ATI RN COMPREHENSIVE PREICTOR B 1 180 QUESTIONS AN ANSWERS

1. A nurse is assessing a client who has left-sided heart failure. Which of the following will the nurse identify as the highest priority? A. Jugular distention B. Frothy pink septum C. Hepatomegaly D. Weight gain 2. A nurse in the emergency department is assisting with the suturing of a laceration to the client. Which of the following actions should the nurse take? A. Pour the sterile cleansing solution holding on the bottle10 cm(4 in) above the sterile field B. Pull the top flap of the suture tray towards the body when opening C. Place the bottle of local anesthetics 5 cm (2 in) inside the sterile field border. D. Drop the suture package on the sterile field from a distance of 30 cm (12 in) 3. A nurse is assessing a client 1 hr following delivery and notes that her uterus is boggy and located near the umbilicus. Which of the following actions should the nurse take fisrt? A. Massage the fundus B. Assess lochia C. Take vital signs D. Give oxytocin (Pitocin) IV bolus 4. A nurse in the emergency department is assisting with the suturing of a laceration to the client. Which of the following actions should the nurse take? A. Pour the sterile cleansing solution holding on the bottle10 cm(4 in) above the sterile field B. Pull the top flap of the suture tray towards the body when opening C. Place the bottle of local anesthetics 5 cm (2 in) inside the sterile field border. D. Drop the suture package on the sterile field from a distance of 30 cm (12 in) 5. A nurse is caring for a client who is 1 day postoperative following a hypophysectomy for removal of a pituitary tumor. Which of the following findings requires further assessment by the nurse? A. Urinary output greater than fluid intake B. Report of dry mouth C. Glasgow coma scale score of 15 D. Bloody drainage on the nasal dressings measuring 3 cm 6. A nurse in an emergency department is caring for a client who has multiple wounds due to a motor-vehicle crash. Which of the following interventions are appropriate? (Select all that apply) A. Apply direct pressure to bleeding wounds B. Clean lacerations and abrasions with hydrogen peroxide C. Administer 650 mg aspirin PO as needed for pain D. Cover the wound with sterile dressing E. Determine date of last tetanus toxoid vaccination