair. Ensure the leg is abducted when resting in bed. Flex the foot every hour when awake A nurse is providing education to a client who is at risk for osteoporosis. Which of the following instructions should the nurse include? Begin taking glucosamine supplements. Walk for 30 min four times per week. Jog for 15 min two times per week. Avoid taking over-the-counter calcium supplements. walk for 30 mins 4x a week A nurse is providing preoperative teaching for a client who is scheduled for a mastectomy. Which of the following statements should the nurse make? "You should accept your body image change before discharge." "It is important for you to look at the incisional site when the dressings are removed." "I will refer you to community resources that can provide support." "The scar will remain red and raised for many years after surgery." I will refer you to community resources that can provide support A nurse is caring for a client who has hypothyroidism. Which of the following manifestations should the nurse expect? Constipation Insomnia Tachycardia Diaphoresis constipation A nurse is caring for a client who has terminal cancer. The client tells the nurse, "I wish I could stop these treatments. I am ready to die." Which of the following statements should the nurse make? "Discontinuing with the treatments is your choice if it is your wish to do so." "Your daughter is named as your health care surrogate. I will ask her if you can stop them." "I will call your spiritual advisor to come in, so you can discuss this with them." "Next time you have an oncology appointment, you should ask the oncologist." discontinuing treatments is your choice A nurse at an urgent care clinic is caring for a client who is experiencing an anaphylactic reaction. After ensuring a patent airway, which of the following nursing interventions is the priority? Applying oxygen via face mask Placing the client in Fowler's position Administering epinephrine Initiating an IV infusion of 0.9% sodium chloride applying oxygen via face mask [Show Less]
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ATI Med Surg Mastery Application Exercises Questions and Answers 2023
A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus and reports difficulty following the diet and remembering to take the pr... [Show More] escribed medication. Which of the following actions should the nurse take to promote client compliance? Select all that apply. A. Ask the dietitian to assist with meal planning B. Contact the client's support system C. Assess for age-related cognitive awareness D. Encourage the use of a daily medication dispenser E. Provide educational materials for home use A, B, D, E A: The nurse provides resources to strength coping abilities by asking the dietitian to assist the client with meal planning. This will improve client compliance. B: With the client's consent, the nurse can contact members of the client's support system and encourage the client to use this support during times of illness and stress to improve compliance C: Assessing the client for age-related cognitive awareness is important but it is not an appropriate intervention that enhances the client's compliance. D: The nurse encourages the use of a daily medication dispenser to reduce health risks and improve medication compliance by the client. E: The nurse provides educational materials to the client to improve health awareness and reduce health risks after discharge A nurse in a health care clinic is evaluating the level of wellness for clients using the illness-wellness continuum tool. The nurse should identify which of the following clients as being at the center of the continuum? A. A college student who has influenza B. An older adult who has a new diagnosis of type 2 diabetes mellitus C. A new mother who has a urinary tract infection D. A young male client who has a long history of well-controlled rheumatoid arthritis D A: The client who has influenza is measured on the continuum by the level of health to illness in comparison to the norm for the client. B: The client who is newly diagnosed with type 2 diabetes mellitus is measured on the continuum by the level of health to illness in comparison to the norm for the client. C: The client who has a urinary tract infection is measured on the continuum by the level of health to illness in comparison to the norm for the client. D: The client who has well-controlled rheumatoid arthritis is measure ad the center of the continuum, which is the client's normal state of health A nurse is evaluating clients at a health fair for modifiable variables affecting health and wellness. The nurse should identify which of the following variables as modifiable? (Select all that apply). A. Smoking on social occasions B. BMI of 28 C. Alopecia D. Trisomy 21 E. History of reflux A, B, E A: The nurse identifies smoking as a modifiable variable that a client can change. The nurse should provide the client with educational materials and information on smoking cessation. B: The nurse identifies a BMI of 28 as a modifiable variable that a client can change. The nurse should provide the client with information on weight reduction and exercising. C: The nurse identifies alopecia as a non-modifiable variable because alopecia is a genetic disorder. D: The nurse identifies Trisomy 21 as a non-modifiable variable because Trisomy 21 is genetic in origin E: The nurse identifies reflux as a modifiable variable that a client can change. The nurse should provide the client with step-by-step educational information about treatment. A nurse is caring for a client who was just informed of a new diagnosis of breast cancer. The nurse evaluates the client's response. Which of the following statements by the client reflects a lack of understanding of an illness perspective? A. "I have no family history of breast cancer." B. "I need a second opinion. There is no lump." C. "I am glad we live in the city near several large hospitals." D. "I will schedule surgery next week, over the holidays." B. A: The client's lack of family history of cancer can influence the client's response to the new diagnosis, but it does not reflect a lack of understanding of an illness perspective. B: The client's statement of denial reflects a lack of understanding of the illness perspective and can influence the client's acceptance of the diagnosis. C: Access to health care resources can influence the client's response to the new diagnosis, but it does not reflect a lack of understanding of an illness perspective D: Time constraints can influence a client's response to the diagnosis, but it does not reflect a lack of understanding of an illness perspective. A nurse on a medical-surgical unit is caring for a group of clients. The nurse should notify the rapid response team for which of the following clients? A. Client who has a pressure injury of the right heel whose blood glucose is 300 mg/dL B. Client who reports right calf pain and shortness of breath C. Client who has blood on a pressure dressing in the femoral area following a cardiac catheterization D. Client who has dark red coloration of left toes and absent pedal pulse B. A: The nurse should notify the provider. The situation does not indicate the beginning of a rapid decline in the client's condition B: The nurse should identify that the client is at risk for respiratory arrest due to a possible embolism. The nurse should call the rapid response team because the manifestations can indicate the beginning of a rapid decline in the client's condition. C: This assessment does not indicate the beginning of a rapid decline in the client's condition at this time. The nurse should reassess the client and notify the provider if the bleeding increases. D: The nurse should notify the provider. The situation does not indicate the beginning of a rapid decline in the client's condition A nurse is caring for a client who has ingested a toxic agent. Which of the following actions should the nurse plan to take? (Select all that apply). A. Induce vomiting B. Instill activated charcoal C. Perform a gastric lavage with aspiration D. Administer syrup of ipecac E. Infuse IV fluids B, C, E A: Vomiting places the client at risk for aspiration. B: This is an appropriate action by the nurse because activated charcoal absorbs toxic substances and the charcoal does not pass into the bloodstream. C: This is an appropriate action by the nurse because gastric lavage with aspiration removes the toxic substance when the instill fluid is suctioned from the gastrointestinal tract. D: Administering syrup of ipecac is not recommended because it induces vomiting, which increases the client's risk for aspiration. E: The is an appropriate action by the nurse because intravenous fluids help dilute the toxic substances in the bloodstream and promote elimination from the body through the kidneys. A nurse in the emergency department is caring for a client who fell through the ice on a pond and is unresponsive and breathing slowly. Which of the following actions should the nurse take? (Select all the apply) A. Remove wet clothing B. Maintain normal room temperature C. Apply warm blankets D. Use a rapid rewarming water of 40 to 42C (104 to 108F) E. Infuse warmed IV fluids A, C, D, E A: This is an appropriate action by the nurse because the body temperature can rise more quickly when heat is applied to dry skin. B: The nurse should increase the temperature of the room to help return the client to a normal body temperature. C: This is an appropriate action by the nurse because the client's body temperature can rise more quickly when warm blankets are applied. D: This is an appropriate action by the nurse because the client's body temperature can rise more quickly when a rapid rewarming bath water of 40 to 42 C (104 to 108 F) is used to warm the client's body and preserve tissues E: This is an appropriate action by the nurse because the client's body temperature can rise more quickly when warmed IV fluids are infused A nurse in the emergency department is assessing a client who is unresponsive. The client's partner states: "He was pulling weeds in the yard and slumped to the ground." Which of the following techniques should the nurse use to open the client's airway? A. Head-tilt, chin-lift B. Modified jaw thrust C. Hyperextension of the head D. Flexion of head A A: The nurse should open the client's airway by the head-tilt, chin-lift