ATI comprehensive EXIT EXAM - MUST GO OVER BREFORE

A nurse, an emergency department complete an assessment on an adolescent client that has conduct disorder. The client threaten suicide to a teacher at school which of the following statements should the nurse include in the assessment.

Tell me how often do you drink alcohol?

A nurse is observing bonding to the client, her newborn, which of the following actions by the client requires the nurse to intervene

Viewing the newborn's actions to be uncooperative

A nurse is caring for a client who is taking levothyroxine, which of the following finding should indicate that the medication was effective

Weight loss

A nurse is planning, discharge teaching for cord care for a parent of a newborn which instructions would you include in the teaching

Keep the cord dry until it falls off (cord should be kept clean and dry to prevent infection)

A nurse is assessing a client in PACU, which of the following findings indicates decreased cardiac output

oliguria

A nurse is assisting with mass, casualty triage explosion at a local factory which of the following client. Should the nurse identify as a priority.

A client with indications of hypovolemic shock

A nurse is receiving report on for clients which of the following client should the nurse assess first

A client who is chronic kidney disease with cloudy, diasylate outflow

A nurse is caring for a client just received the first dose of lisinopril. The following is appropriate nursing intervention.

Provide standby assist with the client from bed

A nurse is caring for a client who is in labor, and is receiving electronics fetal monitoring. The nurse is reviewing the monitor tracing in notes early decelerations, which of the following should the nurse expect

Head compression

A nurse is caring for a client who has chronic kidney disease. The nurse should identify which of the following laboratory values as an indication of hemodialysis.

Glomerular filtration rate of 14 ML/minute

A nurse is caring for an infant who has prescription for continuous pulse oximetry. The following is an appropriate action for the nurse to take.

Heat the skin one minute prior to placing the program

A nurse in a mental health facility receives a change of shift report on four clients which of the following client. Should the nurse plan to assess first.

Client placed in restraints to the aggressive behavior

A nurse working at the clinic is teaching a group of clients who are pregnant on the use of nonpharmacological pain management, which of the following statement by the nurse is an appropriate description of the use of hypnosis during labor

Hypnosis promotes increase control of her pain perception during contractions

A nurse in a County Jail health clinic is leading group therapy session. A client who was incarcerated for theft is addressing the group. Which of the following is an example of reaction formation?

I think that people just you're just lazy and should earn money honestly

A nurse is obtaining a medical history of a client who has a new prescription for Isosorbide monotitrate which of the following should the nurse identify as a contraindication to medication

glaucoma

16

No questions

The nurse is caring for a client recovering from an acute myocardial infraction, which of the following intervention should the nurse include in the point of care

Obtain a cardiac rehabilitation consult

A nurse is caring for a client who has breast cancer and has been covering receiving chemotherapy, which of the following laboratory value should nurse report to the provider

WBC 3,000/mm3

Home health nurse is carefully planned for Alzheimer's disease to the following action. Should the nurse include in the plan of care

Place a daily calendar in the kitchen

A nurse is performing change of shift assessments on four clients which of the following findings. Should the nurse report to the provider first.

Client who has gastroenteritis and his lethargic and confused

A nurse is caring for a client who is in the second trimester of pregnancy and ask how to treat constipation which of the following statements by the nurse is appropriate

Drink hot water with lemon juice each morning when you wake up

22

No question

A nurse is caring for a client who is preparing his advance directives, which of the following statements by the client indicates an understanding of advance directives SATA

I have the right to refuse treatment

My health care proxy can make medical decisions for me

A nurse is caring for a client who is 32 weeks gestation and has a history of cardiac disease which of the following positions to the nurse place the client to best promote optimal, cardiac output

Left lateral

A nurse is caring for a group of clients which of the following client. Should the nurse assigned to an AP.

