VATI Adult Medical Surgical
A nurse is collecting data from a client who has acute cholecystitis. Which of the
following manifestations should the nurse expect? - question and answerPain radiating
to the right shoulder.
A nurse is reinforcing teaching with a client who has a prescription for clopidogrel
following a thrombotic stroke. Which of the following information should the nurse
include in the teaching? - question and answer"The medication prevents clot formation."
A nurse is contributing to the plan of care for a client who is in skeletal traction. Which of
the following interventions should the nurse include? - question and answerKeep the
client's body centered in the bed.
A nurse is contributing to the plan of care for a client who has dysphagia following a
stroke. Which of the following actions should the nurse include in the plan of care to
prevent aspiration? - question and answerKeep the client upright for 30 min after a
meal.
A nurse is reinforcing postoperative teaching with a client who is scheduled for cataract
surgery on his right eye. Which of the following instructions should the nurse include? -
question and answer"Wear a protective eye shield while sleeping."
A nurse is collecting data from a client who was admitted with a Glasgow coma scale
(GCS) of 3. Which of the following findings should the nurse expect? - question and
answerNonresponsive to commands.
A nurse is caring for a client who has type 1 diabetes mellitus and has undergone a
below-the-knee amputation. Which of the following is the highest priority finding? -
question and answerSkin flap of the residual limb is cool to the touch.
A nurse is reinforcing teaching about the prevention of sexually transmitted infections
(STIs) which a client who is sexually active. Which of the following information should
the nurse include in the teaching? - question and answerInserting a polyurethane
female condom is effective for prevention of STIs.
, A nurse is administering a tap water enema to a client who has constipation. The client
reports abdominal cramping during installation of the enema. Which of the following
actions should the nurse take? - question and answerSlow the rate of fluid flow.
A nurse is reinforcing teaching about mammograms which an adult client who is
postmenopausal. Which of the following statements indicates to the nurse that the client
understands the teaching? - question and answer"I should have a mammogram every 1
to 2 years."
A nurse is collecting data from a client and osculates intermittent high-pitched sounds
during inspiration over the lower base of the lungs. The nurse should identify this finding
as which of the following lung sounds? - question and answerFine crackles
A nurse is assisting with the care of four clients. Which of the following clients is the
priority for the nurse to see? - question and answerA client who has chest tubes and an
oxygen saturation of 90%
A nurse is preparing to perform a closed irrigation of an indwelling urinary catheter for a
client who had abdominal surgery. Which of the following actions should the nurse plan
to take? - question and answerStop the irrigation if resistance is felt during fluid
instillation.
A nurse is reviewing the medical record of a client who has systemic lupus
erythematous (SLE). Which of the following findings should the nurse expect? -
question and answerJoint pain
A nurse is preparing to transfer a client from a bed to a chair following a total knee
arthroplasty. The client has a prescription for partial weight bearing. Which of the
following actions should the nurse take? - question and answerPosition feet apart
before pivoting the client.
A nurse is reviewing principles of body mechanics which a client following a lumbar
laminectomy. Which of the following statements by the client indicates an understanding
of the teaching? - question and answer"I will flex at the knees and use my leg muscles
to lift an object off the floor."
A nurse is caring for a client who is preoperative and does not speak the same
language as the nurse. Which of the following actions should the nurse take? - question
and answerIncorporate the use of pictures as a communication tool.
A nurse is reinforcing teaching with a client who is scheduled for an
electroencephalogram (EEG). Which of the following information should the nurse
include in the teaching? - question and answer"Shampoo your hair the night before the
procedure."
A nurse is collecting data from a client who has acute cholecystitis. Which of the
following manifestations should the nurse expect? - question and answerPain radiating
to the right shoulder.
A nurse is reinforcing teaching with a client who has a prescription for clopidogrel
following a thrombotic stroke. Which of the following information should the nurse
include in the teaching? - question and answer"The medication prevents clot formation."
A nurse is contributing to the plan of care for a client who is in skeletal traction. Which of
the following interventions should the nurse include? - question and answerKeep the
client's body centered in the bed.
A nurse is contributing to the plan of care for a client who has dysphagia following a
stroke. Which of the following actions should the nurse include in the plan of care to
prevent aspiration? - question and answerKeep the client upright for 30 min after a
meal.
A nurse is reinforcing postoperative teaching with a client who is scheduled for cataract
surgery on his right eye. Which of the following instructions should the nurse include? -
question and answer"Wear a protective eye shield while sleeping."
A nurse is collecting data from a client who was admitted with a Glasgow coma scale
(GCS) of 3. Which of the following findings should the nurse expect? - question and
answerNonresponsive to commands.
A nurse is caring for a client who has type 1 diabetes mellitus and has undergone a
below-the-knee amputation. Which of the following is the highest priority finding? -
question and answerSkin flap of the residual limb is cool to the touch.
A nurse is reinforcing teaching about the prevention of sexually transmitted infections
(STIs) which a client who is sexually active. Which of the following information should
the nurse include in the teaching? - question and answerInserting a polyurethane
female condom is effective for prevention of STIs.
, A nurse is administering a tap water enema to a client who has constipation. The client
reports abdominal cramping during installation of the enema. Which of the following
actions should the nurse take? - question and answerSlow the rate of fluid flow.
A nurse is reinforcing teaching about mammograms which an adult client who is
postmenopausal. Which of the following statements indicates to the nurse that the client
understands the teaching? - question and answer"I should have a mammogram every 1
to 2 years."
A nurse is collecting data from a client and osculates intermittent high-pitched sounds
during inspiration over the lower base of the lungs. The nurse should identify this finding
as which of the following lung sounds? - question and answerFine crackles
A nurse is assisting with the care of four clients. Which of the following clients is the
priority for the nurse to see? - question and answerA client who has chest tubes and an
oxygen saturation of 90%
A nurse is preparing to perform a closed irrigation of an indwelling urinary catheter for a
client who had abdominal surgery. Which of the following actions should the nurse plan
to take? - question and answerStop the irrigation if resistance is felt during fluid
instillation.
A nurse is reviewing the medical record of a client who has systemic lupus
erythematous (SLE). Which of the following findings should the nurse expect? -
question and answerJoint pain
A nurse is preparing to transfer a client from a bed to a chair following a total knee
arthroplasty. The client has a prescription for partial weight bearing. Which of the
following actions should the nurse take? - question and answerPosition feet apart
before pivoting the client.
A nurse is reviewing principles of body mechanics which a client following a lumbar
laminectomy. Which of the following statements by the client indicates an understanding
of the teaching? - question and answer"I will flex at the knees and use my leg muscles
to lift an object off the floor."
A nurse is caring for a client who is preoperative and does not speak the same
language as the nurse. Which of the following actions should the nurse take? - question
and answerIncorporate the use of pictures as a communication tool.
A nurse is reinforcing teaching with a client who is scheduled for an
electroencephalogram (EEG). Which of the following information should the nurse
include in the teaching? - question and answer"Shampoo your hair the night before the
procedure."