because the client is unresponsive without suspicion of trauma B: The nurse should not open the client's airway with the modified jaw thrust because this method is used for a client who is unresponsive with suspected traumatic neck injury. C: The nurse should not open the client's airway with hyperextension of the head because hyperextension of the head can close off the airway and cause injury. D: The nurse should not open the client's airway with flexion of the head because flexion of the head does not open the airway A nurse is reviewing the common emergency management protocol for clients who have asystole. Which of the following actions should the nurse plan to take during this cardiac emergency? A. Perform defibrillation B. Prepare for transcutaneous pacing C. Administer IV epinephrine D. Elevate the client's lower extremities C A: Defibrillation is not indicated for asystole, because this is not considered a shockable cardiac rhythm B. Transcutaneous pacing is not indicated for the treatment of asystole. C: Administering epinephrine during asystole is an appropriate action by the nurse because it increases heart rate, improves cardiac output, and promotes bronchodilation. D: Elevating the client's lower extremities is indicated for the treatment of a client who is in shock, rather than asystole A nurse is caring for a client who is post-procedure following lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? (Select all that apply). A. Use the Glasgow Coma Scale when assessing the client B. Assist the client to a supine position C. Administer an opioid medication D. Encourage the client to increase fluid intake E. Instruct the client to perform deep breathing and coughing exercises B, C, D A: The Glasgow Coma Scale is used to assess a client's level of consciousness and is not necessary following a lumbar puncture. B: The nurse should assist the client to a supine position, which can relieve a headache following a lumbar puncture C: The nurse should administer an opioid medication for a client's report of headache pain D: The nurse should encourage an increased fluid intake to maintain a positive fluid balance, which can relieve a headache following a lumbar puncture E: Coughing can increase ICP, which can result in an increase in the client's headache A nurse is caring for a client who experienced a traumatic head injury and has a intraventricular catheter (ventriculostomy) for ICP monitoring. The nurse should monitor the client for which of the following complications related to the ventriculostomy? A. Headahce B. Infection C. Aphasia D. Hypertension B A: The nurse should monitor a client who has increased ICP for a headache, but a headache does not indicate a complication directly related to the ventriculostomy. B: The nurse should monitor a client who has a ventriculostomy for infection, which is a complication. The nurse should use strict asepsis to avoid this life-threatening condition, which can result in meningitis. C: The nurse should monitor a client who has increased ICP for aphasia related to the head injury, but this is not a complication directly related to the ventriculostomy. D: The nurse should monitor a client with who has increased ICP for hypertension, The nurse should monitor a client who has increase ICP for aphasia related to the head injury, but this is not a complication directly related to the ventriculostomy. A nurse is assessing a client for changes in the level of consciousness using the Glasgow Coma Scale (GCS). The client opens his eyes when spoken to, speaks incoherently, and moves his extremities when pain is applied. Which of the following GCS scores should the nurse document? A. E2 + V3 + M5 = 10 B. E3 + V4 + M4 = 11 C. E4 + V5 + M6 = 15 D. E2 + V2 + M2 = 8 B Calculated as follows: Eye Opening (E) -4 = eye opening occurs spontaneously -3 = eye opening occurs secondary to sound -2 = eye opening occurs secondary to pain -1 = eye opening does not occur Verbal response (V) -5 = Conversation is coherent and oriented -4 = Conversation is incoherent and disoriented -3 = Words are spoken, but inappropriately -2 = Sounds are made, but no words -1 = Vocalization does not occur Motor Response (M) -6 = Commands are followed -5 = Local reaction to pain occurs -4 = General withdrawal from pain -3 = Decorticate posturing (adduction of arms, flexion of elbows and wrists) is present -2 = Decerebrate posture (abduction of arms, extension of elbows and wrists) is present -1 = Motor response does not occur A nurse is developing a plan of care for a client who is scheduled for cerebral angiography with contrast media. Which of the following statements by the client should the nurse report to the provider? (Select all that apply) A. "I think I might be pregnant" B. "I take warfarin" C. "I take antihypertensive medication" D. "I am allergic to shrimp" E. "I ate a light breakfast this morning" A, B, D, E A: The nurse should report the client's statement of possible pregnancy to the provider because the contrast media can place the fetus at risk B: The nurse should report that the client is taking warfarin to the provider due to the potential for bleeding following angiography. C: There is no contraindication related to cerebral angiography for a client who is taking antihypertensive medication. D: The nurse should report a client's report of n allergy to shrimp, which is a shellfish, to the provider due to a potential allergic reaction to the contrast media. E: The nurse should report a client's intake of food to the provider since the client should remain NPO for 4 to 6 hr prior to the procedure A nurse is providing education to a client who is to undergo an electroencephalogram (EEG) the next day. Which of the following should the nurse include in the teaching? A. "Do not wash your hair the morning of the procedure." B. "Try to stay awake most of the night prior to the procedure." C. "The procedure will take approximately 15 minutes." D. "You will need to lie flat for 4 hours after the procedure." B A: The nurse should teach the client to wash her hair on the morning of the procedure to remove oils, gels, and sprays, which can affect the EEG readings. B: The nurse should teach the client to remain awake most of the night to provide cranial stress and increase the possibility of abnormal electrical activity C: The nurse should teach the client that the procedure will take approximately 1 hr D: The nurse should teach the client that normal activity can resume immediately following the procedure A nurse is caring for a client who is experiencing mild acute pain after spraining an ankle. Which of the following analgesics should the nurse expect to administer? A. Ketorolac B. Ketamine C. Meperidine D. Methadone A. A: Ketorolac is in the NSAID category and is useful for anti-inflammatory effects in managing minor pain following a spray.. B: Ketamine is an anesthetic agent that is often used as an adjuvant medication for treating neuropathic pain C: Meperidine is not recommended for regular use due to adverse effects of this medication D: Methadone is effective for treating severe pain A nurse at a clinic is talking with a client who has cancer and takes extended-release opioids twice daily. The client reports an increase in localized, achy pain over the last few days. How should the nurse document this increase in pain? A. Phantom limb pain B. Mixed pain C. Breakthrough pain D. Neuropathic pain C A: Phantom limb pain that is perceived to be initiated from a part of the body that is no longer present B: Mixed pain is pain that is difficult to define, for conditions such as fibromyalgia C: Breakthrough pain is an acute exacerbation of pain beyond the level the client typically experiences D: Neuropathic pain sensations are described as burning, shooting, or pins and needles A nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) infusion device after abdominal surgery. Which of the following client statements indicates that the client understands how to use the device? A. "I'll wait to use the device until it's absolutely necessary." B. "I'll be careful about pushing the button so I don't get an overdose." C. "I should tell the nurse if the pain doesn't stop after I use this device." D. "I will ask my son to push the dose button when I am sleeping." C A. The client may use the device when he begins to feel pain. It will help prevent unnecessary worsening of the pain and more doses of analgesia to provide relief. B: A feature of PCA devices is the timing control or lockout mechanism, which enforces a preset minimum interval between medication doses. This safety feature is one means of preventing an overdose because the client cannot self-administer another dose until that time interval has passed. C: The nurse should identify that PCA is a method of delivering pain medication through an electronic infusion device that allows the client to self-administer pain medication on as as-needed basis. If the client is not achieving adequate pain control, he should let the nurse know so that she can initiate a reevaluation of the client's pain management plan. D: The client is the only one who should operate the PCA pump. In situations where the client is not able to do so, the provider may authorize a nurse or a family member to operate the pump. A nurse is discussing pain assessment with a newly licensed nurse. Which of the following information should the nurse include? A. Most clients exaggerate their levels of pain B. Pain must have an identifiable source to justify the use of opioids C. Objective data are essential in assessing pain D. Pain is whatever the client says it is D A: A misconception about pain is that clients will exaggerate their pain level B: Clients can have pain without being able to identify the source C: Objective data are not always present when the clients have pain D: The nurse should identify that pain is a subjective experience, and the client is that best source of information about it A nurse is monitoring a client who is receiving opioid analgesia. Which of the following findings should the nurse identify as adverse effects of opioid analgesics? (Select all that apply). A. Urinary incontinence B. Diarrhea C. Bradypnea D. Orthostatic hypotension E. Nausea C, D, E A: Urinary retention, not urinary incontinence, is a common adverse effect of opioid analgesia B: Constipation, not diarrhea, is a common adverse effect of opioid analgesia