A nurse is providing teaching about the gastrostomy tube feedings to the parents of a
school age child.
Which of the following instructions should the nurse take?
A. Administer the feeding over 30 min.B. Place the child in as supine position after the
feeding.
C. Charge the feeding bag and t...
ATI PN Comprehensive Exit Exam Form B/Questions & Answers 1. A nurse is providing teaching about the gastrostomy tube feedings to the parents of a school age child. Which of the following instructions should the nurse take? A. Administer the feeding over 30 min.B. Place the child in as supine position after the feedin g. C. Charge the feeding bag and tubing every 3 days. D. Warm the formula in the microwave prior to administration. - ANSWER - A. Administer the feeding over 30 min. 2. A nurse is administering digoxin 0.125 mg Po to an adult client. For which of the following findings should the nurse report to the provider? A. Potassium level 4.2 mEq/L. B. Apical pulse 58/min. C. Digoxin level 1 ng/ml. D. Constipation for 2 days. - ANSWER - C. Digoxin level 1 ng/ml. 3. A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life -sustaining measures. The client's family want the client to have life -sustaining measures. Which of the following action should the nurse take? A. Arrange for an ethics committee meeting to address the family's concerns. B. Support the family's decision and initiate life -sustaining measures. C. Complete an incident report. D. Encourage the family to conta ct an attorney. - ANSWER - A. Arrange for an ethics committee meeting to address the family's concerns. 4. A nurse is caring for a client who wears glasses. Which of the following actions should the nurse take? A.Store the glasses in a labeled case. B. Cl ean the glasses with hot water. C. Clean the glasses with a paper towel. D. Store the glasses on the bedside table. - ANSWER - A. Store the glasses in a labeled case. 5. A nurse is teaching a group of newly licensed nurses about measures to take when carin g for a client who is on contact precautions. Which of the following should the nurse include in the teaching? A. Remove the protective gown after the client's room. B. Place the client in a room with negative pressure. C. Wear gloves when providing care t o the client. D. Wear a mask when changing the linens in the client's room. - ANSWER - C. Wear gloves when providing care to the client. 6.A nurse is planning on care for a client who is recovering from an acute myocardial infarction that occurred 3 days ago. Which of the following instructions should the nurse include? A. Perform an ECG every 12 hr. B. Place the client in a supine position while resting. C. Draw a troponin level every 4hr. D. Obtain a cardiac rehabilitation consultation. - ANSWER - D. Obtain a cardiac rehabilitation consultation. 7. The nurse is reviewing the medical record of a client who is requesting combination oral contraceptives. Which of the following conditions in the client's history is a contradiction to the use of oral co ntraceptives? A.Hyperthyroidism. B. Thrombophlebitis. C. Diverticulosis. D. Hypocalcemia. 8 A nurse is caring for a client - ANSWER - B. Thrombophlebitis. 8 A nurse is caring for a client who request the creation of a living will. Which of the following a ctions should the nurse take? A. Schedule a meeting between the hospital ethics committee and the client. B. Evaluate the client's understanding of life -sustaining measures. C. Determine the client's preferences about post mortem care. D. Request a confere nce with the client's family. - ANSWER - B. Evaluate the client's understanding of life -sustaining measures. 9.A nurse is caring for an adolescent who has sickle -cell anemia. Which of the following manifestations indicates acute chest syndrome and should b e immediately reported to the provider? A. Substernal retractions. B. Hematuria. C. Temperature 37.9 C (100.2 F). D. Sneezing. - ANSWER - A. Substernal retractions. 10.A nurse is preforming a gastric lavage for a client who has upper gastrointestinal bleeding. Which of the .following action should the nurse take? A. Instill 500 ml of solution through the NG tube. B. Insert a large -bore NG tube. C. Use a cold irrigation solution. D. Instruct the client to lie on his right side. - ANSWER - B. Insert a large -bore NG tube. 11. A nurse is providing care for a client who is in the advance stage of amyotrophic lateral sclerosis. (ALS). Which of the following referrals is the nurse's prio rity? A. Psychologist. B. Social worker. C. Occupational therapist. D. Speech -language pathologist. - ANSWER - D. Speech -language pathologist. 12.A nurse is reviewing the laboratory results of a client who has rheumatoid arthritis. Which of the following f indings should the nurse report to the provider? A. WBC count 8,000/mm3. B. Platelets 150,000/mm3. C. Aspartate aminotransferase 10 units/L. D. Erythrocyte sedimentation rate 75 mm/hr - ANSWER - D. Erythrocyte sedimentation rate 75 mm/hr 13. A nurse is car ing for a client who has generalized petechiae and ecchymoses. The nurse should expect a prescription for which of the following laboratory tests? A. Platelet count. B. Potassium level. C. Creatine clearance. D. Prealbumin. - ANSWER - A. Platelet count. 14. A nurse is caring for a client following application of a cast. Which of the following actions should the nurse take first? A. Place an ice pack over the cast. B. Palpate the pulse distal to the cast. C. Teach the client to keep the cast clean and dry. D. Position the casted extremity on a pillow. - ANSWER - B. Palpate the pulse distal to the cast. 15. A nurse is caring for a client who has vision loss. Which of the following actions should the nurse take? (Select all that apply) A. Keep objects in the c lient's room in the same place. B. Ensure there is high -wattage lighting in the client's room. C. Approach the client from the side. D. Allow extra time for the client to perform tasks.
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