ATI Predictor|ati Capstone test bank Latest Fall 2020.
1. A nurse is updating a plan of care after an evaluation of a client who has dysphagia. Which of
... [Show More] the following interventions should the nurse include in the plan? a) Ask the client to tilt their head back when swallowing. b) Have the client sit upright for 1 hr. following meals. c) Administer liquids to the client using a syringe. d) Allow the client to rest for 10 min prior to eating. 2. A nurse is assessing the IV infusion site of a client who report pain at the site. The site is red and there is warmth along the course of the vein. Which of the following actions should the nurse take? a) Initiate a new IV line below the original insertion site. b) Discontinue the infusion c) Raise the head of the bed d) Obtain a culture from the area of the insertion site. 3. A nurse is preparing to perform a routine abdominal assessment for a client. Which of the following actions should the nurse take? a) Document shiny, taut skin as an expected finding. b) Perform palpitation after auscultation. c) Listen for 1 min before documenting absent bowel sounds d) Perform auscultation immediately after the client has consumed a meal. 4. A nurse is discussing immunity with a client who has received an immunization. The nurse should identify that an immunization functions as a part of the which of the following types of immunity? a) Passive immunity b) Active immunity c) Cellular immunity d) Acquired immunity 5. A nurse is reviewing the medical records of a group of older adult clients. The nurse should identify that which of the following is a risk factor that places older clients at an increased risk for developing infections? a) Overproduction of lymphocytes b) Elevated albumin levels c) Lowered immune system function d) Increased body fat 6. A nurse is teaching a client who has asthma the use of a metered dose inhaler. Which of the following instructions should the nurse include in the teaching? a) Hold your breath for 6 seconds after inhaling the medication. b) Inhale the medication deeply for 5 seconds. c) Do not shake the medication in the inhaler d) Hold the inhaler 3 inches away from your mouth. 7. A nurse is performing a focused assessment on a client who has a history of COPD and is experiencing dyspnea. Which of the following findings should the nurse expect? a) Pulse oximetry reading of 95 % b) Decreased depth of respirations c) Flaring of the nostrils d) Respiratory rate of 16/min 8. A nurse is teaching a client about the correct use of a cane. Which of the following instruction should the nurse include in the teaching? (Selected all that apply) a) Ensure the cane has a rubber cap. b) Hold the cane on the weaker side. c) Flex the elbow slightly when using the cane. d) Move the cane and stronger leg forward simultaneously e) Use a quad cane for increased support. 9. A nurse is teaching a group of assistive personnel about the expected integumentary changes in older adult clients. Which of the following findings should the nurse include in the teaching? a) Increase in subcutaneous tissue b) Decrease in pigmentation c) Increase in moisture levels d) Decrease in elasticity 16. A nurse s providing teaching about measures to promote sleep with a client who has insomnia. Which of the following client statements indicates an understanding of the teaching? a) “I can exercise as late as 2 hours before bedtime.” b) “I should reduce my fluid intake 2 hours before bedtime “ c) “I should take a 1 hours nap each day” d) “I can eat a large meal as late as 1 hours before bedtime” 17. A nurse is assessing the pain level of a client who has dementia and difficulty communicating. Which of the following pain assessment techniques should the nurse use? a) Numerical pain scale b) Verbal description c) Faces pain scale d) Behavioral indicators 18. A nurse in an emergency department is monitoring the hydration status of a client who is receiving oral rehydration. Which of the following findings should the nurse identify as requiring further interventions? a) Heart rate 120/min b) BP 121/74 mm Hg c) Temperature 37.78 C (100 F) d) Urine specific gravity 1.020 19. A nurse in a provider’s office is assessing the motor skill development of a 15 month old toddler during a well child visit. Which of the following gross motor skills should the nurse expect? a) Takes several steps on tip toes b) Walks without assistance using a wide stance c) Has an accentuated cervical curvature when standing d) Stands with the feet turned slightly inward. 20. A nurse is teaching a group of parents and guardians about safety risks for adolescents. Which of the following statements should the nurse include in the teaching? a) “Exploring the environment commonly leads to injuries for this age group.” b) “Most injuries sustained during this time of life are caused by developing motor skills.” c) “At this age, peer influence to participate in high -risk behaviors can lead to injury” d) The risk for injuries sustained during this age are often a result of a changes in cognitive function” 21. A nurse is caring for a client who expresses anxiety about an upcoming surgery. Which of the following actions should the nurse take? a) Ask the client to describe their feelings b) Discuss the competency of the surgeon with the client c) Inform the client that others have had the procedure without problems. d) Ask the client why they are experiencing anxiety. 