C: Respiratory depression, which causes respiratory rates to drop to dangerously low levels, is a common adverse effect of opioid analgesia D: Dizziness or lightheadedness when changing positions is a common adverse effect of opioid analgesia E: Nausea and vomiting are common adverse effects of opioid analgesia A nurse is assessing a client who reports severe headache and a stiff neck. The nurse's assessment reveals positive Kernig's and Brudzinski's signs. Which of the following should the nurse perform first? A. Administer antibiotics B. Implement droplet precautions C. Initiate IV access D. Decrease bright lights. B A: The nurse should administer antibiotics to stop the micro-organisms from multiplying, but this is not the priority action. B: When using the urgent vs. nonurgent approach to care, the nurse determines the priority action is to initiate droplet precautions when meningitis is suspected to prevent the spread of disease to others C: The nurse should initiate IV access to allow IV medication and fluid administration, but this is not the priority action. D: The nurse should decrease bright lights because of the client's sensitivity to light, but this is not the priority action. A nurse is assessing for the presence of Brudzinski's sign in a client who has suspected meningitis. Which of the following actions should the nurse take when performing this technique? (Select all that apply) A. Place the client in supine position B. Flex client's hip and knee C. Place hands behind the client's neck D. Bend client's head toward chest E. Straighten the client's flexed leg at the knee A, C, D A: The nurse should place the client in supine position when assessing for Brudzinski's sign B: The nurse should flex the client's hip and knee when assessing for Kernig's sign C: The nurse should place her hands behind the client's neck when assessing for Brudzinski's sign, in order to flex the client's neck D: The nurse should bend the client's head toward the chest when assessing for Brudzinski's sign E: The nurse should straighten the client's flexed leg at the knee when assessing for Kernig's sign A nurse is planning care for a client who has meningitis and is at risk for increased intracranial pressure (ICP). Which of the following actions should the nurse plan to take? (Select all that apply) A. Implement seizure precautions B. Perform neurologic checks 4 times a day C. Administer morphine for the report of neck and generalized pain D. Turn off room lights and television E. Monitor for impaired extraocular movements F. Encourage the client to cough frequently A, D, E A: The client is at risk for seizures due to possible increased ICP. Therefore, the nurse should implement seizure precautions to reduce the client's risk for injury. B: The nurse should perform neurologic checks at least every 2 hours for a client who is at risk for increased ICP C: The nurse should avoid administering opioids to a client who is at risk for increased ICP. Opioids can mask changes in the client's level of consciousness. D: The nurse should turn off room lights and the television because they can increase neuron stimulation and cause a seizure when a client is at risk for increased ICP. E: The nurse should monitor for impaired extraocular movements because this finding can indicate increased ICP F: The nurse should instruct the client to avoid coughing because this action can cause increased ICP A nurse is reviewing the use of meningococcal vaccine (MCV4) for the prevention of meningitis with a newly licensed nurse. Which of the following information should the nurse include? A. The vaccine is indicated to reduce the risk of respiratory infection B. The vaccine is administered in a series of 4 doses C. The vaccine is recommended for adolescents before starting college D. The vaccine is initially given at 2 months of age C A: The pneumococcal vaccine is primarily indicated to reduce the risk of respiratory infection. However, it also reduces the risk of CNS infections B: The HiB vaccine is administered to infants in a series of 4 doses C: The nurse should identify that the meningococcal vaccine is recommended for adolescents prior to starting college due to the increased risk for infection in communal living facilities D: The initial dose of the HiB vaccine is recommended for infants at 2 months of age A nurse is planning care for a client who has bacterial meningitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply) A. Monitor for bradycardia B. Provide an emesis basin at the bedside C. Administer antipyretic medication D. Perform a skin assessment E. Keep the head of the bed flat B, C, D A: The nurse should plan to monitor for tachycardia when a client has meningitis B: The nurse should provide an emesis basin at the bedside because the client who has meningitis can have nausea and vomiting C: The nurse should plan to administer antipyretic medication for fever to a client who has meningitis D: The nurse should perform a skin assessment to determine whether the client has a red macular rash associated with meningococcal meningitis. E: The nurse should elevate the head of the client's bed 30 degrees to promote venous drainage from the head and prevent increased ICP A nurse is assessing a client who has a seizure disorder. The client tells the nurse, "I am about to have a seizure." Which of the following actions should the nurse implement? (Select all that apply). A. Provide privacy B. Ease the client to the floor if standing C. Move furniture away from the client D. Loosen the client's clothing E. Protect the client's head with padding F. Restrain the client A, B, C, D, E A: The nurse should implement privacy to minimize the client's embarrassment. B: The nurse should ease the client to the floor to prevent falling and injury. C: The nurse should move the furniture away from the client to prevent injury D: The nurse should loosen the client's clothing to minimize restriction of movement E: The nurse should protect the client's head in her lap or using a pillow or blanket under the head during a seizure F: The nurse should not restrain the client. Restraint can increase the client's risk for injury or more seizure activity A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? A. Keep the client in a side-lying position B. Document the duration of the seizure C. Reorient the client to the environment D. Provide client hygiene A A: The greatest risk to the client is aspiration during the postictal phase. Therefore, the priority intervention is to keep the client in a side-lying position so secretions can drain from the mouth keeping the airway patent. B: The nurse should document the duration of the seizure in the client's medical record, but there is another action that the nurse should take first. C: The nurse should reorient the client to the environment because the client can feel confused, but there is another action that the nurse should take first. D: The nurse should provide client hygiene if the client experienced incontinence during the seizure, but there is another action that the nurse should take first. A nurse is providing discharge instructions for a client who has a prescription for phenytoin. Which of the following information should the nurse include? A. Consider taking an antacid when on this medication B. Watch for receding gums when taking the medication C. Take the medication at the same time every day D. Provide a urine sample to determine the therapeutic levels of the medication C A: The nurse does not need to instruct the client to consider taking an antacid, because phenytoin does not cause any gastrointestinal adverse effects. B: The nurse should instruct the client that phenytoin causes overgrowth of the gums C: The nurse should instruct the client to take phenytoin at the same time every day to enhance effectiveness D: The nurse should instruct the client to have periodic blood tests to determine the therapeutic level of phenytoin A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. Which of the following information should the nurse include in this review? (Select all that apply) A. Avoid overwhelming fatigue B. Remove caffeinated products from the diet C. Limit looking at flashing lights D. Perform aerobic exercise E. Limit episodes of hypoventilation F. Use of aerosol hairspray is effective A, B, C A: The nurse should instruct the client to avoid overwhelming fatigue, which can trigger a seizure by stimulating abnormal electrical neuron activity. B: The nurse should instruct the client to remove caffeinated products from the diet, which can trigger a seizure by stimulating abnormal electrical neuron activity. C: The nurse should instruct the client to refrain from looking at flashing lights, which can trigger a seizure by stimulating abnormal electrical neuron activity. D: The nurse should instruct the client to avoid vigorous physical activity, which can help to avoid triggering a seizure E: The nurse should instruct the client to limit excess hyperventilation, which can trigger a seizure by stimulating abnormal electrical neuron activity F: The nurse should instruct the client to avoid using aerosol hairspray, which can trigger a seizure by stimulating abnormal electrical activity A nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. Which of the following statements should the nurse include in the teaching? A. "It is safe to use microwaves that are 1,200 watts of less." B. "You should avoid the use of CT scans with contrast." C. "You should place a magnet over the implantable device when you feel an aura occurring." D. "It is recommended that you use ultrasound diathermy for pain management." C A: The nurse should instruct the client to avoid using a microwave, regardless of wattage, which can affect the function of the simulator B: The nurse should instruct the client to avoid MRIs C: The nurse should instruct the client to hold a magnet over the implantable device when an aura occurs so as to decrease seizure activity D: The nurse should instruct the client to avoid the use of ultrasound diathermy for pain management because of its effect on the function of the stimulator. A nurse is caring for a client who displays manifestations of stage III Parkinson's disease. Which of the following actions should the nurse include? A. Recommend a community support group B. Integrate a daily exercise routine C. Provide a walker for ambulation D. Perform ADLs for the client C A: The client/family should be involved in a community support group at the onset of the disease process to enhance coping mechanisms B: The client should perform daily exercises with the onset of the disease process to promote mobility and independence for as long as possible C: The client should use a walker for ambulation in stage III of Parkinson's disease because movement slows down significantly and gait disturbances occur D: The client loses the ability to perform ADLs at stage V of Parkinson's disease and is dependent on others for care at that time. During earlier stages, the client should be encouraged to remain as independent as possible. A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson's disease. Which of the following actions should the nurse include? (Select all that apply). A. Provide three large balanced meals daily B. Record diet and fluid intake daily C. Document weight every other week D. Offer cold fluids such as milkshakes E. Offer nutritional supplements between meals B, D, E A: Plan to provide small, frequent meals during the day to maintain adequate nutrition B: Record the client's diet and fluid intake daily to assess for dietary needs and to maintain adequate nutrition and hydration C: Document the client's weight weekly to identify weight loss and intervene to maintain the client's weight D: Provide cold fluids such as milkshakes. Thick and cold fluids are tolerated easier by the client. E: Offer nutritional supplements between meals to maintain the client's weight [Show Less]
