HERZING UNIVERSITY ATI NURSING CARE SCENARIOS EXAM
2025||168 QUESTIONS ANSWERED
1. What is the primary nursing action indicated when a nurse observes clots in
a client's indwelling urinary catheter after a TURP procedure?
Administer pain medication
Irrigate the indwelling urinary catheter
Increase the client's fluid intake
Notify the healthcare provider immediately
2. A PACU nurse is monitoring a patient who had a laparoscopic
cholecystectomy. The patient's baseline heart rate is 72/min, but it has
increased to 100/min. The blood pressure remains stable at 120/80 mm Hg.
What should the nurse's next action be in response to this change?
Document the findings and continue monitoring.
Administer a beta-blocker to lower the heart rate.
Assess for other signs of hemorrhage or distress.
Notify the physician immediately.
3. A nurse is reviewing the laboratory findings of a client who is experiencing
chest pain with radiation to the jaw . Which of the following elevated
laboratory results should the nurse identify as the most reliable indicator of
a myocardial infarction ( MI ) ?
Troponin
Myoglobin
, Lactic dehydrogenase
Creatine phosphokinase
4. A nurse is caring for a postoperative client who is at risk for
thromboembolism after a total knee arthroplasty. In addition to instructing
, the client to flex the foot every hour, which of the following interventions
should the nurse implement to further reduce this risk?
Encourage the client to remain in bed for the first 48 hours
Administer anticoagulant medication as prescribed
Limit fluid intake to reduce swelling
Instruct the client to keep the leg straight at all times
5. What is one recommended strategy for assisting a patient with Alzheimer's
disease in selecting their daily clothing?
Provide a selection of clothing options without any organization.
Create complete outfits and allow the client to select one each
day.
Encourage the client to choose clothing from a pile of mixed items.
Limit the client to wearing only pajamas for comfort.
6. The nurse is providing teaching to a patient with HIV. Which statement
indicated understanding?
I will wash my toothbrush monthly in the dishwasher
I should eat more fresh fruits and veggies
I will avoid drinking a glass of cold water that has been sitting out
for more than 30 minutes
I will take my temperature once per day
7. A nurse is caring for a client who has just undergone a mastectomy and is
expressing feelings of anxiety about body image. Which intervention
should the nurse prioritize to support the client's emotional well-being?
, Encourage the client to discuss their feelings with family members
Provide pamphlets about surgical recovery
2025||168 QUESTIONS ANSWERED
1. What is the primary nursing action indicated when a nurse observes clots in
a client's indwelling urinary catheter after a TURP procedure?
Administer pain medication
Irrigate the indwelling urinary catheter
Increase the client's fluid intake
Notify the healthcare provider immediately
2. A PACU nurse is monitoring a patient who had a laparoscopic
cholecystectomy. The patient's baseline heart rate is 72/min, but it has
increased to 100/min. The blood pressure remains stable at 120/80 mm Hg.
What should the nurse's next action be in response to this change?
Document the findings and continue monitoring.
Administer a beta-blocker to lower the heart rate.
Assess for other signs of hemorrhage or distress.
Notify the physician immediately.
3. A nurse is reviewing the laboratory findings of a client who is experiencing
chest pain with radiation to the jaw . Which of the following elevated
laboratory results should the nurse identify as the most reliable indicator of
a myocardial infarction ( MI ) ?
Troponin
Myoglobin
, Lactic dehydrogenase
Creatine phosphokinase
4. A nurse is caring for a postoperative client who is at risk for
thromboembolism after a total knee arthroplasty. In addition to instructing
, the client to flex the foot every hour, which of the following interventions
should the nurse implement to further reduce this risk?
Encourage the client to remain in bed for the first 48 hours
Administer anticoagulant medication as prescribed
Limit fluid intake to reduce swelling
Instruct the client to keep the leg straight at all times
5. What is one recommended strategy for assisting a patient with Alzheimer's
disease in selecting their daily clothing?
Provide a selection of clothing options without any organization.
Create complete outfits and allow the client to select one each
day.
Encourage the client to choose clothing from a pile of mixed items.
Limit the client to wearing only pajamas for comfort.
6. The nurse is providing teaching to a patient with HIV. Which statement
indicated understanding?
I will wash my toothbrush monthly in the dishwasher
I should eat more fresh fruits and veggies
I will avoid drinking a glass of cold water that has been sitting out
for more than 30 minutes
I will take my temperature once per day
7. A nurse is caring for a client who has just undergone a mastectomy and is
expressing feelings of anxiety about body image. Which intervention
should the nurse prioritize to support the client's emotional well-being?
, Encourage the client to discuss their feelings with family members
Provide pamphlets about surgical recovery
