ATI RN Comprehensive Online Practice 2019 B

A nurse is assessing a client who received 2 units of packed RBCs 48 hr ago. Which of the following findings should indicate to the nurse that the therapy has been effective? - Hemoglobin 14.9 g/dL A nurse working in an emergency department is triaging four clients. Which of the following clients should the nurse recommend for treatment first? - A middle adult client who has unstable vital signs A nurse is caring for a client who has fluid volume overload. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? - Measure the client's daily weight. A nurse is preparing to administer mannitol 0.2g/kg IV bolus over 5 min as a test dose to a client who has severe oliguria. The client weighs 198 lb. What is the amount in grams the nurse should administer? - 18 g A nurse is conducting a physical examination for an adolescent and is assessing the range of motion of the legs. Which of the following images indicates the adolescent is abducting the hip joint? - D A nurse is caring for a client who has hyperthyroidism. Which of the following findings should the nurse expect? - Tremors A nurse is assessing a school-age child who has bacterial meningitis. Which of the following findings should the nurse expect? - Nuchal rigidity A nurse is assessing a newborn's heart rate. Which of the following actions should the nurse take? - Auscultate the apical pulse at least 1 min. A nurse is preparing to assist with a thoracentesis for a client who has pleurisy. The nurse should plan to perform which of the following actions? - Instruct the client to avoid coughing during the procedure. A nurse in the emergency department is assessing a preschooler who has a facial laceration. The nurse should identify which of the following findings as a potential indication of child sexual abuse? - The child exhibits discomfort while walking. A nurse is preparing to teach about dietary management to a client who has Crohn's disease and an enteroenteric fistula. Which of the following nutrients should the nurse instruct the client to decrease in their diet? - Fiber A nurse is caring for a client who has a prescription for a continuous passive motion (CPM) machine following a total knee arthroplasty. Which of the following actions should the nurse take? - Turn off the CPM machine during mealtime. A nurse is preparing to initiate IV access for an older adult client. Which of the following sites should the nurse select when initiating the IV for this client? - Radial vein of the inner arm A nurse is developing an education program about osteoporosis for older adult clients. The nurse should include which of the following variables as a risk factor for osteoporosis? - Sedentary lifestyle A nurse in the emergency department is caring for a child who has a fever and fluid-filled vesicles on the trunk and extremities. Which of the following interventions should the nurse identify as the priority? - Initiate transmission-based precautions. A nurse is caring for a client who has a clogged percutaneous gastrostomy feeding tube. Which of the following actions should the nurse take first? - Change the position of the client. A home health care nurse is developing a teaching plan for a client who has a new ileostomy. Which of the following instructions should the nurse include? - Empty the appliance when it is one-third to one-half full. A nurse is reviewing the laboratory report of a client who has end-stage kidney disease and received hemodialysis 24 hr ago. Which of the following laboratory values should the nurse report to the provider? - Sodium 148 mEq/L A nurse is caring for four clients. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? - Arrange the lunch tray for a client who has a hip fracture. A nurse is preparing a client for a paracentesis. Which of the following actions should the nurse take? - Instruct the client to void. A nurse has received change-of-shift report on four assigned clients. For which of the following clients should the nurse intervene to prevent a potential food and medication interaction? - A client who is receiving an MAOI and is requesting a cheeseburger for dinner. A nurse is planning care for a client who has rheumatoid arthritis and has moderate to severe pain in multiple joints. Which of the following actions should the nurse plan to take? - Allow for frequent rest periods throughout the day. A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate. The client reports bladder spasms, and the nurse observes a decreased urinary output. Which of the following actions should the nurse take? - Irrigate the catheter with 0.9% sodium chloride irrigation. A nurse is assessing a client who has COPD. Which of the following findings should the nurse expect? - pH 7.31 A nurse in a community center is providing an educational session to a group of clients about ovarian cancer. Which of the following manifestations of ovarian cancer should the nurse include in the teaching? - Abdominal bloating A nurse is caring for a