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PN Adult Medical Surgical Online Practice 2022 B with NGN Questions Answered 100% correct
A nurse is reinforcing teaching with a client who has osteoporosis and a new prescription for calcitonin. Which of the following statements should the nurs... [Show More] e make to describe the effect of calcitonin in treating osteoporosis? "Calcitonin will slow the breakdown of bone in your body." A nurse is reviewing the medical record of a client who is postoperative. Which of the following findings should the nurse identify as a complication of surgery? WBC count of 15,000/mm3 A nurse is caring for a client following a gastrectomy. Which of the following actions should the nurse take to decrease episodes of dumping syndrome? Place the client in the supine position after meals. A nurse is caring for a client who is suspected of having a myocardial infarction. Which of the following actions should the nurse take to prepare the client for an ECG? Cleanse the client's skin prior to electrode placement. A nurse is collecting data from a client who is being treated for hypovolemia due to nausea and vomiting. Which of the following findings should the nurse report to the provider? Heat rate 120/min A nurse is reinforcing discharge teaching with a client who has Crohn's disease. Which of the following statements should the nurse include in the teaching? "Maintain a low-residue diet." A nurse is caring for a client who has an intestinal obstruction and reports a new onset of nausea. The client has an NG tube set at low intermittent suction and is receiving continuous IV infusion of 0.9% sodium chloride. Which of the following actions should the nurse take first? Check for kinks in the NG tube. A nurse is caring for a client who is 2 hr postoperative following the amputation of a foot. Which of the following actions should the nurse take first? Check the incisional dressing A nurse is assisting in the care of a client who has AIDS-related pneumonia. The client is receiving antibiotic therapy and albuterol nebulizer treatments daily. Which of the following findings should indicate to the nurse that the client's therapeutic regimen is effective? Decrease in exertional dyspnea A nurse is caring for a client who has neutropenia. Which of the following nursing interventions should the nurse implement? Limit visitors to healthy adults. A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about glycosylated hemoglobin (HbA1c) testing. Which of the following information should the nurse include in the teaching? HbA1c results measure glucose control for the prior 3 months. A nurse is caring for a client who is receiving a continuous tube feeding of 60 mL/hr at 1.2 cal/mL. How many calories will the client receive in 12 hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 864 cal A nurse is repositioning a client who has low back pain. Which of the following positions is should the nurse place the client in? Semi-Fowler's with knees flexed A nurse is preparing to administer an influenza vaccine to a client. Which of the following statements by the client should cause the nurse to postpone administration of the vaccine? "I had a low fever this morning." A nurse is reinforcing teaching with a client about testicular self-examination. Which of the following instructions should the nurse include in the teaching? "Perform testicular self-examination after taking a warm shower." A nurse is preparing to assist a client out of bed 4 hr following a laparoscopic cholecystectomy. Which of the following actions should the nurse take first? Obtain the client's blood pressure. A nurse is collecting data from a client who has 30% body surface area deep partial-thickness and full-thickness burns. Which of the following findings indicates that fluid resuscitation is adequate? Urine output is 50 mL/hr. A nurse is reinforcing teaching with a client who has a new diagnosis of tuberculosis (TB) and a prescription for isoniazid and rifampin. Which of the following information should the nurse include in the teaching? Household family members should be tested for TB. A nurse is contributing to the plan of care for a client who had a stroke. For which of the following interprofessional team members should the nurse recommend a referral prior to initiating oral intake for the client? Speech-language pathologist A nurse is reinforcing teaching with a client who has a new diagnosis of genital herpes. Which of the following information should the nurse include? "The virus can be transmitted without lesions being present." A nurse is assisting with an educational program for clients who have been newly diagnosed with diabetes mellitus. Which of the following instructions should the nurse include in the program regarding insulin? Opened insulin can be stored on a cool countertop away from light A nurse is caring for a client who is postoperative following an above-the-knee amputation of the right leg and reports pain in the absent portion of the limb. The client received an opioid analgesic 1 hr prior. Which of the following actions should the nurse take? Collaborate with the physical therapist to initiate alternative pain therapies Click to highlight the findings the nurse should report to the charge nurse immediately. To deselect a finding, clink on the finding again. Perineal pad is saturated with blood, and large clots are present Blood pressure 98/56 mm Hg Heart rate 102/min A nurse is reinforcing teaching with a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? "Take calcium supplements with meals." A nurse is contributing to the plan of care for a client who has tuberculosis (TB). Which of the following interventions should the nurse include? Place the client in a negative-pressure airflow room. A nurse is reviewing the chart of a client who is experiencing an adrenal crisis, which was precipitated by the client not taking their medication for several days. The nurse should identify that withdrawal from which of the following medications potentiated the adrenal crisis? Prednisone A nurse is reinforcing teaching with a client who is taking levothyroxine. Which of the following statements by the client indicates an understanding of the teaching? "The medication should be taken before I eat breakfast every morning." A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. While taking the client's apical pulse, the nurse notes a rate of 58/min. Which of the following actions should the nurse take? Withhold the dose. A nurse is reinforcing teaching with a client who has asthma and a new prescription for a corticosteroid. Which of the following findings should the nurse include as an adverse effect of the medication? Frequent colds A nurse is contributing to the plan of care for a client who has a head injury and is at risk for increased intracranial pressure (ICP). Which of the following actions should the nurse include in the plan? Use a turn sheet to reposition the client. A nurse is collecting data from an older adult client who has several concerns. Which of the following concerns should the nurse recognize as an expected change associated with aging? "My food tastes bland even after I add seasoning." A nurse is reinforcing discharge teaching with a client who has leukemia and is receiving chemotherapy. Which of the following statements should the nurse include in the teaching? "You should place your toothbrush in hydrogen peroxide." A nurse is reinforcing teaching with a client prior to the removal of a leg cast. Which of the following statements should indicate to the nurse that the client understands the teaching? "I will feel vibrations on my leg from the cast cutter." For each finding, click to specify if the finding is consistent with emphysema, asthma, or pneumonia. Each finding may support more than 1 disease process. Temperature - pneumonia Breath sounds - emphysema, asthma, & pneumonia Respiratory rate - emphysema, asthma, & pneumonia Cough - emphysema, asthma, & pneumonia A nurse is delegating the task of repositioning a client who is in skeletal traction to an assistive personnel (AP). Which of the following instructions should the nurse give the AP? Allow the weights to hang freely. A nurse is reinforcing teaching with a client about preventing osteoporosis. Which of the following client statements indicates an understanding of the teaching? "I will limit my coffee intake." A nurse is reviewing the laboratory reports of a client who reports chest pain. Which of the following laboratory results indicates the client is experiencing a myocardial infarction? Elevated troponin A nurse is preparing a client for a cardiac catheterization. Which of the following actions should the nurse take first? Verify the client has given informed consent. For each potential nursing intervention, click to specify if the intervention is indicated or not indicated. Request a chest x-ray - not indicated Place the client in reverse Trendelenburg position - indicated Assist with administering a 0.9% sodium chloride 200 mL IV bolus - indicated Apply oxygen at 2 L/min via nasal cannula - indicated Notify the charge nurse immediately - indicated Obtain the client's blood glucose level - not indicated A nurse is reinforcing instructions with a client who has a new hearing aid. Which of the following instructions should the nurse include? "Adjust the volume to a level where you can hear others speak at a distance of 3 feet." [Show Less]