22. A nurse is reviewing information about advance directives with a newly admitted client. Which of the following statements by the client indicates an understanding of the teaching? a) “I need to have an attorney sign my advance directives” b) “I have a living will that outlines my wishes if I am unable to make decisions” c) “I must have a family member appointed to make my health care decisions” d) “I will need to sign a document stating that I want to be resuscitated if I required CPR.” 23. A nurse is planning a community education program about colorectal cancer. Which of the following risk factors should the nurse identify as modifiable? (Select all that apply) a) Smoking b) Alcohol consumption c) Inflammatory bowel disease d) High-fat diet e) Colorectal polyps 24. A nurse is reviewing the laboratory report of a client who has been experiencing a fever for the last 3 days. Which of the following laboratory results indicates the client is experiencing fluid volume deficit? a) Decreased blood urea nitrogen (BUN) b) Increased hematocrit c) Decreased urine specific gravity d) Increased calcium level 25. A charge nurse discovered that a nurse did not notify the provider that a client’s condition had changed. The charge nurse should identify that the nurse is accountable for which of the following torts? a) Negligence b) Slander c) Invasion of privacy d) Libel 26. A nurse is performing a cultural assessment of a group of clients to maintain respect for their value systems and beliefs. Which of the following should the nurse identify as examples of cultural variables? (Select all that apply). a) Eye contact b) Personal space c) Level of education d) Touch e) Blood Type 27. A nurse is admitting a client who has recently developed fever, confusion, and a decreased level of consciousness. Which of the following actions should the nurse take first after obtaining the client’s history and assessment? a) Insert an intravenous catheter to begin fluid therapy b) Develop actions to address the client’s manifestations c) Identify the client’s needs d) Determine the effectiveness of treatment. 28. A nurse is planning to administer several medications to a client through a nasogastric (NG) tube. Which of the following actions should the nurse take? a) Mix the medications together and administer through the NG tube . b) Crush the sublingual medication into powder form c) Dissolve crushed tablet medications in sterile water. d) Flush the tube with 5 ml saline between each medication. 29. A nurse is preparing to perform a sterile dressing change for a client who has surgical wound. Which of the following actions should the nurse take to prevent contamination during the dressing change? a) Remove a piece of the new dressing that falls 5cm(2in) from the edge of the sterile field during the dressing change. b) Begin the dressing change by applying sterile gloves and removing the existing dressing c) Restart the procedure if the sterile solution splashes onto the sterile flied when pouring the solution into the dressing tray d) Place the existing dressing on the outermost portion of the sterile field and discard it when the dressing change is finished. 31. A nurse is reviewing the health history of an older adult client who has a hip fracture . The nurse should identify that which of the following findings places the client at risk for developing a pressure injury? a) Osteoporosis b) Urinary incontinence c) Macular degeneration d) Psoriasis 32. A nurse is performing a focused assessment for a client who has dysrhythmia. Which of the following indicates ineffective cardiac contractions? a) Carotid bruit b) Heart murmur c) Pulse deficit d) Bounding radial pulse 33. A nurse is preparing to transfer a client from a chair to the client’s bed. The client can bear partial weight and has upper body strength. Which of the following devices should the nurse to transfer the client? a) A stand-assist lift b) A footboard c) A slide boards d) A mechanical lift with a full body sling 34. A charge nurse is making assignments for the upcoming shift. Which of the following client assignments should the charge nurse assign to a licensed practical nurse (LPN) a) A client who is to received moderate (conscious) sedation. b) A client who was just admitted with multiple rib fractures c) A client who is scheduled for a bone marrow transplant d) A client who has dehydration and inflammatory bowel disease. 35. A nurse is caring for a client who has a prescription for a narcotic medication. After the medication is administered, the nurse is left with an unused portion. Which of the following actions should the nurse take? a) Discard the medication with another nurse as a witness b) Send the remaining medication back to pharmacy c) Place the unused portion of the medication in the sharp’s container. d) Dispose of the unused portion of the medication in the trash. 