ATI RN Adult Medical Surgical Online Practice 2019 A with options(Completed)

a nurse is caring for a client who has hepatic encephalopathy that is being treated with lactulose. the client is experiencing excessive stools. which of the following findings is an adverse effect of the medication? hypokalemia Lactulose works by stimulating the production of excess stools to rid the body of excess ammonia. These excessive stools can result in hypokalemia and dehydration. a nurse is caring for a client who has emphysema and is receiving mechanical ventilation. the client appears anxious and restless, and the high-pressure alarm is sounding. which of the following actions should the nurse take first? instruct the client to allow the machine to breathe for them. When providing client care, the nurse should first use the least restrictive intervention. Therefore, the first action the nurse should take is to provide verbal instructions and emotional support to help the client relax and allow the ventilator to work. Clients can exhibit anxiety and restlessness when trying to "fight the ventilator." 00:50 01:14 a nurse is teaching a client who has a family history of colorectal cancer. to help mitigate this risk, which of the following dietary alterations should the nurse recommend? add cabbage to the diet. To help reduce the risk for colorectal cancer, the client should consume a diet that is high in fiber, low in fat, and low in refined carbohydrates. Brassica vegetables, such as cabbage, cauliflower, and broccoli, are high in fiber. a home health nurse is assigned to a client who was recently discharged from a rehabilitation center after experiencing a right-hemispheric stroke. which of the following neurological deficits should the nurse expect to find when assessing the client? visual spatial deficits left hemianopsia one-sided neglect a nurse is caring for a client who has viral pneumonia. the client's pulse oximeter readings have fluctuated between 79% and 88% for the last 30 min. which of the following oxygen delivery systems should the nurse initiate to provide the highest concentration of oxygen? nonrebreather mask The nurse should initiate a nonrebreather mask to deliver between 80% to 95% oxygen to the client. A client who has an unstable respiratory status should receive oxygen via a nonrebreather mask. a nurse is caring for a client who has bilateral pneumonia and an SaO2 of 85%. the client has dyspnea with a productive cough and is using accessory muscles to breathe. which of the following actions should the nurse take first? place the client in high-fowler's position. The greatest risk to this client is injury from airway obstruction. Therefore, the priority intervention the nurse should take is to move the client into high-Fowler's position. High-Fowler's position facilitates lung expansion and improves ventilation and gas exchange. a nurse is planning care for a client who has extensive burn injuries and is immunocompromised. which of the following precautions should the nurse include in the plan of care to prevent a Pseudomonas aeruginosa infection. avoid placing plants or flowers in the client's room. Live plants can harbor P. aeruginosa, and this bacterium can infect burn wounds and cause life-threatening complications. The nurse should ensure no one brings live plants or flowers into the client's room. an older adult client is brought to an emergency department by a family member. which of the following assessment findings should cause the nurse to suspect that the client has hypertonic dehydration? Urine specific gravity of 1.045 A urine specific gravity greater than 1.030 indicates a decrease in urine volume and an increase in osmolarity, which is a manifestation of hypertonic dehydration. a nurse in an emergency department is reviewing the providers prescriptions for a client who sustained a rattlesnake bite to the lower leg. which of the following prescriptions should the nurse expect? administer an opioid analgesic to the client. The nurse should expect a prescription for an opioid analgesic to promote comfort following a rattlesnake bite. a nurse is assessing a client who has had a suspected stroke. the nurse should place the priority on which of the following findings? dysphagia Dysphagia indicates that this client is at greatest risk for aspiration due to impaired sensation and function within the oral cavity. Therefore, the nurse should place priority on this finding. a nurse is teaching a young adult client how to perform testicular self-examination. which of the following instructions should the nurse include? roll each testicle between the thumb and fingers. The nurse should instruct the client to roll each testicle horizontally between the thumbs and fingers to feel for any lumps deep in the center of the testicle. a nurse is providing instructions to a client who has type 2 diabetes mellitus and a new prescription for metformin. which of the following statements by the client indicates an understanding of the teaching? "I should take this medication with a meal." The client should take metformin with or immediately following meals to improve absorption and to minimize gastrointestinal distress. a nurse is teaching a client who has venous insufficiency about self-care. which of the following statements should the nurse identify as an indication that the client understands the teaching? "I will wear clean graduated compression stockings every day." The client should apply a clean pair of graduated compression stockings each day and clean soiled stockings with mild detergent and warm water by hand. a nurse is assessing a client who has acute cholecystitis. which of the following findings is the nurse's priority? tachycardia When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is tachycardia. Tachycardia is a manifestation of biliary colic, which can lead to shock. The nurse should position the head of the client's bed flat and