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ATI Med-Surg Proctored Exam Review Questions and Answers 2023
Respiratory Alkalosis S/S lethargy lightheadedness confusion tachycardia dysrhythmias related to hypokalemia nausea vomiting epigastric pain numbn... [Show More] ess and tingling of the extremities hyperventilation (tachypnea) A nurse is contributing to the plan of care for an older adult client who is at risk for Osteoporosis. Which intervention should the nurse include to prevent bone loss? Encourage weight bearing exercises (such as walking because it can help maintain bone mass by reducing bone demineralization, thus helping to prevent osteoporosis.) A nurse is caring for a client who has meningococal pneumonia. Which of the following personal protective equipment should the nurse use? Mask (this disease requires droplet precautions) A nurse is reinforcing teaching with a client who is taking insulin Glargine. What information should the nurse include in the teaching? This type of insulin should be given at the same time everyday. (It is released over a 24hr period) A home health nurse is reinforcing teaching with a client about preventing complications of peripheral vascular disease. What statement by the client indicates that they are adhering to the nurse's instructions? "I don't cross my legs anymore". A nurse is caring for a client who has a methicillin-resistant Staphlococcus aureus (MRSA) infections in a surgical wound. What information should the nurse plan to share with visitors? Visitors must don a gown & gloves prior to entering the client's room. A nurse is reinforcing teaching with a client who has heart failure and a new prescription for hydrochlorothiazide. What should the client report to the provider? Onset of nausea A nurse is reinforcing discharge teaching with a client who has hearing loss. What action should the nurse take when communicating with the client? Rephrase client instructions when not understood. A nurse is caring for a client who is 1 day post operative following a hip arthroplasty. The client is exhibiting hypotension, tachycardia, & tacky-nearly. The nurse should recognize these findings as what complication? Pulmonary Embolism A nurse is monitoring a client who recently had a cast placed on the right lower extremity for a bone fracture. What finding should the nurse recognize as abnormal? Lack of sensation between the first and second toes A nurse reinforcing teaching with a client who has systemic lupus erythematosus (SLE) and is to begin taking methylprednisolone orally. What should the nurse include in the teaching? Limit contact with large groups of people A nurse is caring for a client who is 24hr postoperative following abdominal surgery & has an NG tube. What action should the nurse plan to take to decrease the risk of postoperative complications? Encourage the client to use an incentive spirometer every hour while awake A nurse is collecting data from a client who has chronic kidney disease with hyperkalemia. What finding should the nurse expect related to hyperkalemia? Bradycardia A nurse is assisting in the care of a client who has manifestations of sepsis. What provider prescriptions should the nurse implement first? Initiate oxygen at 4 L/min via nasal cannula A nurse is caring for a client who has terminal pancreatic cancer. The client states, "I don't think I can go on any longer." What response should the nurse make? "Tell me more about the way you are feeling." A nurse is collecting data from a client who has hypokalemia. What finding should the nurse identify as the priority? Dysrhythmia A nurse is caring for a client who is in Buck's traction. What intervention should the nurse perform to reduce skin breakdown? Keep the skin dry and free of perspiration A nurse is contributing to the plan of care for a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infections and is on contract isolation precautions. What action should the nurse take? Have a designated stethoscope in the client's room A nurse enters the room of a client whose transfusion of packed RBCs was initiated 15 min ago by the RN. The client reports dyspnea and urticaria. What action should the nurse perform first? Stop the infusion A nurse is preparing to auscultate the bowel sounds of a client who has a mechanical bowel obstruction in the descending colon. When listening in the left upper quadrant, the nurse should identify this sound as what? Hyperactive bowel sounds A nurse is preparing to administer furosemide to a client who has heart failure. What should the nurse report before administering the medication? Decreased potassium A nurse is reinforcing teaching about joint protection with a client who has an acute exacerbation of rheumatoid arthritis. What information should the nurse include in the teaching? Apply cold packs to the joints A nurse is collecting data from a client who has hypothyroidism. What manifestation should the nurse expect? Bradycardia A nurse is reinforcing teaching with an older adult client who has osteoporosis. What instructions should the nurse include in the teaching? Take the calcium supplements with meals A nurse is reviewing the medical record for an older adult client who is experiencing nausea & vomiting. Based on the client data, what action should the nurse take? (Na 142 mEq, K+ 4.2 mEq/L, BUN 36 mg/dL, Creatinine 1.4 mg/dL) Notify the charge nurse of the client's BUN level A nurse is admitting a client who is suspected having active tuberculosis (TB). What action should should the nurse take first? Institute airborne precautions A nurse is monitoring a client who has a wrist cast and reports intense itching underneath the cast. What action should the nurse take? Blow cool air into the cast using a blow dryer on a cool setting A nurse is planning care for a group of clients after receiving change-of-shift report. What client should the nurse see first? A client who is dehydrated, has mental confusion, & was found getting out of bed several times during the night. A nurse is caring for a client who reports shortness of breath and has an oxygen saturation of 90%. What action should the nurse take? Administer oxygen via nasal cannula A nurse is caring for a client who has a prescription for digoxin 0.25mg PO daily. While taking the client's apical pulse, the nurse notes a rate of 58/ min. What action should the nurse take? Withhold the dose A nurse is caring for a client who has an intestinal obstruction & reports a new onset of nausea. The client has an NG tube set at low intermittent suction & is receiving continuous IV infusion of 0.9% sodium chloride. What action should the nurse take first? Check for kinks in the NG tube A nurse is reinforcing teaching with a client who is postoperative following a cemented total hip arthroplasty. What instructions should the nurse include in the teaching? Maintain hip flex ion to 90 or less when sitting A nurse is caring for a client who is 24hr postoperative following an abdominal surgery. What finding requires immediate attention from the nurse? Oxygen saturation of 88% A nurse is caring for a client following a gastrectomy. What action should the nurse take to decrease episodes of dumping syndrome? Place the client in the supine position after meals [Show Less]
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ATI Med Surg Proctored Exam Practice Qs Questions and Answers 2023
A nurse is caring for a client who experienced a traumatic head injury and has an intraventricular catheter (Ventriculostomy) for ICP monitoring. The nurse... [Show More] should monitor the client for which of the following complications related to the ventriculostomy?: a. Headache b. Infection c. Aphasia d. Hypertension b. Infection Monitor for infection and use strict asepsis to avoid life-threatening meningitis. A nurse is providing education to a client who is to undergo an EEG the next day. Which of the following info should the nurse include in the teaching? a. "Do not wash your hair the morning of the procedure." b. "Try and stay awake most of the night prior to the procedure." c. "The procedure will take approximately 15 mins." d. "You will need to lie flat for 4 hours after the procedure." b. "Try and stay awake most of the night prior to the procedure." Tell the client to remain awake to provide cranial stress and increase the possibility of abnormal electrical activity A nurse is caring for a client who is postprocedural following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? SATA. a. Use the GCS scale to assess the client b. Assist the client into a supine position c. Administer an opioid analgesic d. Encourage the client to increase PO fluid intake e. Instruct the client to perform coughing and deep breathing B, D A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following findings should the nurse report to the provider? a Output equal to the instilled irrigate b. Client reports bladder spasms c. Viscous urinary output with clots d. Reports of strong urge to urinate c. Viscous urinary output with clots Urine that is bright red with clots is an indication of arterial bleeding. A nurse is monitoring the ECG of a client who has hypocalcemia. Which of the following findings should the nurse expect? a. Flattened T waves b. Prolonged QT intervals c. Shortened QT intervals d Widened QRS complexes b. Prolonged QT intervals Manifestations of hypocalcemia include tingling, numbness, tetany, seizures, prolonged QT intervals, and laryngospasm. A nurse is preparing a client who has a brain tumor for a CT scan. Which of the following factors affects the manner in which the nurse will prepare the client for the scan? a. No food or fluids consumed for 4 hours b. Difficulty recalling recent events c. Development of hives while eating shrimp d. Paresthesia in both hands