RN Capstone Comprehensive Practice B / ATI Comprehensive Test B

A nurse is caring for a client who had abdominal surgery 24 hr ago. Which of the following actions is the nurse's priority? Correct Ans - Assist with deep breathing and coughing A nurse is talking with a client who has stage IV breast cancer. The nurse should recognize which of the following statements by the client as a constructive use of a defense mechanism? Correct Ans - "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 caring for a client who has immunosuppression and a continuous IV infusion. Which of the following actions should the nurse take? Correct Ans - Monitor the client's mouth every 8 hr 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? Correct Ans - C The nurse should assess the infant's abdomen for distention and visible peristalsis, which are manifestations of HD A nurse at a mental health clinic is caring for four clients. The nurse should recognize the following clients is using dissociation as a defense mechanism? Correct Ans - A client who was abused as a child describes the abuse as if it happened to someone else 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? Correct Ans - irritability 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? Correct Ans - A client who channels their energy into a new hobby following the loss of their job