report this finding immediately to the provider. a nurse is reviewing the health record of a client who is scheduled for allergy skin testing. the nurse should postpone the testing and report to the provider with if the following findings? current medications The nurse should review the client's medication record and identify medications, including ACE inhibitors, beta blockers, theophylline, nifedipine, and glucocorticoids, such as prednisone, that can alter the allergy skin test results. These medications can diminish the client's reaction to the allergens. The nurse should notify the provider and instruct the client to discontinue prednisone for 2 weeks before allergy skin testing. a nurse is caring for a group of clients. the nurse should plan to make a referral to physical therapy for which of the following clients? a client who is receiving preoperative teaching for a right knee arthroplasty The nurse should make a referral to physical therapy for a client who is receiving preoperative teaching for a knee arthroplasty so the client can begin understanding postoperative exercises and physical restrictions. a nurse is caring for a client who has DKA. which of the following laboratory findings should the nurse expect? BUN 32 mg/dl DKA results in osmotic diuresis and subsequent dehydration. The nurse should expect a client who has DKA to have elevated BUN, creatinine, and specific gravity levels resulting from the excess glucose present in the urine. a nurse is planning teaching for a client who has bladder cancer and is to undergo a cutaneous diversion procedure to establish a ureterostomy. which of the following statements should the nurse include in the teaching "you should cut the opening of the skin barrier one-eighth inch wider than the stoma." The client should cut the opening of the skin barrier 0.3 cm (1/8-in) wider than the stoma to minimize irritation of the skin from exposure to urine. a nurse is providing teaching for a female client who has recurrent urinary tract infections. which fo the following information should the nurse include in the teaching? void before and after intercourse. The nurse should instruct the client to empty her bladder before and after intercourse, which flushes bacteria out of the urinary tract and prevents the occurrence of infection. a nurse and an assistive personnel are caring for a client who has bacterial meningitis. the nurse should give the AP which of the following instructions? wear a mask. Bacterial meningitis requires droplet precautions; therefore, the AP and the nurse should wear a mask when coming within 0.9 m (3 ft) of the client until 24 hr after the client has begun receiving antibiotic therapy. a nurse is caring for a client who is 12 hr postoperative following a total hip arthroplasty. which of the following actions should the nurse take? place a pillow between the client's legs. The nurse should place a pillow between the client's legs to prevent hip dislocation. a nurse in a provider's office is assessing a client who has migraine headaches and is taking feverfew to prevent headaches. the nurse should identify that which of the following client medications interact with feverfew naproxen Both naproxen and feverfew impair platelet aggregation and place the client at risk for bleeding. a nurse is caring for a client who has pancreatitis. the nurse should expect which of the following laboratory results to be below the expected reference range? calcium A client who has pancreatitis is expected to have decreased calcium and magnesium levels due to fat necrosis. a nurse is providing discharge instructions to a client following an upper gastrointestinal series with barium contract. which of the following information should the nurse provide? increase fluid intake. Increasing fluid intake will help to prevent constipation. Therefore, the nurse should instruct the client to increase fluid intake to facilitate the elimination of the barium used during the test. a nurse is assessing a client who had extracorporeal shock wake lithotripsy (ESWL) 6 hr ago. which of the following findings should the nurse expect? stone fragments in the urine ESWL is an effort to break the calculi so that the fragments pass down the ureter, into the bladder, and through the urethra during voiding. Following the procedure, the nurse should strain the client's urine to confirm the passage of stones. a nurse is assessing a group of clients for indications of role changes. the nurse should identify that which of the following clients is at risk for experiencing a role change? a client who has multiple sclerosis and is experiencing progressive difficulty ambulating. The nurse should identify that progression of a neurologic disease such as multiple sclerosis can lead to a role change as the client becomes less independent. a nurse is caring for a client who has a new diagnosis of hyperthyroidism. which of the following is the priority assessment finding that the nurse should report to the provider? blood pressure 170/80 mm Hg Using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is a systolic blood pressure of 170 mm Hg, which indicates that the client is at risk for thyroid storm. a nurse is providing discharge instructions to a client who has a partial-thickness burn on the hand. which of the following instructions should the nurse include? wrap fingers with individual dressings. The nurse should instruct the client to wrap the fingers individually to allow for functional use of the hand while healing occurs. The nurse should also instruct the client to perform range-of-motion exercises to each finger every hour while awake to promote function of the injured hand. a nurse is providing teaching to a client who is receiving chemotherapy and has a new prescription for epoetin alfa. which of the following client statements indicates an understanding of the teaching? I will monitor my blood pressure while taking this medication