VATI Adult Medical Surgical
1. Pain radiating to the right shoulder.: A nurse is collecting data from a client who has
acute cholecystitis. Which of the following manifestations should the nurse expect?
2. "The medication prevents clot formation.": A nurse is reinforcing teaching with a
client who has a prescription for clopidogrel following a thrombotic stroke. Which of the
following information should the nurse include in the teaching?
3. Keep the client's body centered in the bed.: A nurse is contributing to the plan of care
for a client who is in skeletal traction. Which of the following interventions should the
nurse include?
4. Keep the client upright for 30 min after a meal.: A nurse is contributing to the plan
of care for a client who has dysphagia following a stroke. Which of the following actions
should the nurse include in the plan of care to prevent aspiration?
5. "Wear a protective eye shield while sleeping.": A nurse is reinforcing postop- erative
teaching with a client who is scheduled for cataract surgery on his right eye. Which of the
following instructions should the nurse include?
6. Nonresponsive to commands.: A nurse is collecting data from a client who was
admitted with a Glasgow coma scale (GCS) of 3. Which of the following findings should
the nurse expect?
7. Skin flap of the residual limb is cool to the touch.: A nurse is caring for a client who
has type 1 diabetes mellitus and has undergone a below-the-knee amputation. Which of the
following is the highest priority finding?
8. Inserting a polyurethane female condom is effective for prevention of STIs.-
: A nurse is reinforcing teaching about the prevention of sexually transmitted infec- tions
(STIs) which a client who is sexually active. Which of the following information should
the nurse include in the teaching?
9.Slow the rate of fluid flow.: A nurse is administering a tap water enema to a client who
has constipation. The client reports abdominal cramping during installation of the enema.
Which of the following actions should the nurse take?
10."I should have a mammogram every 1 to 2 years.": A nurse is reinforcing teaching
about mammograms which an adult client who is postmenopausal. Which of the following
statements indicates to the nurse that the client understands the teaching?
11.Fine crackles: A nurse is collecting data from a client and osculates intermittent high-
pitched sounds during inspiration over the lower base of the lungs. The nurse should
1/
, VATI Adult Medical Surgical
identify this finding as which of the following lung sounds?
12.A client who has chest tubes and an oxygen saturation of 90%: A nurse is assisting
with the care of four clients. Which of the following clients is the priority for the nurse to
see?
2/
1. Pain radiating to the right shoulder.: A nurse is collecting data from a client who has
acute cholecystitis. Which of the following manifestations should the nurse expect?
2. "The medication prevents clot formation.": A nurse is reinforcing teaching with a
client who has a prescription for clopidogrel following a thrombotic stroke. Which of the
following information should the nurse include in the teaching?
3. Keep the client's body centered in the bed.: A nurse is contributing to the plan of care
for a client who is in skeletal traction. Which of the following interventions should the
nurse include?
4. Keep the client upright for 30 min after a meal.: A nurse is contributing to the plan
of care for a client who has dysphagia following a stroke. Which of the following actions
should the nurse include in the plan of care to prevent aspiration?
5. "Wear a protective eye shield while sleeping.": A nurse is reinforcing postop- erative
teaching with a client who is scheduled for cataract surgery on his right eye. Which of the
following instructions should the nurse include?
6. Nonresponsive to commands.: A nurse is collecting data from a client who was
admitted with a Glasgow coma scale (GCS) of 3. Which of the following findings should
the nurse expect?
7. Skin flap of the residual limb is cool to the touch.: A nurse is caring for a client who
has type 1 diabetes mellitus and has undergone a below-the-knee amputation. Which of the
following is the highest priority finding?
8. Inserting a polyurethane female condom is effective for prevention of STIs.-
: A nurse is reinforcing teaching about the prevention of sexually transmitted infec- tions
(STIs) which a client who is sexually active. Which of the following information should
the nurse include in the teaching?
9.Slow the rate of fluid flow.: A nurse is administering a tap water enema to a client who
has constipation. The client reports abdominal cramping during installation of the enema.
Which of the following actions should the nurse take?
10."I should have a mammogram every 1 to 2 years.": A nurse is reinforcing teaching
about mammograms which an adult client who is postmenopausal. Which of the following
statements indicates to the nurse that the client understands the teaching?
11.Fine crackles: A nurse is collecting data from a client and osculates intermittent high-
pitched sounds during inspiration over the lower base of the lungs. The nurse should
1/
, VATI Adult Medical Surgical
identify this finding as which of the following lung sounds?
12.A client who has chest tubes and an oxygen saturation of 90%: A nurse is assisting
with the care of four clients. Which of the following clients is the priority for the nurse to
see?
2/