Client who had a cerebral vascular accident two days ago, and needs help toileting

A nurse is providing discharge, teaching to a client who has schizophrenia, isn't starting therapy with clozapine which of the following is the highest priority for the client to report to the provider

Fever

A nurse observes an AP providing care to a child, who is in a skeletal traction, which of the following action requires intervention

Placing weights as a child's bed

A nurse is planning to delegate twin a piece of fasting blood glucose testing for a client who has diabetes which of the following action should the nurse take

Determine if the AP is qualified to perform the test

A nurse is assessing a client brought to the hospital psychiatric emergency service by law-enforcement officer. The client has just organized incoherent speech with loose associations and religious contact. You should recognize the signs and symptoms as being consistent with which of the following.

Schizophrenia

A nurse is caring for a child who has infectious mononucleosis which of the following findings are associated with this diagnosis SATA

Splenomegaly

Malaise

Sore throat

A nurse is performing dressing change for a client with a sacral wound using negative pressure wound therapy which of the following action should the nurse take first

Determine pain level

A nurse is caring for a client recovery from a bowel surgery has a nasogastric tube connected to load intermittent section which of the following assessment findings should indicate to the nurse at the NG tube may not be functioning properly

Abdominal rigidity

A nurse is preparing to administer TPN with added fat supplements to client who has malnutrition which of the following action should the nurse take

Check for an allergy to eggs

A charge nurse is discussing the use of applying ice to the clients injured knee with a newly licensed nurse, which of the following should the nurse identify as a benefit

decreased capillary permeability

A nurse is developing discharge care plans for a client who has osteoporosis to prevent injury. The nurse should instruct the client to.

Perform weight-bearing exercises

A nurse on a cute meds. Surgical unit is performing assessments on a group of clients which is highest priority.

A client has surgical hypoparathyroidism, and positive trousseau sign

A nurse is caring for a client with congestive heart failure, which of the following prescriptions for the provider should the nurse anticipate

Give the client enalapril 2.5 MGPO twice daily.

A nurse is caring for a client who has a prescription for sertraline to treat depression, which of the following statements by the client indicates an understanding of the medication treatment plan

I understand I may experience difficulty sleeping on this medication

A nurse has been caring for a female client who has bruises on her arms that she explains are a result of physical abuse by her husband. The client states I do not know how much longer I can take this, but I'm afraid he'll really hurt me if I leave which of the following is an appropriate nursing intervention

Help the client to recognize the signs of escalation of the best behavior

A client was having suicidal thoughts tells a nurse it just does not seem worth it anymore. Why not and my misery which of the following responses for the nurses appropriate

Do you have a plan to end your life?

A nurse is caring for a client who has schizophrenia which of the following assessment findings should the nurse expect

Poor problem solving ability

A nurse is caring for a client who has deep vein, thrombosis of the left lower extremity which of the following action. Should the nurse take "possible NGN"

Withhold heparin IV infusion

A nurse is caring for a client with a new prescription of enoxaparin for the prevention of DVT. Which of the following is an appropriate action by the nurse.

Inject a medication into lateral abdominal wall

A nurse is caring for four clients which of the following client data. Should the nurse report to the provider.

A client who has a prescription for chemotherapy and an absolute neutrophil count of 75/mm3

A nurse is caring for a client with end stage osteoporosis and is reporting severe pain clans. Respiratory rate is 14 permanent which of the following medication should the nurse expect to be highest priority to minister to the client.

Hydromorphone

A nurse is caring for a client who has DVT, which of the following instructions should the nurse include in the plan of care

Elevate the client's affected extremity when in bed

A nurse is caring for a client who is receiving Oxytocin IV for argumentation of labor. The clients contractions are hurting every 45 seconds within nine second generation the fetal heart rate is 170 to 180 for a minute which of the following action should the nurse take

Discontinue Oxytocin infusion

A nurse is admitting a client who is in labor and at 38 weeks gestation to the maternal newborn unit. The client has a history of herpes simplex virus 2 which of the following questions is most appropriate for the nurse to ask the client.