client who has active tuberculosis (TB). Which of the following actions should the nurse plan to take to prevent the transmission of the disease? - Have the client wear a surgical mask while being transported outside the room. A nurse is caring for a group of clients. Which of the following clients should the nurse attend to first? - An older adult client who is anxious and attempting to pull out an IV line An RN is observing a licensed practical nurse (LPN) and an assistive personnel (AP) move a client up in bed. For which of the following situations should the nurse intervene? - The LPN and the AP grasp the client under his arms to lift him up in bed. A nurse is preparing to administer insulin to a client via a pen device. Which of the following actions should the nurse take? - Hold the insulin pen device perpendicular to the client's skin to inject the medication. A nurse is caring for a client who has immunosuppression and a continuous IV infusion. Which of the following actions should the nurse take? - Monitor the client's mouth every 8 hr. A nurse is providing teaching about advanced directives to a middle adult client. Which of the following client responses indicates an understanding of the teaching? - "I can designate my partner as my health care surrogate." A nurse is assessing a client following a vaginal delivery and notes heavy lochia and a boggy fundus. Which of the following medications should the nurse expect to administer? - Oxytocin A nurse manager is planning to use a democratic leadership style with the nurses on the unit. Which of the following actions by the nurse manager demonstrates a democratic leadership style? - Seeks input from the other nurses A nurse is assigning task roles for a group of clients in a community mental health clinic. Which of the following tasks should the nurse assign to the member of the group functioning as the orienteer? - Noting the progress of the group toward assigned goals A nurse is creating a plan of care for a newly admitted child. Which of the following actions should the nurse include in the plan? - Administer high-dose antibiotic therapy. A nurse is caring for a newborn immediately after delivery. Which of the following interventions should the nurse implement to prevent heat loss by conduction. - Use a protective cover on the scale when weighing the infant. A nurse is caring for a client who had abdominal surgery 24 hr ago. Which of the following actions is the nurse's priority? - Assist with deep breathing and coughing. A nurse in an outpatient mental health clinic is caring for four clients. The nurse should recognize that which of the following clients is effectively using sublimation as a defense mechanism? - A client who channels their energy into a new hobby following the loss of their job A nurse is assessing for correct placement of a client's NG feeding tube prior to administering a bolus feeding. Which of the following actions should the nurse take? - Aspirate contents from the tube and verify the pH level. An antepartum nurse is caring for four clients. For which of the following clients should the nurse initiate seizure precautions? - A client who is at 33 weeks of gestation and has sever gestational hypertension A nurse is providing discharge teaching to a client who is to receive home oxygen therapy. Which of the following instructions should the nurse include in the teaching? - Wear clothing made with cotton fabrics while oxygen is in use. A nurse is providing teaching for a client who has a fracture of the right fibula with a short-leg cast in place and a new prescription for crutches. The client is nonweight- bearing for 6 weeks. Which of the following instructions should the nurse include in the teaching? - Use a three-point gait. A nurse is preparing to transfer a client from the ICU to the medical floor. The client was recently weaned from mechanical ventilation following a pneumonectomy. Which of the following information should the nurse include in the change-of-shift report? - The time of the client's last dose of pain medication A nurse is assessing an infant who has hydrocephalus and is 6 hr postoperative following the placement of a ventriculoperitoneal (VP) shunt. Which of the following findings should the nurse report tot he provider? - Irritability when being held A nurse is caring for a client who has a prescription for chlorpromazine. Which of the following findings should the nurse identify as an indication that the medication is effective? - Decreased hallucinations A nurse is providing teaching about lithium to a client who has bipolar disorder. Which of the following statements should the nurse include in the teaching? - "Notify your provider if you experience increased thirst." A nurse is caring for a client who has a fecal impaction. Which of the following actions should the nurse take when digitally evacuating the stool? - Insert a lubricated gloved finger and advance along the rectal wall. A nurse is planning to delegate client care tasks to