37. A nurse is caring for an older adult client who has a nonpalpable skin lesion that is less than 0.5cm (0.2 in) in diameter. Which of the following terms should the nurse use to document this finding? a) Papule b) Vesicle c) Nodule d) Macule Capstone Med Surg 1. A nurse is teaching a client about using a continuous positive airway pressure (CPAP) device to treat obstructive sleep apnea. Which of the following information should the nurse include in the teaching? It delivers a present amount of inspiratory pressure at the beginning of each breath It has a continuous adjustment feature that charges the airway pressure throughout the cycle. It delivers a present amount of airway pressure throughout the breathing cycle It delivers positive pressure at the end of each breath 2. A nurse is providing discharge teaching to a client following a heart transplant. Which of the following information should the nurse include in the teaching? Immunosuppressant medications need to be taken for up to 1 year. Shortness of breath might be an indication of transplant rejection The surgical site will heal in 3 to 4 weeks after surgery 3. A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and is receiving 3 % sodium chloride via continuous IV. Which of the following laboratory finding should the nurse identify as an indication that the SIADH is resolving? Urine specific gravity 1. 020 Sodium 119 mEq/L No tiene pregunta 4. A nurse is teaching a client About fecal occult blood testing (FOBT) for the screening of colorectal cancer. Which of the following statements should the nurse include in the teaching? Your provider will use stool from your digital rectal examination to perform the test Your provider will prescribe a stimulant laxative prior to the procedure to You should begin annual fecal occult blood testing for colorectal cancer screening at 40 years old 5. A nurse is preparing a client for a colonoscopy. Which of the following medications should the nurse anticipate the provider to prescribe as an anesthetic for the procedure? Propofol Pancuronium 6. No se ve la pregunta 7. A nurse is reviewing the medical record of a client who has unstable angina. Which of the findings should the nurse report to the provider? Breath Sounds Temperature 8. A nurse is caring for a client eho has burn injuries covering their upper body and is concerned about thei altered appearance .Which of the following statements should the nurse make ? No aparece la respuesta 9. Anurse is developing a plan of care for a client who will be placed in halo traction following surgical repair of the cervical spine .Which of the following interventions should the nurse include in the plan ? Inspect thi pin site every 48 hr Monitor the client skin under the alo vest . Ensure two personnel hold the halo device when repositioning the client . 10. A nurse is caring for a client who has a traumatic brain injury . Which of the following finding should indicate to the nurse the need for inmediate intervention ¿ Axillary temperature 37.2 C (99F) Apical pulse 100/min Respiratory rate 30/min 11. A nurse is assessing a client who has meningitis. The nurse should edentify which of the following finding as a positive Kerning s sign ? After stroking the lateral área of the foot , the clients toes contract and draw together. After hip flexion, the client is unable to extend their leg complety without pain 12. A nurse is providing discharge teaching to a client who has heart failure an a prescription for furosemide 20 mg PO two time daily. Which of the following instructions should the nurse include in the teaching? Monitor for increased blood pressure Increase intake of high-potassium foods Expect an increase in swelling in the hands and feet. 13. A nurse is providing discharge instructions to a client who has GERD. Which of the following statements by the client demostrates an understanting of the teaching?( no aparece la respuesta ) I should take my medicine with orange juice . Abedtime snack will prevent heartburn 14. A nurse at a provide office is interviewing a client who has multiple sclerosis and has been taking dantrolone for several months . Which of the following client statements should the nurse identify as an indication that the medication is effective ? I dont have muscle spasms as frequently I havent gotten any colds , even throught it is flu season 15. A nurse is assessing a client who reports a posible exposure to HIV. Which of the following finding should the nurse identify as an early manifestation of HIV infection? Stomatitis Fatigue Wasting Syndrome 16. A nurse is teaching a client who has type 1 diabetes mellitus about hypoglycemia .which of the following statements by the client indicates an understanting of the teaching? Exercise reduces the risk for hypoglyemia I can skip my insulin when I dont eat I can drink 4 ounces of soda if my blood sugar is low 17. A nure is teaching a client who has hypertension about dietary modifications to help control blood pressure . Which of the following food choices should the nurse recommend as the client to include in their diet ? 1 packet of reconstituted dry onion soup 3 oz of lean cured ham 3 oz of chicken breast 18. A nurse is planning care for a client who as acute pancreatitis .Which of the following interventions should the nurse include in the clients plan? Initiate insulin drip Monitor blood glucose levels Continue regular diet as tolerated Mantain NPO status until pain free Manage acute pain Capstone Mental health 1- A nurse is creating a plan of care for a client who has panic disorder. Which of the following interventions should the nurse include. Use simple words to describe procedures to the client 2- A nurse is caring for a client is experiencing visual hallucinations followed by impaired consciousness as a result of alcohol withdrawal. Which of the following conditions should the nurse identify as causing these manifiestations? Delirium 3- A nurse is teaching male client who has a depressive disorder about sertraline. Which of the following information should the nurse include in the teaching? "This medication may cause an inability to orgasm." 