c. Development of hives while eating shrimp Shellfish allergy is contraindication of use of contrast media during a CT scan. A nurse is preparing an in-service program about the stages of acute kidney injury. Which of the following pieces of info should the nurse include about prerenal azotemia? a. Prerenal azotemia begins prior to the onset of symptoms b. Interference with renal perfusion causes renal azotemia c. Prerenal azotemia is irreversible, even in early stages d. Infections and tumors cause prerenal azotemia b. Interference with renal perfusion causes prerenal azotemia. Prerenal = interference with renal perfusion, such as from heart failure or hypovolemic shock. A nurse is teaching a client who has CAD about the difference between angina pectoris and MI. Which of the following should the nurse identify as indications of MI? SATA. a. N/V b. Diaphoresis and dizziness c. Chest and left arm pain that subsides with rest d. Anxiety and feelings of doom e. Bounding pulse and bradypnea A, B, D A nurse is reviewing the lab results of a lumbar puncture for a client who has manifestations of bacterial meningitis. Which of the following findings should the nurse expect? a. Elevated glucose b. Elevated protein c. Presence of RBCs d. Presence of D-dimer b. Elevated protein Manifestations of bacterial meningitis include increase protein in the CSF, decreased glucose. RBCs can indicate bleeding, however, WBCs are what indicates bacterial meningitis. A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis (MG). Which of the following pieces of information should the nurse include? A. Use enemas to treat constipation caused by daily medications B. Take a hot bath when muscles ache C. Eat a low-calorie diet D. Set an alarm to ensure medication dosages are taken on time D. Set an alarm to ensure medication dosages are taken on time The nurse should instruct the client to take medication dosages on time to maintain a therapeutic blood level. Dosages should not be missed or postponed because this can cause an exacerbation of the disease. A nurse is teaching a client who has a new diagnosis of primary open-angle glaucoma (POAG). Which of the following pieces of information should the nurse include in the teaching? (Select all that apply.) A. Lost vision can improve with eye drops. B. Administer eye drops as needed for vision loss. C. Glasses will be necessary to correct the accompanying presbyopia. D. Driving can be dangerous due to the loss of peripheral vision. E. Laser surgery can help reestablish the flow of aqueous humor. D. Driving can be dangerous due to the loss of peripheral vision. E. Laser surgery can help reestablish the flow of aqueous humor. A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider? A. Ecchymosis of the thigh B. Serous drainage at the pin site C. Chest petechiae D. Muscle spasms in the left leg C. Chest petechiae The nurse should identify chest petechiae as an indication of fat embolism syndrome. Clients who have fractures of the long bones such as the femur are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets from the marrow enter into the systemic circulation and are deposited in the lungs. The nurse should immediately notify the provider because the client could progress to acute respiratory failure. A nurse is assessing a client who has Kaposi's sarcoma. Which of the following findings should the nurse expect? A. Nonproductive cough, fever, and shortness of breath B. Lesions on the retina that produce blurred vision C. Onset of progressive dementia D. Reddish-purple skin lesions D. Reddish-purple skin lesions Kaposi's sarcoma is commonly associated with AIDS and manifests as hyperpigmented multicentric lesions that can be firm, flat, raised, or nodular. Following a biopsy, the lesions are treated with radiation and/or chemotherapy. A nurse is completing an assessment for a client who has a history of unstable angina. Which of the following findings should the nurse expect? A. Chest pain is relieved soon after resting. B. Nitroglycerin relieves chest pain. C. Physical exertion does not precipitate chest pain. D. Chest pain lasts for longer than 15 min. D. Chest pain lasts for longer than 15 min. A client who has unstable angina will have chest pain lasting longer than 15 minutes. This is due to reduced blood flow in a coronary artery from atherosclerotic plaque and thrombus formation causing partial arterial obstruction or from an artery spasm. Incorrect Answers: A. A client who has unstable angina will have chest pain even while resting because of insufficient blood flow to the coronary arteries and a decreased oxygen supply. Chest pain at rest is a condition called variant (Prinzmetal's) angina and is caused by an arterial spasm. B. A client who has unstable angina will have minimal, if any, relief of chest pain with nitroglycerin. C. A client who has unstable angina will report chest pain or discomfort with exertion, which can limit the client's activity. A nurse is assessing a client with a closed head injury who has received mannitol for manifestations of increased intracranial pressure (ICP). Which of the following findings indicates that the medication is having a therapeutic effect? A. The client's serum osmolarity is 310 mOsm/L. B. The client's pupils are dilated. C. The client's heart rate is 56/min. D. The client is restless. A. The client's serum osmolarity is 310 mOsm/L. Mannitol is an osmotic diuretic used to reduce cerebral edema by drawing water out of the brain tissue. A serum osmolarity of 310 mOsm/L is desired. A decrease in cerebral edema should result in a decrease in ICP. [Show Less]
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Med surg- proctored ATI Questions Answered 100% correct
An older adult is brought to an emergency department by a family member. Which of the following assessment findings should cause the nurse to suspect that ... [Show More] the client has hypertonic dehydration? Urine Specific gravity 1.045 A urine specific gravity greater than 1.030 indicates a decrease in urine volume and an increase in osmolarity, which is a manifestation of hypertonic dehydration. A nurse in a community clinic is caring for a client who reports an increase in the frequency of migraine headaches. To help reduce the risk for migraine headaches, which of the following foods should the nurse recommend the client avoid? Aged cheese Foods that contain tyramine, such as aged cheese and sausage, can trigger migraine headaches. A nurse is planning teaching for a client who has bladder cancer and is to undergo a cutaneous diversion procedure to establish a ureterostomy. Which of the following statements should the nurse include in the teaching? "You should cut the opening of the skin barrier one-eight inch wider than the stoma." The client should cut the opening of the skin barrier 0.3 cm (1/8in) wider than the stoma to minimize irritation of the skin from exposure to urine. A nurse is providing teaching to a client who has hypothyroidism and is receiving levothyroxine. The nurse should instruct the client that which of the following supplements can interfere with the effectiveness of the medication? Calcium Calcium limits the development of osteoporosis in clients who are postmenopausal and works as an antacid. Calcium supplements can interfere with the metabolism of a number of medications, including levothyroxine. The nurse should instruct the client to avoid taking calcium within 4 hr of levothyroxine administration. A nurse is conducting an admission history for a client who is to undergo a CT scan with an IV contrast agent. The nurse should identify that which of the following findings requires further assessment? History of asthma A client who has a history of asthma has a greater risk of reacting to the contrast dye used during the procedure. Other conditions that can result in a reaction to contrast media include allergies to foods, such as shellfish, eggs, milk, and chocolate. A nurse in an ICU is assessing a client who has a traumatic brain injury. Which of the following findings should the nurse identify as a component of Cushing's triad? Bradycardia A client who has increased intracranial pressure from a traumatic brain injury can develop bradycardia, which is one component of Cushing's triad. The other components of Cushing's triad are severe hypertension and a widened pulse pressure. A nurse is planning to irrigate and dress a clean, granulating wound for a client who has a pressure injury. Which of the following actions should the nurse take? Use a 30-mL syringe The nurse should use a 30-mL to 60-mL syringe with an 18- or 19- gauge catheter to deliver the ideal pressure of 8 pounds per square inch (psi) when irrigating a wound. To maintain healthy granulation tissue, the wound irrigation should be delivered at between 4 and 15 psi. A nurse in an emergency department is reviewing the provider's prescriptions for a client who sustained a rattlesnake bite to the lower leg. Which of the following prescriptions should the expect? Administer an opioid analgesic to the client. The nurse should expect a prescription for an opioid analgesic to promote comfort following a rattlesnake bite. A nurse is reviewing the health record of a client who is scheduled for allergy skin testing. The nurse should postpone the testing and report to the provider which of the following findings? (Click on the "Exhibit" button for additional information about the client). Current medications The nurse should review the client's medication record and identify medications, including ACE inhibitors, beta blockers, theophylline, nifedipine, and glucocorticoids, such as prednisone, that can alter the allergy skin test results. These medications can diminish the client's reaction to the allergens. The nurse should notify the provider and instruct the client to discontinue prednisone for 2 weeks before allergy skin testing. A nurse is a caring for a client who is on bed rest and has a new prescription for enoxaparin subcutaneous. Which of the following actions should the nurse take? Inject the medication into the anterolateral abdominal wall. The nurse should inject the medication into the anterolateral or posterolateral abdominal wall to enhance medication absorption and prevent hematoma formation. A nurse is caring for a client who has a stage III pressure injury. Which if the following findings contribute to delayed wound healing? Urine output 25 mL/hr Urinary output reflects fluid status. Inadequate urine output can indicate dehydration, which can delay wound healing. A nurse is caring for a client who has a new prescription for total parenteral nutrition (TPN). The client is to receive 2,000 kcal per day. The TPN solution has 500kcal/L. The IV pump should be set at how many mL/hr? (Rounding to the nearest whole number.) 