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ATI PN Comprehensive Predictor 2023 Quizlet
1. How should a healthcare professional assess and manage a patient with ascites?
- A. Monitor abdominal girth and administer diuretics
- B. Administer pain relief and monitor fluid intake
- C. Restrict fluid intake and encourage bed rest
- D. Administer albumin and check electrolyte levels
Correct answer: A
Rationale: Correct! When managing a patient with ascites, monitoring abdominal girth is crucial as it helps assess the extent of fluid retention. Administering diuretics is also essential to help reduce fluid buildup in the body, thereby managing ascites effectively. Option B is incorrect as pain relief is not the primary intervention for ascites. Option C is incorrect as restricting fluid intake can worsen the condition by causing dehydration and further fluid imbalances. Option D is incorrect as administering albumin and checking electrolyte levels are not first-line interventions for managing ascites; these interventions may be considered in specific cases but are not the initial steps in managing ascites.
2. A nurse is caring for a client who is having difficulty voiding following the removal of an indwelling urinary catheter. Which of the following interventions should the nurse take?
- A. Assess for bladder distention after 6 hours
- B. Encourage the client to use a bedpan in the supine position
- C. Restrict the client's intake of oral fluids
- D. Pour warm water over the client's perineum
Correct answer: D
Rationale: The correct answer is to pour warm water over the client's perineum. This intervention can help stimulate voiding after catheter removal by promoting relaxation of the perineal muscles and increasing sensory input to the bladder. Assessing for bladder distention after 6 hours (Choice A) is important but not the initial intervention for difficulty voiding. Encouraging the client to use a bedpan in the supine position (Choice B) may not be effective in promoting voiding. Restricting the client's intake of oral fluids (Choice C) is not appropriate as hydration is important for urinary function.
3. A client has undergone a bronchoscopy, and a nurse is providing care post-procedure. What should the nurse do first?
- A. Monitor the client's oxygen levels
- B. Encourage the client to eat
- C. Check for a gag reflex
- D. Administer IV fluids
Correct answer: C
Rationale: After a bronchoscopy, the nurse's priority is to check for a gag reflex. This action helps assess the client's ability to protect their airway after sedation. Maintaining airway patency is crucial post-procedure. Monitoring oxygen levels is important but ensuring airway protection takes precedence. Encouraging the client to eat and administering IV fluids are essential aspects of care but are not the immediate priority in this situation.
4. A nurse is teaching a client who is undergoing chemotherapy about measures to prevent infection. Which of the following instructions should the nurse include?
- A. Avoid crowded places
- B. Wear a mask at home
- C. Drink unfiltered water
- D. Avoid washing hands frequently
Correct answer: A
Rationale: The correct instruction the nurse should include is to advise the client to avoid crowded places. Immunocompromised clients undergoing chemotherapy are at a higher risk of infections, so avoiding crowded places can help reduce exposure to pathogens. Wearing a mask at home is not necessary unless someone in the household is sick. Drinking unfiltered water can introduce harmful bacteria, increasing the risk of infection. Avoiding washing hands frequently is incorrect as hand hygiene is crucial in preventing the spread of infections.
5. What is the priority nursing action for a client with dehydration?
- A. Administer oral fluids
- B. Monitor electrolyte levels
- C. Administer antiemetics as needed
- D. