ATI correct answers

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1. A nurse is caring for a client who is at 33 weeks of gestation following an amniocentesis. The nurse should monitor the client for which of the following complications? a. Vomiting b. Hypertensi ... on c. Epigastric pain d. Contractions (Rationale: post procedures notify HCP immediately for bleeding, contractions. ATI book pg 119.) 2. A nurse is providing teaching to an older client about methods to promote nighttime sleep. Which of the following instructions should the nurse include? a. Stay in bed at least 1 hr if unable to fall asleep b. Take a 1 hr nap during the day c. Preform exercises prior to bedtime d. Eat a light snack before bedtime 3. A nurse on a telemetry unit is caring for a client who becomes unconscious and whose monitor displays ventricular tachycardia. Which of the following actions should the nurse take first after determining the client does not have a palpable pulse? a. Assess heart sounds b. Defibrillate ( Rationale: V-tach= >150 bpm it decreases cardiac output, if there’s a pulse do a cardioversion but PULSELESS you defibrillate) c. Establish IV access d. Administer epinephrine 4. A nurse is admitting a client who is 1 week postpartum and reports excessive vaginal bleeding. The nurse does not speak the same language as the client. The client’s partner and 10-year old child are accompanying her. Which of the following actions should the nurse take to gather the client's admission data? a. Have the clients child translate b. Allow the clients partner to translate c. Request a female interpreter through the facility d. Ask a nurse student who speaks the same language as the client to translate 5. A nurse is caring for a client who is febrile. To reduce the clients fever, the nurse applies a cooling blanket. Which of the following findings indicates the client is having an adverse reaction to the cooling? a. Flushing b. Tachycardia c. Restlessness d. Shivering 6. A nurse is caring for a client who has deep-vein thrombosis of the left lower extremity. Which of the following actions should the nurse take? a. Position the client with the affected extremity lower than the heart (elevate instead; arteries dangle, veins elevate) b. Withhold heparin IV infusion c. Administer acetaminophen (Rationale: TX; NSAID, heparin, Coumadin, thrombolytic, altepase pg 62 ATI book) d. Massage the affected extremity every 4 hr 7. A nurse is reviewing assessment data from several clients. For which of the following clients should the nurse recommend referral to a dietitian? a. An older adult client who has a BMI of 24 b. A client who has a non healing leg ulcer c. An older client who has presbyopia d. A client who has an albumin level of 3.7 g/dL 8. A nurse is providing discharge teaching who has chronic kidney disease and is receiving hemodialysis. Which of the following instructions should the nurse include in the teaching? a. Eat 1 g/dL of protein per day (Diet is moderate protein (1-4g/dl), high carbs)) b. Take magnesium hydroxide for indigestion (cant excrete) c. Drink at least 3 L of fluid daily (cant excrete) d. Consume foods high in potassium (cant excrete, already in hyperkalemia) 9. A nurse is caring for a client who is receiving intermittent enteral tube feedings. Which of the following places the client at risk for aspiration? a. Sitting in a high fowler's position during the feeding b. A history of gastroesophageal reflux disease c. Receiving a high osmolality formula d. A residual of 65 mL 1 hr postprandial (residual has to be 500 ml> for risk for aspiration, NCLEX book says 250ml) 10. A nurse is providing parental teaching to a client who is at 12 weeks of gestation. The nurse should tell the client that she will undergo which of the following screening tests at 16 weeks of gestation? a. Chorionic villus sampling (9-10wks) b. Cervical cultures for chlamydia (1st trimester) c. Nonstress test (3rd trimester) d. Maternal serum alpha-fetoprotein ( done 16-18 wks, if decreased= down syndrome, if increased= neural tube defect) 11. A nurse is caring for a client who is on bed rest. The nurse should recognize that which of the following findings is a complication of immobility? a. Decreased serum calcium levels b. Increased blood pressure c. Swollen area on calf (Rationale: possible DVT) d. Urinary frequency 12. A nurse in a acute care mental health facility is participation in a medication-education group. The leader of the group uses a laissez-faire leadership style. Which of the following actions should the nurse expect from the leader during the session? a. The leader encourages group members to remain silent until questions are called for b. The leader lectures medication adverse effects to the group members c. The leader allows the group to discuss whatever they would like to regarding their medications d. The leader has group members vote on what they would like to learn about during the session 13. A nurse is providing teaching about digoxin administration to the parents of a toddler who has heart failure. Which of the following statements should the nurse include in the teaching? a. “You can add the medication to half-cup of your child's favorite juice” b. “Repeat the dose of your child vomits within 1 hr after taking the medication” c. “Limit your child's potassium intake while she is taking the medication” d. “Have your child drink a small glass of water after swallowing the medication” 14. A nurse is providing teaching to a client who has a depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse instruct the client to avoid? a. Grapefruit b. Spinach c. Cottage cheese ( has to be aged cheese for toxicity) d. Smoked salmon (Rationale: avoid aged cheese, cured or smoke meat or fish, sauage, salami, beer, wine, soy,) 15. A nurse is planning care for a client who has COPD and weighs 99 lbs. The provider has prescribed a diet of 1.5 g protein/kg/day. How many grams of protein per day should the nurse include in the client's dietary plan? (round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero) 68g/day (Rationale: 99 /2.2= 45 x 1.5= 67.5 (68g/day) 16. A nurse is planning care for a client who has bipolar disorder and is experiencing mania. Which of the following intervention should the nurse include in the plan? a. Encourage the client to spend time in the day room b. Withdraw the client's TV privileges if he doesn't attend group thera [Show More]

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