A nurse is reinforcing teaching with a client who has HIV and is being discharged to home. Which of the following instructions should the nurse include in the teaching? - Take temperature once a day
A nurse is caring for a client who is postoperative following a tracheostomy, and has copious and...
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MedSurg 2021/22 proctored ATI
A nurse is reinforcing teaching with a client who has HIV and is being discharged to home. Which of the
following instructions should the nurse include in the teaching? - Take temperature once a day
A nurse is caring for a client who is postoperative following a tracheostomy, and has copious and
tenacious secretions. Which of the following is an acceptable method for the nurse to use to thin this
client's secretions? - Provide humidified oxygen
Following admission, a client with a vascular occlusion of the right lower extremity calls the nurse and
reports difficulty sleeping because of cold feet. Which of the following nursing actions should the nurse
take to promote the client's comfort? - Obtain a pair of slipper socks for the client
A nurse is caring for a client is who is 4 hr postoperative following a transurethral resection of the
prostate (TURP). Which of the following is the priority finding for the nurse report to the provider? -
Thick, red-colored urine
A nurse is caring for a client who has a temperature of 39.7° C (103.5° F) and has a prescription for a
hypothermia blanket. The nurse should monitor the client for which of the following adverse effects of
the hypothermia blanket? - Shivering
A nurse is reinforcing teaching about exercise with a client who has type 1 diabetes mellitus. Which of
the following statements by the client indicates an understanding of the teaching? - "I will not exercise if
my urine is positive for ketones."
A nurse notes a small section of bowel protruding from the abdominal incision of a client who is
postoperative. After calling for assistance, which of the following actions should the nurse take first? -
Cover the client's wound with a moist, sterile dressing
A nurse is collecting data from a client who has alcohol use disorder and is experiencing metabolic
acidosis. Which of the following manifestations should the nurse expect? - Hyperventilation
A nurse is reinforcing discharge teaching with a client following a cataract extraction. Which of the
following should the nurse include in the teaching? - Avoid bending at the waist
, A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily. The client
refuses breakfast and reports nausea. Which of the following actions should the nurse take first? - Check
the client's vital signs
A nurse is caring for a client who is 3 days postoperative following a cholecystectomy. The nurse
suspects the client's wound is infected because the drainage from the dressing is yellow and thick.
Which of the following findings should the nurse report as the type of drainage found? - Purulent
A nurse is reinforcing discharge teaching to a client following arthroscopic surgery. To prevent
postoperative complications which of the following actions should be reinforced during the teaching? -
Administer an opioid analgesic to the client 30 min prior to initiating CPM exercises
A nurse is collecting data from a client who has emphysema. Which of the following findings should the
nurse expect? (Select all that apply.) - Dyspnea, Barrel chest, Clubbing of the fingers, Shallow
respirations
A nurse is caring for a client who sustained a basal skull fracture. When performing morning hygiene
care, the nurse notices a thin stream of clear drainage coming from out of the client's right nostril.
Which of the following actions should the nurse take first? - Test the drainage for glucose
A nurse is caring for a client who has a spinal cord injury at T-4. The nurse should recognize that the
client is at risk for autonomic dysreflexia. Which of the following interventions should the nurse take to
prevent autonomic dysreflexia? - Prevent bladder distention
A nurse is caring for a client who is being evaluated for endometrial cancer. Which of the following
findings should the nurse expect the client to report? - Abnormal vaginal bleeding
A nurse is caring for a client following an open reduction and internal fixation of a fractured femur.
Which of the following findings is the nurse's priority? - Altered level of consciousness
A nurse is assisting in the care of a client who is 2 hours postoperative following a wedge resection of
the left lung and has a chest tube to suction. Which of the following is the priority finding the nurse
should report to the provider? - Abdomen is distended
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