ATI NUR 2241 LP4 TEST WITH
CORRECT ANSWERS
A nurse is caring for an older adult client who has received three courses of
chemotherapy and has a WBC count of 2000/mm³. Which of the following
actions will the nurse take?
a. Add humidity to the client's room
b. Provide cooked fruit during meals
c. Soak dentures in a denture cup
d. Change water in flower vases daily. - ANSWER b. Provide cooked fruit
during meals
The nurse has accidentally stuck her hand with a syringe needle after giving a
client an IM injection. Which of the following is the first action that should be
taken by the nurse?
a. Informed charge nurse of the incident
b. Washed the area of the puncture thoroughly with soap and water
c. Filled out an incident report
d. Went to employee health services - ANSWER b. Washed the area of the
puncture thoroughly with soap and water
,A nurse has completed care activities for a client in airborne precautions. The
first of the following PPE items that the nurse should remove is
a. Mask
b. Gloves
c. Gown
d. Goggles ANS b. Gloves
A nurse is caring for a client who has a disposable, three-chamber chest tube
in place. The nurse should identify which of the following findings as
indicating that the client is developing a complication?
a. Constant bubbling in the waterseal chamber
b. Intermittent bubbling in the waterseal chamber
c. Constant bubbling in the suctioncontrol chamber
d. Variations in the fluid level of the waterseal chamber - ANSWER a.
Constant bubbling in the waterseal chamber
A nurse is assessing a client who has chronic respiratory insufficiency. Which
of the following manifestations does the nurse anticipate finding due to the
prolonged inadequate oxygenation?
, a. Restlessness
b. Retractions
c. Dependent edema
d. Clubbing of the fingers
A PACU nurse is providing care for a client with an endotracheal (ET) tube
who demonstrates that the left side of the chest wall is not rising when the
client inspires. The nurse suspects which of the following complications?
a. The client's tongue obstructing the ET tube
b. Displacement of the ET tube into the esophagus
c. Movement of the ET tube into the right main bronchus
d. Infection of the vocal cords - ANSWER c. Movement of the ET tube into the
right main bronchus
The nurse working in the emergency department is caring for a client who
was injured in a motor-vehicle crash. The client reports dyspnea and severe
pain. The nurse observes that the client's chest abnormally moves inward
during inspiration and bulges outward during exhalation. The nurse should
identify this finding as which of the following?
a. Atelectasis
b. Flail chest
CORRECT ANSWERS
A nurse is caring for an older adult client who has received three courses of
chemotherapy and has a WBC count of 2000/mm³. Which of the following
actions will the nurse take?
a. Add humidity to the client's room
b. Provide cooked fruit during meals
c. Soak dentures in a denture cup
d. Change water in flower vases daily. - ANSWER b. Provide cooked fruit
during meals
The nurse has accidentally stuck her hand with a syringe needle after giving a
client an IM injection. Which of the following is the first action that should be
taken by the nurse?
a. Informed charge nurse of the incident
b. Washed the area of the puncture thoroughly with soap and water
c. Filled out an incident report
d. Went to employee health services - ANSWER b. Washed the area of the
puncture thoroughly with soap and water
,A nurse has completed care activities for a client in airborne precautions. The
first of the following PPE items that the nurse should remove is
a. Mask
b. Gloves
c. Gown
d. Goggles ANS b. Gloves
A nurse is caring for a client who has a disposable, three-chamber chest tube
in place. The nurse should identify which of the following findings as
indicating that the client is developing a complication?
a. Constant bubbling in the waterseal chamber
b. Intermittent bubbling in the waterseal chamber
c. Constant bubbling in the suctioncontrol chamber
d. Variations in the fluid level of the waterseal chamber - ANSWER a.
Constant bubbling in the waterseal chamber
A nurse is assessing a client who has chronic respiratory insufficiency. Which
of the following manifestations does the nurse anticipate finding due to the
prolonged inadequate oxygenation?
, a. Restlessness
b. Retractions
c. Dependent edema
d. Clubbing of the fingers
A PACU nurse is providing care for a client with an endotracheal (ET) tube
who demonstrates that the left side of the chest wall is not rising when the
client inspires. The nurse suspects which of the following complications?
a. The client's tongue obstructing the ET tube
b. Displacement of the ET tube into the esophagus
c. Movement of the ET tube into the right main bronchus
d. Infection of the vocal cords - ANSWER c. Movement of the ET tube into the
right main bronchus
The nurse working in the emergency department is caring for a client who
was injured in a motor-vehicle crash. The client reports dyspnea and severe
pain. The nurse observes that the client's chest abnormally moves inward
during inspiration and bulges outward during exhalation. The nurse should
identify this finding as which of the following?
a. Atelectasis
b. Flail chest
