ATI NCLEX prep review 2025
Questions and Answers 100% Solved
A client is receiving home oxygen. What teaching points should the nurse provide
the client and the caregiver regarding home oxygen safety? - ....ANSWER ...-
Since oxygen is combustible, the following nursing actions are important for the
nurse to implement: Post ""No Smoking"" or ""Oxygen in Use"" signs to alert
others of the fire hazard. Know where to find the closest fire extinguisher. Educate
about the fire hazard of smoking with oxygen use. Have clients wear a cotton
gown because synthetic or wool fabrics can generate static electricity. Ensure that
all electric devices (razors, hearing aids, radios) are working well. Make sure all
electric machinery (monitors, suction machines) is grounded. Do not use volatile,
flammable materials (alcohol, acetone) near clients receiving oxygen.
How should the nurse respond when a client asks the purpose of an advance
directive? - ....ANSWER ...-The purpose of advance directives is to
communicate a client's wishes regarding end-of-life care should the client become
unable to do so. The PSDA requires asking all clients on admission to a health care
facility whether they have advance directives. Staff should give clients who do not
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,have advance directives written information that outlines their rights related to
health care decisions and how to formulate advance directives. A health care
representative should be available to help with this process.
List at least three (3) priority considerations when performing a sterile dressing
change. - ....ANSWER ...-Prolonged exposure to airborne micro-organisms
can make sterile items non-sterile.
Avoid coughing, sneezing, and talking directly over a sterile field.
Air movement should be controlled by special ventilation.
Only sterile items may be in a sterile field.
A nurse is caring for an elderly client with constipation. What are three (3)
complications to monitor for during care of this client? - ....ANSWER ...-
Complications of constipation include: Fecal impaction. Development of
hemorrhoids or rectal fissures. Bradycardia, hypotension, and syncope associated
with the Valsalva maneuver (occurs with straining/bearing down).
A nurse is caring for a client with severe nausea and vomiting. What are
manifestations of possible dehydration and the need for IV fluid replacement? -
....ANSWER ...-Manifestations of dehydration include: hyperthermia
(dehydration), tachycardia, thready pulse, hypotension, orthostatic hypotension,
decreased central venous pressure, tachypnea (increased respirations), hypoxia,
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
, dizziness, syncope, confusion, weakness, fatigue; seizures (rapid/severe
dehydration), thirst, dry mucous membranes, dry furrowed tongue, nausea,
vomiting, anorexia, acute weight loss, oliguria, diminished capillary refill, cool
clammy skin, diaphoresis, sunken eyeballs, flattened neck veins, absence of tears,
decreased skin turgor
A nurse is reviewing medications while preparing to administer morning
medications. List three (3) risk factors that can cause a decrease in medication
effectiveness. - ....ANSWER ...-Risk factors that can cause a decrease in
medication effectiveness include increase body weight, genetics, tolerance to the
medication, inadequate gastric acid, diarrhea, vascular insufficiency, and prolonged
gastric emptying time.
Discuss passive and active immunity. - ....ANSWER ...-Passive: Antibodies
are produced by an external source. Temporary immunity that does not have
memory of past exposures. Intact skin, the body's first line of defense. Mucous
membranes, secretions, enzymes, phagocytic cells, and protective proteins.
Inflammatory response with phagocytic cells, the complement system, and
interferons to localize the invasion and prevent its spread
Active: Antibodies are produced in response to an antigen. Requires time to react
to antigens. Provides permanent immunity. Involves B- and T-lymphocytes.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
Questions and Answers 100% Solved
A client is receiving home oxygen. What teaching points should the nurse provide
the client and the caregiver regarding home oxygen safety? - ....ANSWER ...-
Since oxygen is combustible, the following nursing actions are important for the
nurse to implement: Post ""No Smoking"" or ""Oxygen in Use"" signs to alert
others of the fire hazard. Know where to find the closest fire extinguisher. Educate
about the fire hazard of smoking with oxygen use. Have clients wear a cotton
gown because synthetic or wool fabrics can generate static electricity. Ensure that
all electric devices (razors, hearing aids, radios) are working well. Make sure all
electric machinery (monitors, suction machines) is grounded. Do not use volatile,
flammable materials (alcohol, acetone) near clients receiving oxygen.
How should the nurse respond when a client asks the purpose of an advance
directive? - ....ANSWER ...-The purpose of advance directives is to
communicate a client's wishes regarding end-of-life care should the client become
unable to do so. The PSDA requires asking all clients on admission to a health care
facility whether they have advance directives. Staff should give clients who do not
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 1
,have advance directives written information that outlines their rights related to
health care decisions and how to formulate advance directives. A health care
representative should be available to help with this process.
List at least three (3) priority considerations when performing a sterile dressing
change. - ....ANSWER ...-Prolonged exposure to airborne micro-organisms
can make sterile items non-sterile.
Avoid coughing, sneezing, and talking directly over a sterile field.
Air movement should be controlled by special ventilation.
Only sterile items may be in a sterile field.
A nurse is caring for an elderly client with constipation. What are three (3)
complications to monitor for during care of this client? - ....ANSWER ...-
Complications of constipation include: Fecal impaction. Development of
hemorrhoids or rectal fissures. Bradycardia, hypotension, and syncope associated
with the Valsalva maneuver (occurs with straining/bearing down).
A nurse is caring for a client with severe nausea and vomiting. What are
manifestations of possible dehydration and the need for IV fluid replacement? -
....ANSWER ...-Manifestations of dehydration include: hyperthermia
(dehydration), tachycardia, thready pulse, hypotension, orthostatic hypotension,
decreased central venous pressure, tachypnea (increased respirations), hypoxia,
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 2
, dizziness, syncope, confusion, weakness, fatigue; seizures (rapid/severe
dehydration), thirst, dry mucous membranes, dry furrowed tongue, nausea,
vomiting, anorexia, acute weight loss, oliguria, diminished capillary refill, cool
clammy skin, diaphoresis, sunken eyeballs, flattened neck veins, absence of tears,
decreased skin turgor
A nurse is reviewing medications while preparing to administer morning
medications. List three (3) risk factors that can cause a decrease in medication
effectiveness. - ....ANSWER ...-Risk factors that can cause a decrease in
medication effectiveness include increase body weight, genetics, tolerance to the
medication, inadequate gastric acid, diarrhea, vascular insufficiency, and prolonged
gastric emptying time.
Discuss passive and active immunity. - ....ANSWER ...-Passive: Antibodies
are produced by an external source. Temporary immunity that does not have
memory of past exposures. Intact skin, the body's first line of defense. Mucous
membranes, secretions, enzymes, phagocytic cells, and protective proteins.
Inflammatory response with phagocytic cells, the complement system, and
interferons to localize the invasion and prevent its spread
Active: Antibodies are produced in response to an antigen. Requires time to react
to antigens. Provides permanent immunity. Involves B- and T-lymphocytes.
....COPYRIGHT ©️ 2025 ALL RIGHTS RESERVED...TRUSTED & VERIFIED 3
