ATI PN EXIT EXAM

1. A nurse is making a follow-up call to a client who has a new prescription for an ACE inhibitor to treat hypertension. The client reports lightheadedness upon standing. Which of the following statements should the nurse make? A. "Sit back down for a few minutes when this occurs." B. "Restrict your daily fluid intake." C. "Discontinue this medication if this occurs again." D. Take a daily potassium supplement." A. "Sit back down for a few minutes when this occurs." 1. A nurse is caring for a client who has dehydration due to diarrhea. Which of the following findings should the nurse report to the provider? A. BUN 18 mg/dL B. Urine output 12 mi/hr C. Urine specific gravity 1,020 D. Serum creatinine 1.0 mg/di B. Urine output 12 mi/hr 1. A nurse is collecting data from a client who uses a continuous positive airway pressure (CPAP) machine at night for sleep apnea. The nurse should identify which of the following findings is an indication of proper CPAP use? A. The mask is secured over the client's mouth and the client's nose is uncovered. B. The therapeutic dose of albuterol is being inhaled. C. There is one finger width between the strap on the mask and the client's face. D. The mask fits loosely so air can escape from underneath. B. The therapeutic dose of albuterol is being inhaled. 1. A nurse is reinforcing teaching with a parent of a preschooler about immunizations. Which of the following statements by the parent indicates an understanding of the teaching? A. "My child will need to start the human papillomavirus series when he enters kindergarten" B. "I understand that immunizations will be withheld if my child has lactose intolerance" C. "It is recommended that my child receive his first flu immunization at the age of 6" D. "I can make several office visits, so my child does not get so many immunizations at once." D. "I can make several office visits, so my child does not get so many immunizations at once." 1. A charge nurse in a long-term care facility is discussing ethical theories with a group of newly licensed nurses. Which of the following statements should the charge nurse identify as an indication that a newly licensed nurse understands utilitarianism? A. "I will withhold a terminal diagnosis from a client who has cancer." B. "I will respect the decision of a client who has a chronic illness to stop treatment. C. "I will place a higher emphasis on human dignity than on the needs of a D. "I will consider what is going to benefit the most people when making decisions" B. "I will respect the decision of a client who has a chronic illness to stop treatment. 1. A nurse is transcribing a client's prescription for erythromycin 500 mg four times per day. Which of the following information should the nurse clarify with the provider? A. Medication B. Dosage C. Route D. Time C. Route Rationale: There is no indicated route which is necessary for carrying out order 1. A nurse is reviewing the medication administration record of a client who takes atenolol PO and applies a nitroglycerin transdermal patch daily. For which of the following interactions should the nurse monitor this client? A. Dry cough B. Hypotension C. Thrombocytopenia Hyperglycemia B. Hypotension 1. A nurse is reviewing the laboratory values of a client who has COPD. Which of the following findings should the nurse report to the provider? A. WBC 13.000/mm2 B. Potassium 3.7 mEq/L C. Iron 150 mcg/dL D. Hgb 20 g/dL. A. WBC 13.000/mm2 Rationale: COPD patients are at risk of lung infection. An elevated white blood cell (WBC) count should be reported to rule out lung infection. 1. A nurse is monitoring a client who is postoperative following a thyroidectomy. Which of the following findings should indicate to the nurse that the client is developing a thyroid storm? A. Increased incision and drainage B. Decreased body temperature C. Hypertension D. Bradycardia C. Hypertension 1. A nurse is planning care for four clients. Which of the following tasks should the nurse ask the charge nurse to reassign to an RN? A. Administering a subcutaneous insulin injection B. Removing an NG tube C. Collecting a sputum culture D. Providing discharge teaching about home IV medication therapy D. Providing discharge teaching about home IV medication therapy 1. A nurse in a family practice office routinely reviews clients' immunization status at their annual physical examination visits. For which of the following clients should the nurse recommend a human papillomavirus immunization? A. A teenage boy B. A preschool-age girl C. An older adult woman D. A middle adult man A. A teenage boy 1. A nurse is caring for a 2-year-old child who has Clostridium difficile. Which of the following actions should the nurse take? A. Initiate contact precautions. B. Place child in a room that has a HEPA filtration system. C. Use an N95 respirator. D. Instruct the parents to avoid bringing fresh flowers into the room. A. Initiate contact precautions. A nurse is giving a change-of-shift report on a group of clients. Which of the following statements should the nurse make? (Select all that apply.). A. The dient in room 204 has a new prescription for IV gentamicin. B. The client in room 205 has had several visitors today C. The client in