ATI.Capstone.Adult.Medical.Surgical.Assessme
nt.2
1..A.nurse.is.teaching.a.group.of.assistive.personnel.
(AP).about.caring.for.clients.who.have.Alzheimer's.disease..Which.of.the.following.information.
should.the.nurse.include.in.the.teaching?
Explain.procedures.in.full.detail.to.client.before.initiating.care
Limit.a.client's.activities.to.minimize.emotional.outbursts
Speak.clearly.and.loudly.to.a.client.who.is.unable.to.form.words.or.sentences.
Provide.supervision.to.prevent.a.client.from.becoming.injured.or.lost
Provide.supervision.to.prevent.a.client.from.becoming.injured.or.lost
A.client.who.has.Alzheimer's.disease.can.wander.and.become.lost..The.AP.should.initiate.interv
entions.to.keep.the.client.safe,.such.as.redirection,.frequent.monitoring,.and.reorientation..The.
AP.should.encourage.a.client.who.has.Alzheimer's.disease.to.participate.in.activities.for.as.long
.as.possible.because.socializing.with.others.can.provide.the.client.with.comfort.=.D
A.nurse.is.developing.a.plan.of.care.for.a.client.who.will.be.placed.in.halo.traction.following.sur
gical.repair.of.the.cervical.spine..Which.of.the.following.interventions.should.the.nurse.include.
in.the.plan?
Monitor.the.client’s.skin.under.the.halo.vest
A.nurse.is.providing.discharge.teaching.for.a.client.who.has.COPD.about.nutrition..Which.of.th
e.following.instructions.should.the.nurse.include?
Consume.high-calorie.foods
4..A.nurse.is.caring.for.a.client.who.has.anew.diagnosis.of.tuberculosis..Which.of.the.following.
precautions.should.the.nurse.initiate.to.prevent.transmission.of.the.disease?
Airborne.precautions
5..A.nurse.is.preparing.a.client.for.a.colonoscopy..Which.of.the.following.medications.should.th
e.nurse.anticipate.the.provider.to.prescribe.as.an.anesthetic.for.the.procedure?
Propofol
6..A.nurse.is.teaching.a.group.of.clients.about.the.risk.factors.for.osteoporosis..Which.of.the.fol
lowing.should.the.nurse.include.as.a.risk.factor.for.osteoporosis?
, Early.menopause
7..A.nurse.is.caring.for.a.client.who.has.a.peripherally.inserted.central.catheter.
(PICC)..For.which.of.the.following.findings.should.the.nurse.notify.the.provider?
The.dressing.was.changed.7.days.ago
8..A.nurse.is.reviewing.the.medical.record.of.a.client.who.has.unstable.angina..Which.of.the.fol
lowing.findings.should.the.nurse.report.to.the.provider?
Exhibit.1.-.Graphic.record:.BP.106/62.mm.Hg,.Temp.38°C.(100.4°F),.HR.112/
min,.Resp.rate.26/min,.urine.output.90.mL/h.hr
Exhibit.2.-.Nurse's.notes:.Skin.is.cool.&.moist.with.pallor.need.Bilateral.breath.sounds.with.crac
kles.heard.at.bases.of.lungs.
Pedal.pulses.are.present.at.1+.bilateral..Exhibit.3.-.Diagnostic.results:.Creatine.kinase
Breath.sounds
9..A.nurse.is.planning.care.for.a.group.of.postoperative.clients..Which.of.the.following.interven
tions.should.the.nurse.identify.as.the.priority?
Administer.oxygen.to.a.client.who.has.an.oxygen.saturation.of.91%
10..A.nurse.is.providing.discharge.teaching.to.a.client.who.has.heart.failure.and.a.prescription.f
or.furosemide.20.mg.PO.two.times.daily..Which.of.the.following.instructions.should.the.nurse.i
nclude.in.the.teaching?
Increase.intake.of.high-potassium.foods
A.nurse.is.teaching.a.client.who.has.hypertension.about.dietary.modifications.to.help.control.bl
ood.pressure..Which.of.the.following.food.choices.should.the.nurse.recommend.as.the.best.ch
oice.for.the.client.to.include.in.their.diet?
3.oz.of.chicken.breast
12..A.home.health.nurse.is.providing.teaching.to.the.family.of.a.client.who.has.a.seizure.disord
er..Which.of.the.following.interventions.should.the.nurse.include.in.the.teaching?
Position.the.client.on.their.side.during.a.seizure
13..A.nurse.is.assessing.a.client.who.has.meningitis..The.nurse.should.identify.which.of.the.foll
owing.findings.as.a.positive.Kernig's.sign?
After.hip.flexion,.the.client.is.unable.to.extend.their.leg.completely.without.pain
14..A.nurse.is.assessing.a.client.who.has.a.heart.rate.of.40/
min..The.client.is.diaphoretic.and.has.chest.pain..Which.of.the.following.medications.should.th
e.nurse.plan.to.administer?
nt.2
1..A.nurse.is.teaching.a.group.of.assistive.personnel.