an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP? - Perform gastrostomy feedings through a client's established gastrostomy tube. A nurse manager is preparing an educational session for nursing staff about how to provide cost-effective care. Which of the following methods should the nurse include in the teaching? - Delegate non-nursing tasks to ancillary staff. A nurse on an inpatient mental health unit is monitoring a visit between a client who has a history of aggressive behavior and the client's partner. Which of the following observations should the nurse identify as an indication for potential violence? - The client is pacing around the chair in which their partner is sitting. A nurse is caring for a client who has signed an informed consent form to receive electroconvulsive therapy (ECT). The client states to the nurse, "I'm not sure about this now. I'm afraid it's too risky." Which of the following responses should the nurse make? - "You have the right to change your mind about this procedure at any time." A rural community health nurse is developing a plan to improve health care delivery for migrant farmworkers. To identify health services date for this minority group, the nurse should gather information from which of the following sources? - Agency for Healthcare Research and Quality A nurse is assessing a newborn following a vaginal delivery. Which of the following findings should the nurse report to the provider? - Nasal flaring A charge nurse is speaking with the partner of a client. The partner states that the client is not receiving adequate care. Which of the following actions should the charge nurse take first to resolve the situation? - Ask the partner to list specific concerns. A nurse is providing information to a client immediately before his scheduled Romberg test. Which of the following statements should the nurse make? - "I will be checking you once with your eyes open and once with them closed." A nurse is teaching a client who is at 20 weeks gestation about common discomforts associated with pregnancy. Which of the following statements indicates an understanding of the teaching? - "I will wear a supportive bra overnight." A nurse is caring for a client who is taking valproic acid for seizure control. For which of the following adverse effects should the nurse monitor and report? - Jaundice A nurse is providing discharge instructions about newborn care to a client who is postpartum. Which of the following statements indicates to the nurse that the client understands the teaching? - "I will cover my baby's body when I wash her hair." "I will use the bulb syringe first in her mouth and then in her nose." A nurse on a mental health unit is conducting a mental status examination (MSE) on a newly admitted client. Which of the following components of the MSE is the priority for the nurse to assess? - Ideas of self-harm A nurse is preparing to administer lactated Ringer's 1,500 mL IV to infuse at 50 mL/hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? - 13 gtt/min A nurse is providing teaching to a client who has a new diagnosis of type 1 diabetes mellitus. The nurse should instruct the client to monitor for which of the following findings as a manifestation of hypoglycemia? - Irritability A nurse is providing teaching to a client who is scheduled for electroconvulsive therapy (ECT). The nurse should inform the client that which of the following findings is an adverse effect of ECT? - Short-term memory loss A charge nurse notices that one of the nurses on the shift frequently violates unit policies by taking an extended amount of time for break. Which of the following statements should the charge nurse make to address this conflict? - "I would like to talk to you about the unit policies regarding break time." A nurse in the emergency department is caring for a client who is at 9 weeks gestation and reports nausea and vomiting for the past 2 days. Which of the following findings should the nurse expect? - Urine specific gravity 1.052 A nurse is caring for an older adult client who is experiencing chronic anorexia and is receiving enteral tube feedings. Which of the following laboratory values indicates that the client needs additional nutrients added to the feeding? - Albumin 2.8 g/dL A nurse is conducting group therapy with clients who have breast cancer. The nurse should recognize which of the following statements by a client is an example of altruism. - "I told my doctor that I would like to start a support group for other women who are sick in my community." A nurse is providing dietary teaching to a client who has a new prescription for phenelzine. Which of the following food recommendations should the nurse make? - Broccoli Yogurt Cream cheese A nurse is assessing a client for compartment syndrome. Which of the following findings should the nurse expect? - Edema A nurse is providing discharge teaching about disease management for a client who has a new diagnosis of type 1 diabetes mellitus. Which of the following