ATI NCLEX MEDICAL SURGICAL ASSESSMENT 1 ALL ANSWERS ARE CORRECT; LATEST SPRING 2022/2023

ATI NCLEX MEDICAL SURGICAL ASSESSMENT 1 ALL ANSWERS ARE CORRECT; LATEST SPRING 2022/2023 A nurse is planning care for a client who is receiving mechanical ventilation. Which of the following actions should the nurse include in the plan A. Provide the client with a means of communication B. Maintain the head of the client's bed in a flat position C. Suction the client's endotracheal tube every 4 hr D. Perform oral hygiene for the client every 8 hr - AnswerA Use electronic tablet computer, programmable speech generating device, alphabet board, pencil and paper, etc B, keep head of bed higher than 30 degrees to prevent aspiration and ventilator associated pneumonia. Turn the client q 2hr to prevent complications related to immobility C, assess the need to suction q 2-4 hr, but not perform routine suctioning. Base the need for suctioning on assessments, not a schedule. Unnecessary suctioning can cause bronco spasms and injury tracheal mucosa D, oral hygiene should be performed q 2 hr to decrease the risk of ventilator associated pneumonia A nurse is caring for a client who is receiving IV fluid replacement therapy for dehydration. Which of the following laboratory results indicates effectiveness of the treatment A. Sodium 165 mEq/L B. Potassium 5.2 mEq/L C. Urine specific gravity 1.020 D. Hct 62% - AnswerC Within the expected range of 1.005-1.030 -- A, sodium range is 136-145 B, potassium range is 3.5-5 D, Hct range is 37%-52% A nurse is monitoring the laboratory findings for a client who is postoperative following a total hip arthroplasty 6 hr ago. Which of the following values indicates that the client has an increased risk for bleeding A. PT 11.5 seconds B. aPTT 35 seconds C. Platelets 80,000