Do you have any active lesions?

A nurse is providing teaching for a child prescribed Ferris sulfate, which of the following instruction should the nurse include

Take with a glass of orange juice

Four clients present to the emergency department, the nurse should plan to see which of the following clients first

a 50-year old client who has slurred speech, is disoriented and reports a headache

A nurse is completing a dietary assessment for a client who is Jewish and observes, kosher dietary practices which of the following behaviors should the nurse expect to find

meat and dairy products are eaten separately

52

No question

A nurse in the ER caring for a client or multiple wins, do to motor vehicle crash, which of the following interventions are appropriate SATA

Apply direct pressure to bleeding wounds

Cover wounds with a sterile dressing

Determine date of last tetanus toxoid vaccination

The nurse reviewing clients in Mission laboratory results, which of the findings require further evaluation

Creatinine 1.8

A nurse is providing teaching for a client who has a new prescription for methadone, which of the following client statements indicates need for further teaching

I understand the methadone may cause me to have difficulty sleeping

Which of the following client is appropriate for the nurse to refer to speech therapy for swallowing evaluation

An older adults who has difficulty taking in fluids

A nurse is caring for a group of clients which of the following client should the nurse assess first

A client whose abdominal pain and is vomiting coffee ground emesis

And our sister gay medication history from a client with type two diabetes is scheduled for an arterial gram which of the following medication's to the nurse instruct the client to discontinue 48 hours prior to the procedure

Metformin

The nurse is assessing a client with post traumatic stress disorder, which of the following findings should the nurse expect to find

Loss of interest in usual activities

A nurse working in a long-term care facility is caring for an older adult client with dementia the clients, often agitated and frequently wandering the halls which of the following intervention should the nurse include in the plan of care

Maintain nutritional requirements by offering finger foods

A nurse on a mental health unit receives report on for clients which of the following client. Should the nurse attend first

Client was having auditory hallucinations is becoming agitated

A nurse is caring for a full term newborn immediately following birth, which of the following action, should the nurse take first

Dry the newborn

A nurse receives report on a group of clients which of the following client should the nurse attend first

A client was admitted with angina and reports left arm pain of 4 on a scale of 0 to 10

A client at 38 weeks of gestation interest emergency department. The nurse should recognize that which of the following indicates that the client is in the latent phase of labor.

The cervix is dilated 2 cm

The charge nurse for medical surgical units, discovers client care assignments that should be reassigned, which of the following delegated to should be reassigned

A license practical nurse to provide internal feeding for a client who had a cerebral vascular accident

A nurse is caring for a client who has a cast due to a compound fracture to the right ankle, which of the following findings requires immediate intervention

Paresthesia of the distal extremity

The nurse is providing care for preschoolers with acute gastroenteritis spacing information below which of the following is an appropriate nursing action "possible NGN"

Administer oral rehydration solution

The nurse caring for a client who is taking allopurinol. The nurse should monitor which of the following laboratory findings to determine the affectedness of the medication.

Uric acid level

A nurse is caring for a client on the cardiac unit who is hemodynamically unstable, which of the following dysrhythmias should the nurse plan for cardioversion

Arterial fibrillation

A nurse manager preparing an educational program on infection control measures which of the following should the nurse include when discussing contact precautions

Herpes simplex

A nurse is assessing an older adult client with the decrease caloric, intake, and weight loss which of the following findings should the nurse report to the provider immediately

The client experiences, coughing, and wheezing after eating

A nurse and an AP came for a group of clients which of the following task is appropriate for the nurse to delegate to an AP

Administrative oral fluids to a client with dysphasia

A nurse from the state health department is instructing a group of nurses regarding reportable infections, which of the following instructions. Should the nurse report to the CDC.