167 mL/hr A nurse is teaching a client who has a family history of colorectal cancer. To help mitigate this risk, which of the following dietary alterations should the nurse recommend? Add cabbage to the diet. To help reduce the risk for colorectal cancer, the client should consume a diet that is high in fiber, low in fat, and low in refined carbohydrates. Brassica vegetables such as cabbage, cauliflower, and broccoli, are high in fiber. A nurse is caring for a client who has a prescription for silver sulfadiazine cream to be applied to her burn wounds. The nurse should evaluate the client for which of the following laboratory findings? Leukopenia Transient leukopenia is an adverse effect of silver sulfadiazine. A nurse is teaching a client with systemic erythematosus who has a new prescription for prednisone. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? Infection The nurse should instruct the client to avoid contact with people who are ill and monitor for manifestations of an infection such as a fever or a sore throat. Prednisone can suppress the client's immune response and mask the manifestations of an infection. A nurse is providing preoperative teaching to a client who will undergo a total laryngectomy. Which of the following statements indicates that the client understands the impact of the surgery? "I understand that I will have a permanent tracheostomy after the surgery." With a partial laryngectomy, the tracheostomy is temporary. This client will have a total laryngectomy, so the tracheostomy will be permanent. A nurse is assessing a client who has systemic scleroderma. Which of the following findings should the nurse expect? Finger contractures Scleroderma is a chronic disease that can cause thickening, hardening, or tightening of the skin, blood vessels, and internal organs. There are 2 types of scleroderma: localized scleroderma, which mainly affects the skin, and systemic scleroderma, which can affect internal organs. Manifestations include skin changes, Raynaud's phenomenon, arthritis, muscle weakness, and dry mucous membranes. With scleroderma the body produces and deposits too much collagen, causing thickening and hardening. In addition to the client's skin and subcutaneous tissues becoming increasingly hard and rigid, the extremities stiffen and lose mobility. Contractures develop with advanced systemic scleroderma unless clients follow a regimen of range-of-motion and muscle-strengthening exercises. A nurse is caring for a client who has tracheostomy and is receiving mechanical ventilation. When the low-pressure alarm on the ventilator sounds, it indicates which of the following to the nurse? A leak within the ventilator's circuitry The low-pressure alarm means that either the ventilator tubing has come apart or the tubing detached from the client. Low-pressure alarms are often the result of a malfunction or displacement of connections somewhere between the endotracheal or tracheostomy tube and the ventilator. A nurse is monitoring a client following a thyroidectomy for the presence of hypoparathyroidism. Which of the following findings should the nurse expect? Involuntary muscle spasms The nurse should identify involuntary muscle spasms as an indication of hypoparathyroidism, which can occur if the parathyroid glands are damaged or removed during a thyroidectomy. Muscle twitching and paresthesias can result due to decreased parathyroid hormone levels and calcium deficiency. [Show Less]
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PN Adult Medical Surgical Practice A with NGN Questions Answered 100% correct 2023
A nurse is caring for a client who is scheduled for surgery and is experiencing anxiety. Which of the following interventions should the nurse identify as ... [Show More] the priority? Determine the client's understanding of the procedure. A nurse is contributing to the plan of care for a client who has peripheral arterial disease of the lower extremities. Which of the following interventions should the nurse include? Dangle the extremities off the side of the bed. A nurse is assisting in the plan of care for a client who had a recent left hemispheric stroke. Which of the following actions should the nurse include in the plan? Use simple verbal cues when directing tasks. A nurse is reinforcing teaching with the caregiver of a client who is terminally ill about manifestations of impending death. Which of the following manifestations should the nurse include? Incontinence of the bowel and bladder A nurse is preparing to remove a client's NG tube. Which of the following interventions should the nurse take to decrease the risk for aspiration? Pinch the NG tube. A nurse is caring for a client who is preoperative and is receiving an IV infusion of cefazolin. Ten minutes after beginning the infusion, the client reports intense itching. Which of the following actions should the nurse take first? Stop the medication infusion. A nurse is reinforcing discharge teaching with a client who has cirrhosis. Which of the following instructions should the nurse include? "Consume foods that are low in sodium." A nurse is reinforcing teaching with a client who is scheduled for a guaiac fecal occult blood test. Which of the following instructions should the nurse include in the teaching? Avoid eating red meat for 3 days prior to the test. A nurse is preparing to administer phytonadione 7 mg subcutaneously to a client who has an INR of 4. Available is phytonadione 10 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) 0.7 mL A nurse is reinforcing teaching with a client who is taking insulin glargine. Which of the following information should the nurse include in the teaching? "This type of insulin should be given at the same time every day." A nurse is caring for a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection in a surgical wound. Which of the following information should the nurse plan to share with visitors? Visitors must don a gown and gloves prior to entering the client's room. A nurse is collecting data from a 55-year-old female client who reports vaginal dryness and hot flashes. The client is interested in trying hormone replacement therapy (HRT). Which of the following should the nurse recognize as a contraindication to HRT? History of treatment for blood clots A nurse is reinforcing teaching about management of constipation with a client who has hypothyroidism. Which of the following instructions should the nurse include in the teaching? Increase intake of fiber-rich foods. A nurse is reinforcing teaching with a client who has multiple sclerosis and a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? Avoid stopping this medication suddenly. A nurse is caring for a client who has an area indicating potential breakdown over the sacrum. Which of the following actions should the nurse take? Minimize the time the head of the bed is elevated. A nurse is assisting with the care of a client who is receiving 0.9% sodium chloride by continuous IV infusion. The client reports pain and swelling at the IV site. In which order should the nurse perform the following steps? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) Check IV site Stop the infusion Withdraw the IV catheter Elevate the affected arm Notify the charge nurse Drag words from the choices below to fill in each blank in the following sentence. During the emergent phase of burn care, the client is at risk for developing____________ and _____________. Hypovolemia Respiratory failure A nurse in an oncology clinic is reinforcing teaching about Mohs surgery with a client who has skin cancer. Which of the following information should the nurse include in the teaching? Mohs surgery is a horizontal shaving of thin layers of the tumor. A nurse is contributing to the plan of care for a client who is postoperative following a total knee arthroplasty. The client is using a continuous passive motion (CPM) machine. Which of the following interventions should the nurse recommend for the plan of care? Keep a sheepskin pad between the client's extremity and the CPM machine. A nurse is reinforcing teaching about joint protection with a client who has an acute exacerbation of rheumatoid arthritis. Which of the following information should the nurse include in the teaching? Apply cold packs to the inflamed joints. A nurse is caring for a client who has difficulty swallowing. Which of the following actions should the nurse implement to prevent aspiration? Give the client liquids with increased viscosity. A nurse is discussing health screening guidelines with an older adult client. Which of the following statements should the nurse include? "You should have a pneumococcal immunization every 10 years." A nurse is planning to implement droplet precautions for a client who has manifestations of pertussis. Which of the following interventions should the nurse include when contributing to the plan of care? Apply a mask on the client if transport is needed. A nurse is contributing to the plan of care for a client who was admitted to the neurological unit following a stroke 3 hr ago. Which of the following interventions should the nurse identify as the priority? Keep the client in a side-lying position. A nurse is caring for a client who has a compound fracture of the femur and was placed in balanced suspension skeletal traction 4 days ago. Which of the following actions should the nurse take? Perform pin site care daily. A nurse is reinforcing discharge teaching about wound care with the caregiver of a client who is postoperative. Which of the following instructions should the nurse include in the teaching? Report purulent drainage to the provider. A nurse is collecting data from a client who has hypokalemia. Which of the following findings should the nurse identify as the priority? Dysrhythmia Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Reduce the temperature in the clients room. Limit visitors Hyperthyroidism Increased temperature Weight daily A nurse is caring for a client who reports stomatitis. Which of the following dietary recommendations should the nurse make? "Eat soft foods." [Show Less]