room 203 will undergo surgery at 0900 tomorrow. D. The client in room 204 received some pain medicine earlier today. E. The client in room 205 is scheduled for a dressing change at 800," Rationale: the specified procedure is mentioned with specific time A. The dient in room 204 has a new prescription for IV gentamicin C. The client in room 203 will undergo surgery at 0900 tomorrow. A nurse overhears two assistive personnel discussing a client's medical history in the hallway. Which of the following actions should the nurse take first? A. Participate in an in-service about client confidentiality. B. Tell the staff members to stop their discussion. C. Report the incident to the charge nurse. D. Speak to the staff members in private about client confidentiality. B. Tell the staff members to stop their discussion. A nurse is reinforcing teaching with a client who has GERD and a prescription for pantoprazole. Which of the following statements indicates an understanding of the teaching? A. "I will need to remain upright for 1 hour after taking the medication." B. I have to take this medication on an empty stomach." C. "I should expect to have diarrhea while taking this medication." D. "I can take antacids at the same time as this medication. A. "I will need to remain upright for 1 hour after taking the medication." A nurse is assisting with preparing a client who is to have a central venous catheter inserted for the administration of total parenteral nutrition (TPN). Which of the following actions should the nurse take? A. Use clean technique when changing the catheter dressing. B. Prepare the client for a chest x-ray to verify catheter placement. C. Place the client in Sims position for catheter insertion D. verify the amount of TPN solution the client is receiving every 4 hr B. Prepare the client for a chest x-ray to verify catheter placement. A nurse is reinforcing teaching about toilet training with the guardians of a toddler who has a cognitive impairment. Which of the following instructions should the nurse include? A. Give the toddler a sticker after each successful toileting attempt. B. Have the toddler remain on the toilet for a minimum of 20 min. C. Entourage the toddler to flush the toilet while still seated, D. Wake the idler every 2 in the night to prevent tied wetting A. Give the toddler a sticker after each successful toileting attempt. A nurse is preparing a vitamin K injection to give to a newborn. The newborn's mother questions the purpose of the medication. Which of the following responses should the nurse make? A. This medication will decrease the possibility of your newborn developing jaundice." B. "This medication will decrease the risk of hemorrhage in your newborn." C. "This medication will increase the absorption of nutrients in the intestines. D. "This medication will increase the immunity of your newborn." B. "This medication will decrease the risk of hemorrhage in your newborn." A nurse is caring for a client who has end-stage kidney disease. The client has decided to stop dialysis treatment. Which of the following actions should the nurse take? A. Tell the client she should discuss this decision with her family. B. Support the client's decision to stop the treatment. C. Discuss alternative treatment methods with the client. D. Ask the facility chaplain to visit the client. B. Support the client's decision to stop the treatment. 20. A nurse is caring for a client who has schizophrenia. Which of the following behaviors of the client should the nurse identify as a negative symptom of schizophrenia? A. Has a preoccupation with religious thoughts B. Smells odors that don't exist? C. Mimics the nurse's movements D. Initiates speech rarely? D. Initiates speech rarely? Remember that positive symptoms are when symptoms are present (that are not considered typical), and that negative symptoms are a lack of normal function/thoughts/perceptions. A nurse is reinforcing teaching about common discomforts during the first trimester with a client who is at 10 weeks of gestation. Which of the following examples should the nurse include? A. Leukorrhea B. Diarrhea C. Burning during urination D. Swelling of the face D. Swelling of the face A nurse is reinforcing teaching with a client who has a prescription for ferrous sulfate elixir. Which of the following statements by the client indicates an understanding of the teaching? A. "I can prevent nausea if I take the medication on an empty stomach. B. "I will report black stools to my doctor." C. I can prevent constipation if I drink more milk while taking this medication." D. "I will mix the medication with a full glass of water! D. "I will mix the medication with a full glass of water! Mix with water or fruit juice to avoid temporary staining of the teeth, do not mix with milk. Avoid taking antacids, dairy products, tea, or coffee within 2 hours before or after this medication because they will decrease its effectiveness. A nurse is reinforcing teaching about hand hygiene with a newly licensed nurse. Which of the following information should the nurse include in the teaching? A. Interlace the fingers while rubbing hands together. B. Dry hands starting from forearm to fingers. C. Apply friction to hands for 10 seconds