ATI Community Health Nursing Proctored Focus Latest Updated A+ Score Guide.

DA nurse is teaching a client who has a new prescription for metformin extended release tablets. Which of the following statements by the client indicates an understanding of the teaching? I will avoid crushing this medication - ANS I'll switch to a lactose-free formula: I will avoid crushing this medication 2. A nurse is assessing a client who is receiving enteral feeding via an NG tube. The client has developed hyperosmolar dehydration. Which of the following actions should the nurse take when administering the client's findings? Empty your ostomy pouch when it is half full Switch to a lactose-free formula. - ANS: Switch to a lactose-free formula. 3. A nurse is teaching the parents of a school-age child who has sickle cell anemia about managing the disease at home which of the following instructions should the nurse include? Apply cold compresses too painful areas- ANS I should boil tap water for 2 minutes and call it before I mix it with powdered formula: Apply cold compresses too painful areas 4. A nurse is teaching about Safe Handling of formula to a client who is postpartum and chooses to bottle feed her newborn. Which of the following statements by the client indicates an understanding of the teaching? I should boil tap water for 2 minutes before I mix it with powdered formula - ANS I should use sterile water when I mix it with powdered formula: I should boil tap water for 2 minutes before I mix it with powdered formula 5. A nurse is assessing a child who is post-operative following a tonsillecto- my. Which of the following findings should the nurse identify as the priority? During this test, I will punch a button if the baby moves Frequent swallowing - ANS: Frequent swallowing 6. A nurse is teaching a client who is pregnant about non-stress testing. Which of the following statements by the client indicates an understanding of the teaching? During this test, I will punch a button if the baby moves - ANS During this test, I will punch a button if I feel stressed: During this test, I will punch a button if the baby moves 7. A nurse is monitoring a client who is receiving a transfusion of packed RBC's. The client reports chills, headaches, low back pain, and a feeling of tightness in his chest. The nurse should identify that the client has developed which of the following types of transfusion reactions? Pudendal nerve block Acute hemolytic- ANS: Acute hemolytic 8. A nurse is caring for a client who is in the latent phase of Labor and reports severe back pain. The vaginal examination reveals that the cervix is dilated two centimeters, 25% effaced and -2 station. Which of the following interventions should the nurse implement? You should wear a snug fitting bra continuously for 72 hours Request the provider prescribe a pudendal nerve block- ANS: Request the provider prescribe a pudendal nerve block 9. A nurse is teaching about how to suppress lactation with a client who is postpartum and bottle feeding her newborn. Which of the following instruc- tions should the nurse include in the teaching? You should wear a snug fitting bra continuously for 72 hours - ANS Room number: You should wear a snug fitting bra continuously for 72 hours 10. A nurse is preparing to administer medication to a client. What are the following identifiers should the nurse use to identify the client? Room number - ANS MRN: Room number 11. A nurse is caring for a client who is taking antihypertensive medication and is moving from a supine to a seated position. Which of the following find- ings should indicate to the nurse that the client is experiencing orthostatic hypotension? The clients systolic blood pressure decreases by 25 mmHg - ANS The clients systolic blood pressure increases by 35 mmHg: The clients sys- tolic blood pressure decreases by 25 mmHg 12. While a nurse is caring for a client who is receiving mechanical ventilation via an endotracheal tube, the high-pressure alarm of the ventilator sounds. Which of the following actions should the nurse take? Look for a block in the tubes cuff Look for a leak in the tubes cuff- ANS: Look for a leak in the tubes cuff 13. A nurse is preparing to insert an indwelling urinary catheter for a client. Which of the following actions should the nurse take first? Monitor Vital Signs every hour throughout the transfusion Position the sterile drape leaving the perineum exposed- ANS: Position the sterile drape leaving the perineum exposed 14. A nurse is planning to administer packed RBC's to an older adult client who has a low hemoglobin level. Which of the following actions should the nurse plan to take? Monitor Vital Signs every hour throughout the transfusion- ANS Monitor RR every hour throughout the transfusion: Monitor Vital Signs every hour throughout the transfusion 15. A new nurse in an acute mental health facility is teaching a client about potential adverse effects of transcranial magnetic stimulation. The nurse tells the client that he might feel light-headed but that it should not affect his mem- ory. The nurse is demonstrating which of the following ethical principles? Beneficence- ANS Restrictive: Beneficence 16. A nurse is teaching a class about providing care within the legal scope of practice to a group of nurses. The nurse should include that which of the following procedures is outside the legal scope of practice for an RN? Irrigation of the external ear canal- ANS Irrigation of the inferior ear canal: Irrigation of the external ear canal 17. A nurse in an acute care facility is caring for a client who has anorexia nervosa. During the first week of care, which of the following actions should the nurse take? Observe the client for 1 hour after meals- ANS Observe the client for 6 hours after meals: Observe the client for 1 hour after meals 18. A nurse is planning care for a client who has sciatica and a prescription for a transcutaneous electrical nerve stimulation (TENS) unit. Which of the following referral should the nurse anticipate for the client? Primary Care Provider Physical therapist- ANS: Physical therapist