ATI Testing - Nursing Concepts Advanced Test. with complete solutions

A nurse is caring for a client who is receiving parenteral nutrition through a nontunneled central venous catheter and reports hearing a gurgling sound on the side of the catheter. The nurse suspects the catheter has migrated to the jugular vein. Which of the following actions should the nurse take first? a. notify the provider b. obtain a chest x-ray c. flush the catheter d. stop the infusion d. stop the infusion A nurse is caring for a client who was admitted for acute alcohol delirium withdrawal 2 days ago. Which of the following findings is associated with this diagnosis? a. increased appetite b. elevated temperature c. bradycardia d. drowsiness b. elevated temperature A nurse is reinforcing teaching with a client who is prescribed buspirone (BuSpar). Which of the following statements by the client indicates an understanding of the teaching? a. "I will only be on this medication 4 to 6 months because it can lead to physical dependence." b. "I can have 1 to 2 alcoholic beverages each week." c. "I will need to stop taking Xanax two weeks before I can begin taking this medication." d. "I can have 6 to 8 ounces of grapefruit juice each day." b. "I can have 1 to 2 alcoholic beverages each week." A nurse is caring for a client who has a urinary tract infection and is prescribed ciprofloxacin (Cipro). The client exhibits urticaria and angioedema following administration of the medication. Which of the following is the first action the nurse should take? a. administer epinephrine (Adrenaline) b. elevate the lower extremities c. determine respiratory status d. apply oxygen via non-breather mask c. determine respiratory status A nurse is caring for a school-age child who is newly diagnosed with type 1 diabetes mellitus. Which of the following actions by the nurse is appropriate to prepare the child for administration of insulin? a. provide a toy doctor's kit to play with b. keep all syringes and needles out of sight until needed c. use an approach that is firm but direct d. allow the child to manipulate the medical equipment d. allow the child to manipulate the medical equipment A nurse is caring for a neonate who was delivered at 30 weeks of gestation after his mother received two injections of betamethasone (Celestone). Because of the administration of betamethasone to the client's mother, the nurse should monitor the neonate for which of the following effects? a. tachycardia b. sternal retractions c. hypoglycemia d. hypothermia c. hypoglycemia A nurse working in a hospice is talking to a client's son who is distressed because his mother cries frequently and says she wants to die. Which of the following responses by the nurse is appropriate? a. "I know this must be difficult, but your mother will calm down soon." b. "Let's discuss some strategies you can use when this happens again." c. "Individuals near death are ready to let go toward the end." d. "Have you determined why she is crying and saying she is ready to die?" b. "Let's discuss some strategies you can use when this happens again." A nurse is reinforcing teaching about client consent to treatment with a group of newly licensed nurses. Which of the following statements by a newly licensed nurse indicates a need for further teaching? a. "It is necessary to have written consent for invasive procedures." b. "Implied consent is appropriate for some aspects of nursing care." c. "It is the responsibility of the provider to obtain express consent." d. "Informed consent should be obtained separately for each surgical procedure." c. "It is the responsibility of the provider to obtain express consent." A nurse is reinforcing teaching with the caregiver of a client who has aphasia. The nurse should include which of the following communication strategies in the teaching? a. cue the client by providing picture cards that portray common needs b. increase the volume of the voice when speaking to the client c. encourage the client to limit hand gestures when communicating d. vary the use of phrases and terminology in discussions a. cue the client by providing picture cards that portray common needs A nurse at a long-term care facility is participating in a quality improvement project to reduce the occurrence of pressure ulcers. Which of the following audits should be conducted to determine the impact of a new skincare regimen on the incidence of pressure ulcers among clients who are immobile? a. prospective audit b. outcome audit c. process audit d. structure audit b. outcome audit A nurse is caring for a client who has an acid-base imbalance. For which of the following manifestations is metabolic alkalosis a possible complication? a. hyperkalemia b. severe diarrhea c. atelectasis d. excessive vomiting d. excessive vomiting