4- A nurse is conducting a child maltreatment screening of a family who has a toddier. Which of the following finding indicator of possible child neglect? The child has had no immunizations since birth. 5- A nurse is preparing to teach a client who has major depressive disorder and is scheduled to undergo electroconvulsive therapy (ECT). Which of the following statements should the nurse include in the teaching? ECT is delivered through electrodes attached to the head 6- A charge nurse is planning an in-service for newly licensed nurses on tort law in mental health care. Which of the following scenarios should charge nurse provide as an example of an unintentional tort? A nurse did not clarify a client prescription that was difficult to read resulting in a medication error. 7- A nurse is reviewing the medical records of a group of clients. For which of the following clients should the nurse recommend a referral for assertive community treatment (ACT)? A client who has repeated acute care admissions due to schizophrenia 8- A nurse is assessing a client who has delirium as a result of sepsis. Which of the following is apply. Rapid mood changes hallucinations Restiessness 9- Nurse is admitting a client to an alcohol abuse program. The client states, Im here because of my boss. It was part of my job to go to parties id drink with clients. The client's statement is an example of which of the following defense mechanisms? Rationalization 10- A charge nurse in a community mental health clinic is discussing ethical concepts of client care with a newly licensed nurse. The charge nurse should use which of the following situations as an Example of fidelity? Attending an educational conference on identifying client at risk suicide 11- A nurse on an inpatient mental health unit is caring for a client who has major depressive disorder and malnutrition. Which of the following actions should the nurse take to improve the client nutritional status. Weigh the client at the same time every morning. 12- A nurse is caring for a client who is receiving haloperidol 2 mg IM every 6 hr. Available is haloperidol 5 mg/ml. how many ml should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Respuesta 0.4 ml 13- A nurse on an inpatient eating disorders unit is caring for a client who has anorexia nervosa and has a body mass index of 17.2. Which of the following actions should the nurse take? Select all that apply. Provide the client with small meals frequenty Monitor the client weight daily Allow the client to choose the meals she wilf eat Stay with the client during meals and for 1 hr afterward Ofter specific privileges for sustained weight gain. 14- A nurse is caring for a client who has bipolar disorder. The client says to the nurse. Give me your pen to should identify that the client is at risk for which of the following. Self- mutilation 15- A nurse is caring for a client who has dementia and insists a doll is her infant child. Which should the nurse use when interacting with the client? Validation therapy 16- A nurse is discharging a client who was admitted for the treatment of alcohol withdrawal. Which of the following resources recommend to the client. Reach to recovery A 12 step program Al-Anon Light therapy 17- A nurse is conducting an admission assessment for a client is experiencing a manic episode of bipolar disorder. Which of the following behavior should the nurse expect. Select all that apply . Grandiosity Flight of ideas Hyperactivity PHARMACOLOGY fotos en word 1-A nurse is assessing a client who started taking furosemide 2 days ago and has a potassium level 3.1. Which of the following findings should the nurse expected? Depressed deep tendon reflexes. 2-A nurse is caring for a client who has an infection and is starting to take gentamicin. Which of the following client laboratory test should the nurse monitor to detect an adverse effect of the medication? Creatinine 3- A nurse is administering bumetanide to a client who has ascites. The nurse should recognize that which of the following findings is an expected therapeutic effect this medication? Increase urinary output 4- A nurse is providing teaching to a client who has fibromyalgia and a new prescription for pregabalin. Which of the following instruction should the nurse include in the teaching? You should notify your provider if you experience facial swelling. 5- A nurse is assessing a client who is in preterm labor and is receiving magnesium via continuous IV infusion. Which of the following findings should the nurse identify as the priority? Deep tendon reflexes 1 6-A nurse is caring for a client who has a systemic fungal infection and is receiving IV amphotericin B deoxycholate. During previous infusion? Adm diphenhydramine prior to administration. 7- A nurse is providing teaching to a client who has rheumatoid arthritis [Show Less]