activities is the nurse's priority? - Ensure that the client understands the medication regimen. A nurse at an urgent care clinic is assessing a client who reports impaired vision in one eye. Which of the following reports by the client should indicate to the nurse that the client has a detached retina? - Floating dark spots A nurse on a medical-surgical unit is assessing a client who has had a stroke. For which of the following findings should the nurse initiate a referral for occupational therapy? - Difficulty performing ADLs A nurse is assessing a client following a colonoscopy. Which of the following findings should indicate to the nurse that the client is hemorrhaging? - Rapid decrease in blood pressure A nurse is caring for a client who recently signed an informed consent form to donate a kidney to her sibling who has end-stage kidney disease. The donor states to the nurse, "I don't want my brother to die, but what if I need this kidney one day?" Which of the following responses should the nurse make? - "You're afraid that your other kidney will fail at some point after the organ donation." A nurse is assessing a client who has pulmonary edema. Which of the following findings should the nurse expect? - Pink, frothy sputum A nurse administers an incorrect dose of a medication to a client. The nurse recognizes the error immediately and completes an incident report. Which of the following facts related to the incident should the nurse document in the client's medical record? - Time the mediation was given A nurse is caring for a client who is postoperative after receiving moderate (conscious) sedation. The client suddenly becomes restless and reports feeling lightheaded. Which of the following actions should the nurse take? - Check the client's oxygen saturation level. A nurse in an emergency department is assessing a school-age child who was brought in by their parents and has scald burns to both hands and wrists. The nurse suspects physical abuse. Which of the following actions should the nurse take? - Contact Child Protective Services. A nurse is caring for a 2-month-old infant who has Hirschsprung disease (HD). Which of the following areas should the nurse assess for manifestations of HD? - C lower abdomen A nurse is admitting a client to the psychiatric unit after attempting suicide. The client states, "My family does not care whether I live or die." Which of the following responses should the nurse make? - "How does this make you feel?" A nurse is providing discharge teaching for the parents of a preschool-age child who has a new prescription for amoxicillin/clavulanate suspension. Which of the following instructions should the nurse include in the teaching? - "Shake the medication bottle well before each dose is given." "Store the medication in the refrigerator." "Report diarrhea to the provider immediately." A nurse on a medical-surgical unit is caring for a client who has a new diagnosis of terminal cancer. The client tells the nurse that they would like to go home to be with family and loved ones. Which of the following actions should the nurse take? - Make a referral for social services. A nurse is assessing a client who has a chest tube. Which of the following findings should the nurse expect? - Occlusive dressing on the insertion site A nurse is preparing to transfer a client who has had a stroke to a rehabilitation facility. The client's family tells the nurse they are concerned about the level of care the client will receive. Which of the following actions should the nurse take? - Facilitate an interdisciplinary conference at the new facility for the family. A nurse is assessing a client who has major depressive disorder and is taking amitriptyline. Which of the following findings should the nurse identify as an adverse effect of the medication? - Blurred vision A charge nurse is providing an educational session about infection control for a group of staff nurses. Which of the following statements by one of the staff nurses indicates an understanding of isolation precautions? - "A client who requires airborne precautions should be placed in a negative-pressure airflow room." A nurse is preparing to administer a blood transfusion to a client. Which of the following procedures should the nurse follow to ensure proper client identification? - Verify the client and blood product information with another licensed nurse. A nurse in a mental health clinic is assessing a client who has a history of seeking counseling for relationship problems. The client shows the nurse multiple superficial self-inflicted lacerations on their forearms. The nurse should identify these behaviors as characteristics of which of the following personality disorders? - Borderline A nurse is caring for a client who has type 1 diabetes mellitus and reports sever ankle pain after falling off a stepstool at home. Which of the following prescriptions should the nurse clarify with the provider? - Apply a cold pack to the client's ankle for 30 min every hour.