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ATI Med Surg Proctored Exam Practice Qs Questions and Answers Graded A+ 2023
A nurse is caring for a client who experienced a traumatic head injury and has an intraventricular catheter (Ventriculostomy) for ICP monitoring. The nurse... [Show More] should monitor the client for which of the following complications related to the ventriculostomy?: a. Headache b. Infection c. Aphasia d. Hypertension b. Infection Monitor for infection and use strict asepsis to avoid life-threatening meningitis. A nurse is providing education to a client who is to undergo an EEG the next day. Which of the following info should the nurse include in the teaching? a. "Do not wash your hair the morning of the procedure." b. "Try and stay awake most of the night prior to the procedure." c. "The procedure will take approximately 15 mins." d. "You will need to lie flat for 4 hours after the procedure." b. "Try and stay awake most of the night prior to the procedure." Tell the client to remain awake to provide cranial stress and increase the possibility of abnormal electrical activity A nurse is caring for a client who is postprocedural following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? SATA. a. Use the GCS scale to assess the client b. Assist the client into a supine position c. Administer an opioid analgesic d. Encourage the client to increase PO fluid intake e. Instruct the client to perform coughing and deep breathing B, D A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following findings should the nurse report to the provider? a Output equal to the instilled irrigate b. Client reports bladder spasms c. Viscous urinary output with clots d. Reports of strong urge to urinate c. Viscous urinary output with clots Urine that is bright red with clots is an indication of arterial bleeding. A nurse is monitoring the ECG of a client who has hypocalcemia. Which of the following findings should the nurse expect? a. Flattened T waves b. Prolonged QT intervals c. Shortened QT intervals d Widened QRS complexes b. Prolonged QT intervals Manifestations of hypocalcemia include tingling, numbness, tetany, seizures, prolonged QT intervals, and laryngospasm. A nurse is preparing a client who has a brain tumor for a CT scan. Which of the following factors affects the manner in which the nurse will prepare the client for the scan? a. No food or fluids consumed for 4 hours b. Difficulty recalling recent events c. Development of hives while eating shrimp d. Paresthesia in both hands c. Development of hives while eating shrimp Shellfish allergy is contraindication of use of contrast media during a CT scan. A nurse is preparing an in-service program about the stages of acute kidney injury. Which of the following pieces of info should the nurse include about prerenal azotemia? a. Prerenal azotemia begins prior to the onset of symptoms b. Interference with renal perfusion causes renal azotemia c. Prerenal azotemia is irreversible, even in early stages d. Infections and tumors cause prerenal azotemia b. Interference with renal perfusion causes prerenal azotemia. Prerenal = interference with renal perfusion, such as from heart failure or hypovolemic shock. A nurse is teaching a client who has CAD about the difference between angina pectoris and MI. Which of the following should the nurse identify as indications of MI? SATA. a. N/V b. Diaphoresis and dizziness c. Chest and left arm pain that subsides with rest d. Anxiety and feelings of doom e. Bounding pulse and bradypnea A, B, D A nurse is reviewing the lab results of a lumbar puncture for a client who has manifestations of bacterial meningitis. Which of the following findings should the nurse expect? a. Elevated glucose b. Elevated protein c. Presence of RBCs d. Presence of D-dimer b. Elevated protein Manifestations of bacterial meningitis include increase protein in the CSF, decreased glucose. RBCs can indicate bleeding, however, WBCs are what indicates bacterial meningitis. A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis (MG). Which of the following pieces of information should the nurse include? A. Use enemas to treat constipation caused by daily medications B. Take a hot bath when muscles ache C. Eat a low-calorie diet D. Set an alarm to ensure medication dosages are taken on time D. Set an alarm to ensure medication dosages are taken on time The nurse should instruct the client to take medication dosages on time to maintain a therapeutic blood level. Dosages should not be missed or postponed because this can cause an exacerbation of the disease. A nurse is teaching a client who has a new diagnosis of primary open-angle glaucoma (POAG). Which of the following pieces of information should the nurse include in the teaching? (Select all that apply.) A. Lost vision can improve with eye drops. B. Administer eye drops as needed for vision loss. C. Glasses will be necessary to correct the accompanying presbyopia. D. Driving can be dangerous due to the loss of peripheral vision. E. Laser surgery can help reestablish the flow of aqueous humor. D. Driving can be dangerous due to the loss of peripheral vision. E. Laser surgery can help reestablish the flow of aqueous humor. A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider? A. Ecchymosis of the thigh B. Serous drainage at the pin site C. Chest petechiae D. Muscle spasms in the left leg C. Chest petechiae The nurse should identify chest petechiae as an indication of fat embolism syndrome. Clients who have fractures of the long bones such as the femur are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets from the marrow enter into the systemic circulation and are deposited in the lungs. The nurse should immediately notify the provider because the client could progress to acute respiratory failure. A nurse is assessing a client who has Kaposi's sarcoma. Which of the following findings should the nurse expect? A. Nonproductive cough, fever, and shortness of breath B. Lesions on the retina that produce blurred vision C. Onset of progressive dementia D. Reddish-purple skin lesions D. Reddish-purple skin lesions Kaposi's sarcoma is commonly associated with AIDS and manifests as hyperpigmented multicentric lesions that can be firm, flat, raised, or nodular. Following a biopsy, the lesions are treated with radiation and/or chemotherapy. A nurse is completing an assessment for a client who has a history of unstable angina. Which of the following findings should the nurse expect? A. Chest pain is relieved soon after resting. B. Nitroglycerin relieves chest pain. C. Physical exertion does not precipitate chest pain. D. Chest pain lasts for longer than 15 min. D. Chest pain lasts for longer than 15 min. A client who has unstable angina will have chest pain lasting longer than 15 minutes. This is due to reduced blood flow in a coronary artery from atherosclerotic plaque and thrombus formation causing partial arterial obstruction or from an artery spasm. Incorrect Answers: A. A client who has unstable angina will have chest pain even while resting because of insufficient blood flow to the coronary arteries and a decreased oxygen supply. Chest pain at rest is a condition called variant (Prinzmetal's) angina and is caused by an arterial spasm. B. A client who has unstable angina will have minimal, if any, relief of chest pain with nitroglycerin. C. A client who has unstable angina will report chest pain or discomfort with exertion, which can limit the client's activity. A nurse is assessing a client with a closed head injury who has received mannitol for manifestations of increased intracranial pressure (ICP). Which of the following findings indicates that the medication is having a therapeutic effect? A. The client's serum osmolarity is 310 mOsm/L. B. The client's pupils are dilated. C. The client's heart rate is 56/min. D. The client is restless. A. The client's serum osmolarity is 310 mOsm/L. Mannitol is an osmotic diuretic used to reduce cerebral edema by drawing water out of the brain tissue. A serum osmolarity of 310 mOsm/L is desired. A decrease in cerebral edema should result in a decrease in ICP. A nurse is planning care for a client who has AIDS and has developed stomatitis. Which of the following interventions should the nurse include in the plan of care? A. Rinse the mouth with chlorhexidine solution every 2 hr B. Limit fluid intake with meals C. Provide oral hygiene with a firm-bristled toothbrush after each meal D. Avoid salty foods D. Avoid salty foods Stomatitis is an inflammation of the mucosa of the mouth, usually with ulcerations. Foods that are spicy, acidic, or salty should be avoided to prevent further irritation and damage to the oral mucosa. A nurse is caring for a client who had a left lower lobectomy to treat lung cancer. Which of the following factors will have a significant impact on the plan of care for this client? A. The client will need intensive smoking-cessation education. B. After surgery, the prognosis for clients with lung cancer is usually good. C. Lung cancer usually has metastasized before the client presents with symptoms. D. Oxygen therapy is ineffective following a lobectomy. C. Lung cancer usually has metastasized before the client presents with symptoms. The nurse should be aware that lung cancer is usually at an advanced stage before the client has any manifestations. This has implications for both short-term and long-term care options for the client. A nurse is examining the ECG of a client who has hyperkalemia. Which of the following ECG changes should the nurse expect? A. Elevated ST segments B. Absent P waves C. Depressed ST segments D. Varying PP intervals A. Elevated ST segments Elevated ST segments can indicate hyperkalemia and pericarditis. A nurse is caring for a client during the first 72 hr following a cerebrovascular accident (CVA). Which of the following actions should the nurse take? A. Turn the client's head to the side with the head of the bed elevated 60° B. Place the head of the bed flat with pillows under the client's neck and feet C. Elevate the head of the bed 25° to 30° with the client in a neutral midline position D. Position the client in a dorsal recumbent position with pillows under the head and knees ... [Show Less]
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