Adult Health ATI Questions and
Accurate Answers.
A nurse is caring for a client who is postprocedure following lumbar puncture and reports a throbbing
headache when sitting upright. Which of the following actions should the nurse take? (select all that apply)
a. use the Glasgow coma scale when assessing the client
b. assist the client to a supine position
c. administer an opioid medication
d. encourage the client to increase fluid intake
e. instruct the client to perform deep breathing and coughing exercises ANSWER- b. assist the client to a
supine position
c. administer an opioid medication
d. encourage the client to increase fluid intake
A nurse is caring for a client who experienced a traumatic head injury and has an intraventricular catheter for
ICP monitoring. The nurse should monitor the client for which of the following complications related to the
ventriculostomy?
a. headache
b. infection
c. aphasia
d. hypertension ANSWER- b. infection
A nurse is assessing a client for changes in the level of consciousness using the Glasgow coma scale. The client
opens his eyes when spoken to, speaks incoherently, and moves his extremities when pain is applied. Which of
the following GCS scores should the nurse document?
a. E2 + V3 + M5 = 10
b. E3 + V4 + M4 = 11
c. E4 + V5 + M6 = 15
,d. E2 + V2 + M4 = 8 ANSWER- b. E3 + V4 + M4 = 11
A nurse is developing a plan of care for a client who scheduled for cerebral angiography with contrast dye.
Which of the following statements by the client should the nurse report to the provider? (select all that apply)
a. "I think I might be pregnant"
b. "I take warfarin"
c. "I take antihypertensive medication"
d. "I am allergic to shrimp"
e. "I ate a light breakfast this morning" ANSWER- a. "I think I might be pregnant"
b. "I take warfarin"
d. "I am allergic to shrimp"
e. "I ate a light breakfast this morning"
A nurse is providing education to a client who is to undergo an electroencephalogram (EEG) the next day.
Which of the following information should the nurse include in the teaching?
a. "Do not wash your hair the morning of the procedure."
b. "Try to stay awake most of the night prior to the procedure."
c. "The procedure will take approximately 15 minutes."
d. "You will need to lie flat for 4 hours after the procedure." ANSWER- b. "Try to stay awake most of the night
prior to the procedure."
A nurse is assessing a client who has a seizure disorder. The client reports he thinks he is about to have a
seizure. Which of the following actions should the nurse implement?
a. provide privacy
b. ease the client to the floor if standing
c. move furniture away from the client
d. loosen the client's clothing
e. protect the client's head with padding
,f. restrain the client ANSWER- a. provide privacy
b. ease the client to the floor if standing
c. move furniture away from the client
d. loosen the client's clothing
e. protect the client's head with padding
A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should
the nurse perform first?
a. keep the client in a side-lying position
b. document the duration of the seizure
c. reorient the client to the environment
d. provide client hygiene ANSWER- a. keep the client in a side-lying position
A nurse is providing discharge instructions to a female client who has a prescription for phenytoin. Which of
the following information should the nurse include?
a. consider taking oral contraceptives when on this medication
b. watch for receding gums when taking the medication
c. take the medication at the same time every day
d. provide a urine sample to determine therapeutic levels of the medication ANSWER- c. take the medication
at the same time every day
A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized
seizures. Which of the following information should the nurse include in the review? (select all that apply)
a. avoid overwhelming fatigue
b. remove caffeinated products from the diet
c. limit looking at flashing lights
d. perform aerobic exercise
e. limit episodes of hypoventilation
, f. use of aerosol hairspray is recommended ANSWER- a. avoid overwhelming fatigue
b. remove caffeinated products from the diet
c. limit looking at flashing lights
A nurse is completing discharge teaching to a client who has seizures and receiving a vagal nerve stimulator to
decrease seizure activity. Which of the following statements should the nurse include in the teaching?
a. "It is safe to use microwaves that are 1,200 watts or less."
b. "You should avoid the use of CT scans with contrast."
c. "You should place a magnet over the implantable device when you feel an aura occurring."
d. "It is recommended that you use ultrasound diathermy for pain management." ANSWER- c. "You should
place a magnet over the implantable device when you feel an aura occurring."
A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse
expect?
a. fluctuations in blood pressure
b. loss of cognitive function
c. ineffective cough
d. drooping eye lids ANSWER- b. loss of cognitive function
A nurse is beginning a physical assessment of a client who has anew diagnosis of multiple sclerosis. Which of
the following findings should the nurse expect? (select all that apply)
a. areas of paresthesia
b. involuntary eye movements
c. alopecia
d. increased salivation
e. ataxia ANSWER- a. areas of paresthesia
b. involuntary eye movements
e. ataxia
Accurate Answers.