D. Use hot water to wash hands A. Interlace the fingers while rubbing hands together. A nurse in a long-term care facility is caring for a client who has methicillin-resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take? A. Remove personal protective equipment after leaving the client's room. B. Restrict the client's visitors. C. Ensure that the negative air pressure is active for the client's room. D. Wear a gown when assisting the client with personal hygiene. D. Wear a gown when assisting the client with personal hygiene. A nurse is assisting with the care of a client who is in the latent stage of labor and has pelvic pain with contractions. Which of the following actions should the nurse take? A. Tell the client to push during contractions. B. Encourage the client to soak in a hot bath. C. Apply fundal pressure during contractions. D. Instruct the client to change positions frequently. A. Tell the client to push during contractions. A nurse is reinforcing teaching about home safety precautions with the parents of a 3-month-old infant. Which of the following instructions should the nurse include in the teaching? A. Remove bibs when the infant is going to sleep. B. Start using a highchair for feedings. C. Place no more than one small pillow in the crib. D. Make sure the crib mattress is soft. A. Remove bibs when the infant is going to sleep. A nurse is assisting with a prenatal examination of a client who is at 8 weeks of gestation. The nurse notes that the client's vagina and vulva are a purplish color. The nurse should document this finding as which of the following? A. Ballottement B. Hegar's sign C. Chadwick's sign D. Chloasma C. Chadwick's sign 28. A nurse is reinforcing teaching with a new mother about facility security measures. Which of the following statements by the mother indicates an understanding of the teaching? A. "I will carry my baby to the nursery. B. "I will have an identification and that matches the one my baby wears C. " I can take my baby to the lobby to visit family. D. " I can remove my security and to the won a family member B. "I will have an identification and that matches the one my baby wears A nurse is caring for a client who adheres to kosher dietary practices. Which of the following foods should the nurse plan to offer the client? A. Bacon and eggs B. Chicken sandwich C. Shrimp and French fries D. Cheeseburger B. Chicken sandwich A nurse is applying antiembolic stockings for a client who is postoperative. Which of the following actions should the nurse take? A. Have the client point his toes before inserting his foot into the stocking. B. Remove the stockings once every 24 hr. C. Roll the top of the stocking down so it fits snugly above the client's calf. D. Elevate the client's legs for 5 min prior to applying the stockings. B. Remove the stockings once every 24 hr. A nurse is contributing to the plan of care for a client who is experiencing delirium. Which of the following interventions should the nurse recommend? A. Remind the client of the day and time often. B. Alternate daily caregivers. C. Avoid discussing the client's fears. D. Offer the client several choices at mealtimes. A. Remind the client of the day and time often. A nurse is caring for a client who is postoperative following abdominal surgery and has a wound evisceration. Which of the following actions should the nurse take? A. Hold gentle, direct pressure on the protruding organ. B. Place the client's knees in an extended position. C. Cover the wound with sterile, saline-soaked gauze. D. Raise the head of the bed to a 45° angle. C. Cover the wound with sterile, saline-soaked gauze. A nurse delegates a task to an assistive personnel (AP) and the AP refuses to complete the assigned task. Which of the following actions should the nurse take? A. Perform the task on behalf of the AP B. Report the AP to the risk manager. C. Discuss the AP's concerns about performing the task. D. Assign the task to another AP C. Discuss the AP's concerns about performing the task. A nurse is caring for a client who has a chlamydial infection and a new prescription for doxycycline. The client reports nausea and vomiting after starting the medication. Which of the following recommendations should the nurse make? A. Take the medication with an antacid.? B. Take the medication with crackers? C. Take the medication and then lay down for 30 min. D. Take the medication with calcium-fortified orange juice. B. Take the medication with crackers? A charge nurse is observing a newly licensed nurse perform suctioning for a client who has a tracheostomy. For which of the following actions by the newly licensed nurse should the charge nurse intervene? A. Auscultates breath sounds B. Preoxygenation with 100% oxygen C. Suctions for 30 seconds D. Applies suction during catheter removal C. Suctions for 30 seconds A nurse is collecting data from a client whose partner died 1 year ago. Which of the following findings indicates that the client is experiencing complicated grief? A. The client reports he has no interest in dating. B. The client attends a grief support group twice each month. C. The client keeps a framed picture of his partner on the wall. D. The client develops chest pain each time he talks about