CAPSTONE ATI NCLEX MEDICAL
SURGICAL ASSESSMENT 1 WITH
COMPREHENSIVE CORRECT ANSWERS.
A nurse is teaching a client how to administer a medication using an inhaler
with a spacer. Which of the following instructions should the nurse include
A. "Wait at least 5 minutes between puffs from the same inhaler"
B. "Breathe in rapidly when inhaling the medication"
C. "Clean the plastic inhaler cap weekly with cold water"
D. "Shake the inhaler vigorously prior to use" - CorreCt Answers -D .)
"Shake the inhaler vigorously prior to use"
Thoroughly shake the inhaler to disperse the medication because the
medication in the inhaler can separate easily
A nurse in the ICU is caring for a client who is reporting heart palpitations.
The nurse notes ventricular tachycardia on the ECG monitor. Which of the
following actions should the nurse take
A. Defibrillate the client
B. Prepare the client for cardioversion
C. Initiate CPR
D. Administer digoxin - CorreCt Answers -B. Prepare the client for
cardioversion
cardioversion is a synchronized countershock that uses a pulse to help
convert vtach back to sinus rhythm for a client who is STABLE AND
RESPONSIVE
,A nurse is providing discharge teaching to a client who has lithotripsy for
calcium phosphate renal calculi. Which of the following instructions should
the nurse give to the client
A. Limit intake of animal protein to 6 oz per day
B. Increase fluid intake to 1.5L/ day
C. Expect pain in the kidneys and bladder
D. Expect difficulty urinating for up to 1 week - CorreCt Answers -A. Limit
intake of animal protein to 6 oz per day
To prevent further kidney stones, the client should limit animal protein
intake to 5 servings per week. Animal protein contains purine, which
produces uric acid that can accumulate as stones in the kidney
A nurse is reviewing the ABG results of a client who is receiving total
parenteral nutrition. The nurse notes a pH of 7.25, a bicarbonate of 18
mEq/L, and PaCO2 of 43 mm Hg. Which of the following acid base
imbalances is the client experiencing
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis - CorreCt Answers -C. Metabolic acidosis
A nurse is caring for a client who is in the progressive stage of hypovolemic
shock. Which of the following findings should the nurse expect
, A. Acidosis
B. Bradycardia
C. Hypertension
D. Hypokalemia - CorreCt Answers -A. Acidosis
In the progressive stage, compensatory mechanisms have failed. Decreased
perfusion to the tissues results in anaerobic metabolism and the
accumulation of metabolites, causing metabolic acidosis
A nurse is caring for a client who is prescribed bedrest following a stroke.
Which of the following interventions should the nurse implement to
prevent foot drop
A. Maintain the client's feet in plantar flexion
B. Tuck the bed sheet tightly over the client's feet
C. Support the feet with toes pointed upwards using padded splits
D. Position and abductor pillow between the client's legs - CorreCt Answers
-C. Support the feet with toes pointed upwards using padded splits
Position the client's feet in a dorsiflexion position using a firm surface, such
as a footboard, padded splints, or orthotics. The nurse should pad the
splints to prevent areas of pressure on clients skin
A nurse in a postanesthesia care unit is performing a postoperative
assessment on a client who is recovering from a lumbar laminectomy and
has a surgical drain. Which of the following findings should the nurse
identify as a complication of the procedure
SURGICAL ASSESSMENT 1 WITH
COMPREHENSIVE CORRECT ANSWERS.
A nurse is teaching a client how to administer a medication using an inhaler
with a spacer. Which of the following instructions should the nurse include
A. "Wait at least 5 minutes between puffs from the same inhaler"
B. "Breathe in rapidly when inhaling the medication"
C. "Clean the plastic inhaler cap weekly with cold water"
D. "Shake the inhaler vigorously prior to use" - CorreCt Answers -D .)
"Shake the inhaler vigorously prior to use"
Thoroughly shake the inhaler to disperse the medication because the
medication in the inhaler can separate easily
A nurse in the ICU is caring for a client who is reporting heart palpitations.
The nurse notes ventricular tachycardia on the ECG monitor. Which of the
following actions should the nurse take
A. Defibrillate the client
B. Prepare the client for cardioversion
C. Initiate CPR
D. Administer digoxin - CorreCt Answers -B. Prepare the client for
cardioversion
cardioversion is a synchronized countershock that uses a pulse to help
convert vtach back to sinus rhythm for a client who is STABLE AND
RESPONSIVE
,A nurse is providing discharge teaching to a client who has lithotripsy for
calcium phosphate renal calculi. Which of the following instructions should
the nurse give to the client
A. Limit intake of animal protein to 6 oz per day
B. Increase fluid intake to 1.5L/ day
C. Expect pain in the kidneys and bladder
D. Expect difficulty urinating for up to 1 week - CorreCt Answers -A. Limit
intake of animal protein to 6 oz per day
To prevent further kidney stones, the client should limit animal protein
intake to 5 servings per week. Animal protein contains purine, which
produces uric acid that can accumulate as stones in the kidney
A nurse is reviewing the ABG results of a client who is receiving total
parenteral nutrition. The nurse notes a pH of 7.25, a bicarbonate of 18
mEq/L, and PaCO2 of 43 mm Hg. Which of the following acid base
imbalances is the client experiencing
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis - CorreCt Answers -C. Metabolic acidosis
A nurse is caring for a client who is in the progressive stage of hypovolemic
shock. Which of the following findings should the nurse expect
, A. Acidosis
B. Bradycardia
C. Hypertension
D. Hypokalemia - CorreCt Answers -A. Acidosis
In the progressive stage, compensatory mechanisms have failed. Decreased
perfusion to the tissues results in anaerobic metabolism and the
accumulation of metabolites, causing metabolic acidosis
A nurse is caring for a client who is prescribed bedrest following a stroke.
Which of the following interventions should the nurse implement to
prevent foot drop
A. Maintain the client's feet in plantar flexion
B. Tuck the bed sheet tightly over the client's feet
C. Support the feet with toes pointed upwards using padded splits
D. Position and abductor pillow between the client's legs - CorreCt Answers
-C. Support the feet with toes pointed upwards using padded splits
Position the client's feet in a dorsiflexion position using a firm surface, such
as a footboard, padded splints, or orthotics. The nurse should pad the
splints to prevent areas of pressure on clients skin
A nurse in a postanesthesia care unit is performing a postoperative
assessment on a client who is recovering from a lumbar laminectomy and
has a surgical drain. Which of the following findings should the nurse
identify as a complication of the procedure