A nurse is caring for a client who is postprocedure following lumbar puncture and reports a throbbing
headache when sitting upright. Which of the following actions should the nurse take? (select all that apply)
a. use the Glasgow coma scale when assessing the client
b. assist the client to a supine position
c. administer an opioid medication
d. encourage the client to increase fluid intake
e. instruct the client to perform deep breathing and coughing exercises ANSWER- b. assist the client to a
supine position
c. administer an opioid medication
d. encourage the client to increase fluid intake
A nurse is caring for a client who experienced a traumatic head injury and has an intraventricular catheter for
ICP monitoring. The nurse should monitor the client for which of the following complications related to the
ventriculostomy?
a. headache
b. infection
c. aphasia
d. hypertension ANSWER- b. infection
A nurse is assessing a client for changes in the level of consciousness using the Glasgow coma scale. The client
opens his eyes when spoken to, speaks incoherently, and moves his extremities when pain is applied. Which of
the following GCS scores should the nurse document?
a. E2 + V3 + M5 = 10
b. E3 + V4 + M4 = 11
c. E4 + V5 + M6 = 15
,d. E2 + V2 + M4 = 8 ANSWER- b. E3 + V4 + M4 = 11
A nurse is developing a plan of care for a client who scheduled for cerebral angiography with contrast dye.
Which of the following statements by the client should the nurse report to the provider? (select all that apply)
a. "I think I might be pregnant"
b. "I take warfarin"
c. "I take antihypertensive medication"
d. "I am allergic to shrimp"
e. "I ate a light breakfast this morning" ANSWER- a. "I think I might be pregnant"
b. "I take warfarin"
d. "I am allergic to shrimp"
e. "I ate a light breakfast this morning"
A nurse is providing education to a client who is to undergo an electroencephalogram (EEG) the next day.
Which of the following information should the nurse include in the teaching?
a. "Do not wash your hair the morning of the procedure."
b. "Try to stay awake most of the night prior to the procedure."
c. "The procedure will take approximately 15 minutes."
d. "You will need to lie flat for 4 hours after the procedure." ANSWER- b. "Try to stay awake most of the night
prior to the procedure."
A nurse is assessing a client who has a seizure disorder. The client reports he thinks he is about to have a
seizure. Which of the following actions should the nurse implement?
a. provide privacy
b. ease the client to the floor if standing
c. move furniture away from the client
d. loosen the client's clothing
e. protect the client's head with padding
,f. restrain the client ANSWER- a. provide privacy
b. ease the client to the floor if standing
c. move furniture away from the client
d. loosen the client's clothing
e. protect the client's head with padding
A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should
the nurse perform first?
a. keep the client in a side-lying position
b. document the duration of the seizure
c. reorient the client to the environment
d. provide client hygiene ANSWER- a. keep the client in a side-lying position
A nurse is providing discharge instructions to a female client who has a prescription for phenytoin. Which of
the following information should the nurse include?
a. consider taking oral contraceptives when on this medication
b. watch for receding gums when taking the medication
c. take the medication at the same time every day
d. provide a urine sample to determine therapeutic levels of the medication ANSWER- c. take the medication
at the same time every day
A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized
seizures. Which of the following information should the nurse include in the review? (select all that apply)
a. avoid overwhelming fatigue
b. remove caffeinated products from the diet
c. limit looking at flashing lights
d. perform aerobic exercise
e. limit episodes of hypoventilation
, f. use of aerosol hairspray is recommended ANSWER- a. avoid overwhelming fatigue
b. remove caffeinated products from the diet
c. limit looking at flashing lights
A nurse is completing discharge teaching to a client who has seizures and receiving a vagal nerve stimulator to
decrease seizure activity. Which of the following statements should the nurse include in the teaching?
a. "It is safe to use microwaves that are 1,200 watts or less."
b. "You should avoid the use of CT scans with contrast."
c. "You should place a magnet over the implantable device when you feel an aura occurring."
d. "It is recommended that you use ultrasound diathermy for pain management." ANSWER- c. "You should
place a magnet over the implantable device when you feel an aura occurring."
A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse
expect?
a. fluctuations in blood pressure
b. loss of cognitive function
c. ineffective cough
d. drooping eye lids ANSWER- b. loss of cognitive function
A nurse is beginning a physical assessment of a client who has anew diagnosis of multiple sclerosis. Which of
the following findings should the nurse expect? (select all that apply)
a. areas of paresthesia
b. involuntary eye movements
c. alopecia
d. increased salivation
e. ataxia ANSWER- a. areas of paresthesia
b. involuntary eye movements
e. ataxia
