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vati all exit exams questions and answers latest 2022 100% pass Patient refused a newly open fentanyl patch. Which of the following actions should the nurse take? ✔✔Ask another nurse to witness ... the disposal of the new patch. Client receiving heparin continuous IV infusion and warfarin 5 mg PO daily. Lab values are aPTT 98 seconds and INR 1.8 ✔✔Withhold the heparin infusion A nurse at an urgent care clinic is assessing a client who reports impaired vision in one eye . Which indicates the client has a detached retina ✔✔Floating dark spots infant with hydrocephalus 6 hr post op following ventriculoperitoneal shunt placement . finding to report to provider ✔✔Irritability when being held. signifies increased ICP Assessing a newborn heart rate follow actions the nurse should take ✔✔Auscultate the apical pulse and count beats for at least 1 min. Caring for a client who has a fecal impaction actions to be taken when digitally evacuating the stool ✔✔Insert a lubricated gloved finger and advance along the rectal wall. Dietary teaching for a new prescription of phenelzine ✔✔Broccoli, Yogurt, Cream Cheese Nurse administers incorrect dose of medication. Which facts related to incident report should the nurse document in the client's medical record? ✔✔Time the medication was given Nurse on pediatric unit received shift report on 4 children. Which should the nurse assess first? ✔✔A 10-year old child who is awaiting surgery for an appendectomy and experienced sudden relief of pain. Can indicate peritonitis from a ruptured appendix. Community health nurse providing teaching on home safety for older adults ✔✔Have grab bars installed around your bathtub and toilet. School age child with scald burns on both hands and wrists suspected abuse ✔✔Contact child protective services. Client who has acute blood loss following trauma refuses potentially life saving blood transfusion ✔✔Explore the client's reasons fro refusing the treatment Discussing common prenatal discomfort 20 weeks gestational ✔✔I will wear a supportive bra overnight Discharge instructions to client to received home oxygen therapy ✔✔Wear clothing made with cotton fabrics while oxygen is in use. Preparing an educational session about advocacy to a group of nurses ✔✔Advocacy is a leadership role that helps others to self actualize Continuous bladder irrigation following transurethral resection of prostate. Bladder spasms and decreased urinary output ✔✔Irrigate the catheter with 0.9% sodium chloride irrigation Child with sickle cell anemia and is having a vaso-occlusive crisis ✔✔Infuse IV fluids Client teaching about the basal body temp method for birth control ✔✔Your body temperature might decrease slightly just prior to ovulation Caring for a client who is unconscious and requires emergency medical procedures. Unable to locate family to obtain consent ✔✔Proceed with pr [Show More]

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