ATI questions for EXAM 3
" i have cancer of the colon that has begun to spread." - ANS-A nurse is caring for a client who
surgeon informed him postoperatively that he has a metastasizing malignant neoplasm in the
colon. Which of the following statements by the client should the nurse identify as an indication
that a client understands this information?
"A hepatitis B immunization is given to infants and children."
This is given as part of the standard childhood immunizations. - ANS-A nurse is preparing a
community education program about hepatitis B. Which of the following statements should the
nurse include in the teaching?
"Apply moisturizer after bathing the lesions with warm water." - ANS-A nurse is caring for client
who has systemic lupus erythematosus (SLE) and is concerned about skin lesions on her face
and neck. The client asks the nurse, "what should i do about theses spots?" Which of the
following responses should the nurse give?
"Empty your ostomy pouch when it becomes half full."
The nurse should instruct the client to empty the ostomy when it is one-third to one-half full. This
prevents the ostomy from becoming too full of stool and gas and exploding. - ANS-A nurse is
performing discharge teaching about ostomy care while at home for client who has a newly
placed ileostomy. Which of the following instructions should the nurse include in the teaching?
"I can take this medication with aspirin."
The nurse should instruct the client to avoid taking this medication with any other NSAIDs such
as aspirin because this can increase the risk of bleeding and gastrointestinal ulceration. -
ANS-A nurse in a provider;s office is teaching a client with a recent diagnosis of rheumatoid
arthritis who has a new prescription for naproxen tablets. Which of the following statements buy
the client indicates the need to further teaching?
"I will need to take methotrexate even if I'm in remission."
SLE is an autoimmune disorder characterized by exacerbations and remissions. Methotrexate is
on immunosuppressive medication during remission to help prevent exacerbation. The
medication is also given when exacerbations occur to reduce the severity of manifestations. -
ANS-A nurse is providing discharge teaching to a client who has a new diagnosis of systemic
lupus erythematosus (SLE). Which of the following statements by the client indicates an
understanding of the teaching?
"I'll have to consume a soft diet after surgery."
, After surgery, the client quickly returns to a regular diet, and there are no food restrictions unless
the client chooses to decrease the intake of foods that increase gas or odor. - ANS-A nurse is
providing teaching to a client who is scheduled for a sigmoid color resection with colostomy.
Which of the following statements by the client INDICATES a NEED for further teaching?
"Lying quietly in bed helps slow down the activity in your intestines." - ANS-A nurse is caring for
a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges.
When the client asks the nurse why he has to stay in bed, which of the following responses
should the nurse provider?
"Monitor your body temperature and report any elevations promptly."
SLE is chronic autoimmune disorder that can affect any organ of the body. With SLE, the body's
immune system becomes hyperactive, forming antibodies that attack tissues and organs,
including the skin, joints, kidneys, brain, heart, lungs, and blood. SLE is characterized by
periods of exacerbation and remissions. The nurse should teach the client to monitor body
temperature and report any elevations promptly, as a fever can suggest either an exacerbation
or a potentially life-threatening infection. - ANS-A nurse is planning discharge teaching for a
client who has systemic lupus erythematosus (SLE). Which of the following instructions should
the nurse include?
"Perhaps we should review your coping mechanisms and talk about other alternatives." - ANS-A
nurse is caring for a client who has colitis and reported increased exacerbations due to stress at
work. Which of the following responses should the nurse make?
A colostomy is from the large intestine, and an ileostomy is from the small inmtine - ANS-A
nurse is providing pre operative teaching to a client who will undergo surgery to create a
temporary colostomy.. the client asks the nurse about the difference between colostomies and
ileostomies. Which of the following responses should the nurse make?
Abdominal cramps
Clients who have colorectal cancer are likely to have changes in bowel habits, occult blood in
the tool, weight loss, fatigue, and "gas pains" or abdominal cramping. - ANS-A nurse is
preforming an admission assessment for a client who has colorectal cancer. Which of the
following manifestations should the nurse expect to find?
Abdominal pain in the left upper quadrant
When using the urgent vs nonurgent approach to client care, the nurse should determine that
the priority finding is left upper-quadrant pain, which can indicate an enlarged spleen. An
enlarged spleen can rupture, leading to internal hemorrhaging. The nurse should encourage the
client to refrain from engaging in strenuous activities until the splenomegaly is resolved. -
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