ATI NUR MISC HESI EXIT NGN COMPREHENSIVE Exam Questions And Answers Best Rated A+ Guaranteed Success Latest Update 2023/2024
• When caring for a
... [Show More] client with a tracheostomy, which intervention should the nurse delegate to the unlicensed assistive personnel (UAP)?
A. Teach the family about signs and symptoms of hypoxia.
B. Take the vital signs and obtain an O2 saturation level 5 minutes before the procedure.
C. Evaluate the need for tracheal suctioning.
D. Revise the plan of care to include tracheostomy care.
Rationale:
The nurse may delegate obtaining vital signs and O2 saturation; however, the nurse is responsible for following up on any reported data. Options A, C, and D are all part of the nursing process and should not be delegated under the nurse's scope of practice.
• The charge nurse is making assignments for the upcoming shift. Which client is most appropriate to assign to the practical nurse (PN)?
A. A client with nausea who needs a nasogastric tube inserted
B. A client in hypertensive crisis who needs titration of IV nitroglycerin
C. A newly admitted client who needs to have a plan of care established
D. A client who is ready for discharge who needs discharge teaching
Rationale:
The client mentioned in option A has a need for a skill that is within the scope of practice for the PN. Titration of an IV drip, establishing care plans, and discharge teaching are within the scope of practice of a registered nurse (RN) and are not delegated.
• A nurse performs an initial admission assessment of a 56-year-old client. Which factor(s) would indicate that the client is at risk for metabolic syndrome? (Select all that apply.)
A. Abdominal obesity
B. Sedentary lifestyle
C. History of hypoglycemia
D. Hispanic or Asian ethnicity
E. Increased triglycerides
Rationale:
Metabolic syndrome is a name for a group of risk factors that increase the risk for coronary artery disease, type 2 diabetes, and stroke (A, B, D, and E). Hypoglycemia is not a risk factor for metabolic syndrome (C).
• Which clinical manifestation in the client with hyperthyroidism is most important to report to the health care provider?
A. Nervousness
B. Increased appetite
C. Apical heart rate of 130 beats/min
D. Insomnia
Rationale:
The apical heart rate of 130 beats/min is a critical finding that could lead to heart failure or other cardiac disorders. Options A, B, and D are all expected findings that should also be reported but are not as critical. [Show Less]