his partner. D. The client develops chest pain each time he talks about his partner. A nurse is collecting data from a client who is receiving magnesium sulfate via continuous IV infusion to treat preeclampsia. Which of the following findings indicates that the medication is having a therapeutic effect? A. Urinary output 20 mL/hr B. Positive clonus C. Respiratory rate 10/min D. Deep tendon reflexes 2+ D. Deep tendon reflexes 2+ . A nurse is completing postmortem documentation for a client. Which of the following information should the nurse include in the documentation? A. Last set of the client's vital signs B. Copy of the client's advance directives C. Location of the identification tag on the client's body D. Cause of the client's death A. Last set of the client's vital signs A nurse is caring for a client who has a chest tube that was inserted 4 days ago. Which of the following findings should the nurse report to the charge nurse? A. Blood pressure 110/70 mm Hg B. Respiratory rate 16/min C. Fluctuation in the water seal chamber with respiration D. 400 mL of drainage in the collection chamber within 4 hr D. 400 mL of drainage in the collection chamber within 4 hr A nurse is assisting with the care of a client following electroconvulsive therapy for the treatment of a depressive disorder. Which of the following findings should the nurse expect 15 min following the procedure? A. Disorientation B. Tonic-clonic seizures C. Sleep apnea D. Paresthesias A. Disorientation A nurse is reinforcing teaching with a client who has a new diagnosis of COPD. Which of the following statements by the client indicates an understanding of the teaching? A. I should practice pursed-lip breathing exercises." B. "I will consume low-protein, low-calorie foods." C. "I should do aerobic exercises once per day." D. "I will increase my fluid intake to 1.700 milliliters per day A. I should practice pursed-lip breathing exercises." A nurse is collecting data from a client who has anorexia nervosa. Which of the following findings should the nurse identify as a positive outcome of treatment? A. The client resumes menstruation. B. The client's potassium level is 2.7 mEq/L C. The client's pulse rate is 44/min. D. The client develops lanugo D. The client develops lanugo A nurse is caring for a client who is 2 days postoperative following a total bilateral mastectomy. The client is tearful and looks away when her surgical dressings are removed. The nurse should place the priority on which of the following actions? A. Providing the client with information on community resources that will strengthen her coping skills B. Encouraging the client to write about her feelings in a journal each day C. Demonstrating a nonjudgmental attitude toward the client when providing care for her surgical wounds D. Identifying the client's perception of the changes in her physical appearance C. Demonstrating a nonjudgmental attitude toward the client when providing care for her surgical wounds A nurse is contributing to the plan of care for a client who has ascites due to cirrhosis. Which of the following interventions should the nurse recommend to include in the plan? A. Measure the client's abdominal girth daily. B. Restrict the client's sodium intake to 3 g per day. C. Keep the client's daily protein intake below 0.8 g/kg. D. Position the client supine with legs elevated. A. Measure the client's abdominal girth daily. A nurse is reinforcing teaching with the guardians of a 6-year-old child who has cystic fibrosis. Which of the following information should the nurse include in the teaching? A. "Provide homeschooling for your child." B. "Do not include your child when making decisions about treatment." C. "Ensure that your child does not receive the influenza vaccine annually" D. "Have your child wear a medical identification wristband D. "Have your child wear a medical identification wristband A nurse is assisting with staff education about hand hygiene. Which of the following instructions should the nurse include in the teaching? A. Wash hands with soap and water for 20 seconds. B. Wear sterile gloves when in contact with body fluid. C. Use alcohol-based cleanser when hands are visibly soiled. D. Artificial nails can be worn when performing direct client care. A. Wash hands with soap and water for 20 seconds. A nurse is monitoring a client who has received external radiation for throat cancer. Which of the following findings should the nurse expect? A. Increased appetite B. Loose stools C. Loss of taste D. Bladder infection C. Loss of taste A nurse is caring for a client who is postoperative following a total knee arthroplasty. The client reports a pain level of 6 on a scale from 0 to 10. Which of the following medications should the nurse administer? A. Acetaminophen B. Oxycodone C. Celecoxib D. Ibuprofen B. Oxycodone A nurse is caring for a client who has depressive disorder. The client states. "Everyone would be better off if I were not around." Which of the following responses should the nurse make? A. "Are you thinking of hurting yourself? B. "What would your family do without you?" C. "Why would you think a thing like that? D. "When you get better you will not feel this way. A. "Are you thinking of hurting yourself?