ATI Standard Quiz- Medical surgical Final Exam with correct answers

ATI Standard Quiz- Medical surgical Final Exam A nurse is caring for a client who is to have his chest tube removed. Which of the following actions should the nurse take? A. Cover the insertion site with a hydrocolloid dressing after removal B. Provide pain medication immediately after removal C. Instruct the client to perform the Valsalva maneuver during removal D. Delegate removal of the chest tube to a LPN - ANS: C The nurse should instruct the patient to perform the Valsalva maneuver during removal to maintain the appropriate amount of negative pressure in the chest to prevent air entry into the pleural space. A nurse is caring for a client who begins having a tonic clonic seizure while sitting in a chair at the bedside. Which of the following actions should the nurse take first? A. Provide oxygen B. Place the client in a side lying position C. Provide privacy D. Lower the client to the floor - ANS: D A nurse is teaching a client how to perform a breast self exam. The nurse should identify which of the following findings as an indication of breast cancer? A. Lumps that are mobile and tender upon palpation prior to period B. Multiple round masses that are tender and found in both breasts C. Bilaterally darkened areolas D. A nontender, hard lump that is palpated in one breast - ANS: D