Lyme disease

The nurse is assessing an adolescent client for sickle cell anemia which of the following is a priority, finding by the nurse

shortness of breath

A nurse is caring for a client who is one day postop follwoing hypophysectomy for the removal of the pituitary tumor, which of the following findings requires further assessment by the nurse

Urinary output greater than fluid intake

A client with the left leg cast is using crutches for ambulation. The nurse recognizes client needs further instruction when

Maintains 3 to 4 finger with between a crutch pad and axilla

A nurse is caring for a toddler who has respiratory syncytial virus which of the following action should the nurse plan to take

Use a designated stethoscope, when caring for the toddler

A nurse is admitting to a client to emergency department in initiates, continuous, cardiac monitoring, which of the following ECG strips, indicate sinus tachycardia

B

A nurse is planning care for a client to prevent complications of immobility, which of the following action should the nurse include in the plan of care

Remove antiembolism stockings for three hours each day to decrease skin breakdown

A nurse discovers at the wrong dose of medication is given to the client with determining what action to take. You should recognize that which of the following ethical principle should be applied.

Veracity

81

No question

A nurse is reviewing the prescription for doxazosin a client which of the following should be included in the teaching

Rise slowly, when setting up from bed

A nurse, addressing planning to provide teaching too young adult client with insomnia, which of the following should the nurse include in the teaching

Consume a high carbohydrate, snack at bedtime

A nurse is caring for a client who has a store culture that is positive for clostridium difficile which of the following infection control precautions is appropriate

Place the client in private room

A nurse is planning care for a child who has increased intercranial pressure with a decreased level of consciousness, which of the following intervention should the nurse include in the plan of care

Maintain ahead at a midline position

The nurse is assessing a client who is receiving radiation therapy which of the following findings should the nurse expect

Platelets 95,000/mm3

A nurse is caring for a client who has preeclampsia and is experiencing postpartum hemorrhage. The nurse should identify that which of the following medication is contraindicated.

Methylergonovine

A nurse is caring for a client with GERD which of the following assessment findings. Should the nurse expect to find

Atypical chest pain

A nurse is caring for a newborn who is under phototherapy light switch of the following is an appropriate nursing action

Ensure Eyeshield is covering the eyes

The nurse is assessing clients, who had a long arm cast, which of the following findings of the dress moderate and when assessing for acute compartment syndrome "question written bad"

Edema

I just came from client is receiving IV moderate (conscious) sedation with midazolam The client has a respiratory rate of 9/min and is not responding to come out, which is the following is an appropriate action by the nurse..

Administer flumazenil

A nurse in a hospital cafeteria overhears to APs discussing a client. They are using the clients name of discuss the details of his diagnosis which of the following action should the nurse take first.

Tell the AP to discontinue their conversation

A community health nurse is teaching a group of adults about the importance of health screenings the nurse should include African-American males, almost twice as likely as Caucasian males to experience which of the following

stroke

A nurse is caring for a client who sprained his left ankle 12 hours ago which of the following prescription is given by the provider should the nurse clarify

Apply heat to affected extremity for 45 minutes on the 45 is off

A nurse is providing dietary teaching for the client who has hepatic and cephalopathy, which of the following foods elections indicates that the client understands teaching

Rice with black beans

A nurse is planning care for a client with a sailed, radiation implant, and is to remain in the hospital for one week which of the following should the nurse include in the plan of care

Where a dosimeter film badge while in the clients room

A nurse is caring for four clients which of the following client should the nurse care for first

A client with hypothyroidism and has stuporous

The nurse is planning care for a newly admitted adolescent who has bacterial meningitis, which of the following instructions is appropriate for the nurse to include in the plan of care

Initiate droplet precautions for the client

A nurse is giving discharge instructions to a client with a new ileostomy. The nurse should recognize that the teaching has been affected when a client states.

My stoma will drain liquid fluid continuously

A nurse in the providers office is interviewing a client who is requesting an oral contraceptive, which of the following findings in the clients history is a contraindication to use in combination oral contraceptives

impaired liver function