(AP).about.caring.for.clients.who.have.Alzheimer's.disease..Which.of.the.following.information.
should.the.nurse.include.in.the.teaching?
Explain.procedures.in.full.detail.to.client.before.initiating.care
Limit.a.client's.activities.to.minimize.emotional.outbursts
Speak.clearly.and.loudly.to.a.client.who.is.unable.to.form.words.or.sentences.
Provide.supervision.to.prevent.a.client.from.becoming.injured.or.lost
Provide.supervision.to.prevent.a.client.from.becoming.injured.or.lost
A.client.who.has.Alzheimer's.disease.can.wander.and.become.lost..The.AP.should.initiate.interv
entions.to.keep.the.client.safe,.such.as.redirection,.frequent.monitoring,.and.reorientation..The.
AP.should.encourage.a.client.who.has.Alzheimer's.disease.to.participate.in.activities.for.as.long
.as.possible.because.socializing.with.others.can.provide.the.client.with.comfort.=.D
A.nurse.is.developing.a.plan.of.care.for.a.client.who.will.be.placed.in.halo.traction.following.sur
gical.repair.of.the.cervical.spine..Which.of.the.following.interventions.should.the.nurse.include.
in.the.plan?
Monitor.the.client’s.skin.under.the.halo.vest
A.nurse.is.providing.discharge.teaching.for.a.client.who.has.COPD.about.nutrition..Which.of.th
e.following.instructions.should.the.nurse.include?
Consume.high-calorie.foods
4..A.nurse.is.caring.for.a.client.who.has.anew.diagnosis.of.tuberculosis..Which.of.the.following.
precautions.should.the.nurse.initiate.to.prevent.transmission.of.the.disease?
Airborne.precautions
5..A.nurse.is.preparing.a.client.for.a.colonoscopy..Which.of.the.following.medications.should.th
e.nurse.anticipate.the.provider.to.prescribe.as.an.anesthetic.for.the.procedure?
Propofol
6..A.nurse.is.teaching.a.group.of.clients.about.the.risk.factors.for.osteoporosis..Which.of.the.fol
lowing.should.the.nurse.include.as.a.risk.factor.for.osteoporosis?
, Early.menopause
7..A.nurse.is.caring.for.a.client.who.has.a.peripherally.inserted.central.catheter.
(PICC)..For.which.of.the.following.findings.should.the.nurse.notify.the.provider?
The.dressing.was.changed.7.days.ago
8..A.nurse.is.reviewing.the.medical.record.of.a.client.who.has.unstable.angina..Which.of.the.fol
lowing.findings.should.the.nurse.report.to.the.provider?
Exhibit.1.-.Graphic.record:.BP.106/62.mm.Hg,.Temp.38°C.(100.4°F),.HR.112/
min,.Resp.rate.26/min,.urine.output.90.mL/h.hr
Exhibit.2.-.Nurse's.notes:.Skin.is.cool.&.moist.with.pallor.need.Bilateral.breath.sounds.with.crac
kles.heard.at.bases.of.lungs.
Pedal.pulses.are.present.at.1+.bilateral..Exhibit.3.-.Diagnostic.results:.Creatine.kinase
Breath.sounds
9..A.nurse.is.planning.care.for.a.group.of.postoperative.clients..Which.of.the.following.interven
tions.should.the.nurse.identify.as.the.priority?
Administer.oxygen.to.a.client.who.has.an.oxygen.saturation.of.91%
10..A.nurse.is.providing.discharge.teaching.to.a.client.who.has.heart.failure.and.a.prescription.f
or.furosemide.20.mg.PO.two.times.daily..Which.of.the.following.instructions.should.the.nurse.i
nclude.in.the.teaching?
Increase.intake.of.high-potassium.foods
A.nurse.is.teaching.a.client.who.has.hypertension.about.dietary.modifications.to.help.control.bl
ood.pressure..Which.of.the.following.food.choices.should.the.nurse.recommend.as.the.best.ch
oice.for.the.client.to.include.in.their.diet?
3.oz.of.chicken.breast
12..A.home.health.nurse.is.providing.teaching.to.the.family.of.a.client.who.has.a.seizure.disord
er..Which.of.the.following.interventions.should.the.nurse.include.in.the.teaching?
Position.the.client.on.their.side.during.a.seizure
13..A.nurse.is.assessing.a.client.who.has.meningitis..The.nurse.should.identify.which.of.the.foll
owing.findings.as.a.positive.Kernig's.sign?
After.hip.flexion,.the.client.is.unable.to.extend.their.leg.completely.without.pain
14..A.nurse.is.assessing.a.client.who.has.a.heart.rate.of.40/
min..The.client.is.diaphoretic.and.has.chest.pain..Which.of.the.following.medications.should.th
e.nurse.plan.to.administer?
