ATI Post Exam 1

A nurse is preparing a presentation about glucosamine to a group of clients. Which of the following information should the nurse include in the teaching? a. "Avoid using glucosamine with chondroitin." b. "Glucosamine can cause degradation of cartilage when used over a long time." c. "Avoid taking glucosamine if you have a shellfish allergy." d. "You can take glucosamine with an anticoagulant medication." - c. "Avoid taking glucosamine if you have a shellfish allergy." A nurse is caring for a client who has visual loss. Which of the following actions should the nurse implement? a. Remove all objects from the client's bedside table. b. Instruct the client to open items on the food tray. c. Walk a step behind the client when assisting with ambulation. d. Count steps to the bathroom with the client. - d. Count steps to the bathroom with the client. A nurse is discussing activity modification with a client who had a right THA. Which of the following statements should the nurse include in the information? a. "Plan to sit in a straight-backed chair when out of bed." b. "Place a pillow between your legs when lying in bed." c. "You can cross your legs at the ankles when sitting." d. "You should bend at the waist when tying your shoes." - b. "Place a pillow between your legs when lying in bed." A nurse is teaching a newly licensed nurse about preventing a CAUTI for a client who has an indwelling urinary catheter. Which of the following instructions should the nurse include? a. Ensure the urinary catheter tubing is not kinked. b. Rest the catheter bag on the floor when the client is sitting in a chair. c. Clean the perineal area with an antiseptic solution. d. Empty the collection bag for the client every 12 hr. - a. Ensure the urinary catheter tubing is not kinked. A nurse is reviewing the laboratory data of a client who is taking the herbal supplement feverfew to reduce the frequency of migraine headaches. The nurse should identify that which of the following findings indicates a potential contraindication to taking this herbal supplement? a. Potassium 3.5 mEq/L b. Platelet count 100,000/mm3 c. Cholesterol 250 mg/dL d. Urine bilirubin 0.2 mg/dL - b. Platelet count 100,000/mm3 A nurse is providing dietary teaching to a client who has heart failure. The nurse should identify which of the following client statements indicates an understanding of the teaching? a. "I will use homemade vinegar and oil dressings on my salads." b. "I should purchase low-calorie frozen meals for my lunches." c. "I should add salt when cooking my food so I do not add it at the table." d. "I will increase my dietary intake of processed cheese products." - a. "I will use homemade vinegar and oil dressings on my salads." A nurse is caring for a client who is postoperative and has a history of heart failure. The client reports slight dyspnea when ambulating. Which of the following findings should the nurse expect when performing a skin assessment? a. Petechiae over the client's chest and abdomen b. Tenting of the skin on the client's arm c. Shiny areas on the client's ankles and feet d. Dry, flaky skin on the client's arms and hands - c. Shiny areas on the client's ankles and feet A hospice nurse is planning end-of-life comfort care for a client. Which of the following interventions should the nurse include in the plan? a. Cover the client with an electric blanket if extremities become mottled. b. Provide frequent feedings during the day. c. Position the client on their side to improve breathing. d. Remove visitors from the room if the client becomes restless. - c. Position the client on their side to improve breathing. A nurse is assessing a client who has a sodium level of 124 mEq/L. Which of the following findings should the nurse expect? a. Reports thirst b. Decreased consciousness c. Reports constipation d. Swollen tongue - b. Decreased consciousness A nurse is teaching a client who has a prescription for continuous ambulatory peritoneal dialysis. Which of the following instructions should the nurse include? a. Eat a low-fiber diet to maintain dialysate flow. b. Warm the dialysate in the microwave before instillation. c. Expect the dialysate outflow to appear cloudy. d. Allow the dialysate to dwell for 4 hr during each exchange. - d. Allow the dialysate to dwell for 4 hr during each exchange. A nurse is caring for a client who has an endotracheal tube. Which of the following actions should the nurse take? a. Perform endotracheal suctioning on the client every hour. b. Use clean technique to suction the client's endotracheal tube. c. Increase the oxygen flow before suctioning the client's endotracheal tube. d. Instill 0.9% sodium chloride into the client's endotracheal tube before suctioning. - c. Increase the oxygen flow before suctioning the client's endotracheal tube. A nurse is providing hydrotherapy for a client who has full-thickness burns on the lower leg. Which of the following actions should the nurse take? a. Perform the hydrotherapy three times per week. b. Wash the client's burns with mild soap. c. Rinse the client's burns with cold water. d. Immerse the client in a whirlpool tub. - b. Wash the client's burns with mild soap. A nurse is providing discharge teaching with a client who has a new ileostomy. Which of the following instructions should the nurse include? a. Empty the ileostomy pouch when it is one-third full. b. Take a laxative for constipation. c. Remove the pouch system once a day for 1 hr. d. Increase intake of high-fiber foods. - a. Empty the ileostomy pouch when it is one-third full. A nurse is assessing a client who has multiple sclerosis (MS). Which of the following findings should the nurse expect? a. Reduced sense of taste b. Anorexia c. Spasticity d. Negative Babinski's reflex - c. Spasticity A nurse is assessing a client who is receiving head and neck radiation therapy to treat esophageal cancer. The nurse should identify which of the following findings as an adverse effect of this treatment? a. The client has a productive cough. b. The client reports peripheral neuropathy. c. The client reports a dry mouth. d. The client reports diarrhea. - c. The client reports a dry mouth. A nurse is teaching a client who has a new diagnosis of venous insufficiency. Which of the following instructions should the nurse include? a. "Keep your legs below the level of your heart when in bed." b. "Avoid sitting for long periods of time." c. "Roll compression stockings down to your ankles if they become too constricting." d. "Restrict crossing your legs at the knees to 20-minute intervals." - b. "Avoid sitting for long periods of time." A nurse is assessing a client who has an endotracheal tube and is receiving mechanical ventilation. The client is agitated and appears to be in respiratory distress. Which of the following actions should the nurse take first? a. Manually ventilate the client using a bag-valve device. b. Suction the client's endotracheal tube. c. Contact the respiratory therapist to check the client's ventilator. d. Obtain arterial blood gases from the client. - a. Manually ventilate the client using a bag-valve device. A nurse is assisting with a paracentesis for a client who has ascites. Which of the following actions should the nurse take? a. Place the client's peritoneal fluid specimen in the refrigerator following the procedure. b. Position the client into a left lateral position for the procedure. c. Weigh the client before the procedure. d. Instruct the client to have a full bladder during the procedure. - c. Weigh the client before the procedure. A nurse is teaching a client who is receiving radiation therapy to treat uterine cancer and reports nausea. Which of the following instructions should the nurse include? a. Eat foods that are prepared at a warm temperature. b. Sip small amounts of fluids frequently. c. Choose low-carbohydrate foods. d. Discontinue antiemetics when nausea is absent. - b. Sip small amounts of fluids frequently. A nurse is reviewing the WBC differential count of a client who's postoperative. The nurse should identify that which of the following findings is a manifestation of a bacterial wound infection? a. Neutrophil count 9,000/mm3 b. Basophil count 75/mm3 c. Eosinophil count 200/mm3 d. Monocyte count 600/mm3 - a. Neutrophil count 9,000/mm3 A nurse is caring for a client who is postop and has a self-contained closed-wound drainage system. Which of the following actions should the nurse take? a. Use clean technique to empty the reservoir. b. Secure the drain to the client's sheets after emptying. c. Cleanse the drain opening with chlorhexidine gluconate before emptying. d. Compress the reservoir after emptying. - d. Compress the reservoir after emptying.