ATI Comprehensive Final Exam

A nurse in an emergency department completes an assessment on an adolescent client that has conduct disorder. The client threatened suicide to teacher at school. Which of the following statements should the nurse include ...

A nurse in an emergency department completes an assessment on an adolescent client that has conduct disorder. The client threatened suicide to teacher at school. Which of the following statements should the nurse include in the assessment? a) Tell me about your siblings b) Tell me what kind of music you like c) Tell me how often do you drink alcohol d) Tell me about your school schedule Correct Ans ~ c) Tell me how often do you drink alcohol A nurse is observing bonding to the client her newborn. Which of following actions by the client requires the nurse to intervene? a) Holding the newborn in an en face position b) Asking the father to change the newborn's diaper c) Requesting the nurse take the newborn nursery so she can rest d) Viewing the newborn's actions to be uncooperative Correct Ans ~ d) Viewing the newborn's actions to be uncooperative A nurse is caring for client who is taking levothyroxin. Which of the following findings should indicate that the medication is effective? a) Weight loss b) Decreased blood pressure c) Absence of seizures d) Decrease inflammation Correct Ans ~ a) Weight loss A nurse is planning discharge teaching for cord care for the parent of a newborn. Which instructions would you include in the teaching? a) Contact provider if the cord still turns black b) Clean the base of the cord with hydrogen peroxide daily c) Keep the cord dry until it falls off d) The cord stump will fall off in five days Correct Ans ~ c) Keep the cord dry until it falls off A nurse is assessing a client in the PACU. Which of the following findings indicates decreased cardiac output? a) Shivering b) Oliguria c) Bradypnea d) Constricted pupils Correct Ans ~ b) Oliguria A nurse is assisting with mass casualty triage: explosion at a local factory. Which of the following client should the nurse identify as the priority? a) A client that has massive head trauma b) A client has full thickness burns to face and trunk c) A client with indications of hypovolemic shock d) A client with open fracture of the lower extremity Correct Ans ~ c) A client with indications of hypovolemic shock A nurse is a receiving report on four clients. Which of the following clients should the nurse assess first? a) A client who has illeal conduit and mucus in the pouch b) Client pleasant arteriovenous additional vibration palpated c) A client whose chronic kidney disease with cloudy diasylate outflow d) A client was transurethral resection of the prostate with a red tinged urine in the bag Correct Ans ~ c) A client whose chronic kidney disease with cloudy diasylate outflow A nurse is caring for a client just received the first dose of lisinopril. The following is an appropriate nursing intervention? a) Place's cardiac monitoring b) Monitor the clients oxygen saturation level c) Provide standby assist with the client from bed d) Encourage foods high in potassium Correct Ans ~ c) Provide standby assist with the client from bed A nurse is caring for a client who is in labor and his seat is receiving electronic fetal monitoring. The nurse is reviewing the monitor tracing and notes early decelerations. Which the following should the nurse expect? a) Feta hypoxia b) Abrupto placentae c) Post maturity d) Head Compression Correct Ans ~ d) Head Compression A nurse is caring for a client who has chronic kidney disease. The nurse should identify which of the following laboratory values as in an indication for hemodialysis? a) glomerular filtration rate of 14 mL/ minute b) BUN 16 mg/DL c) serum magnesium 1.8 mg mg/dl d) Serum phosphorus 4.0 mg/dL Correct Ans ~ a) glomerular filtration rate of 14 mL/ minute A nurse is caring for an infant who has a prescription for continuous pulse oximetry. The following is an appropriate action for the nurse to take? a) Placed infant under radiant warmer b) Move the probe site every 3 hours c) Heat the skin one minute prior to placing the program d) Placed a sensor on the index finger Correct Ans ~ c) Heat the skin one minute prior to placing the program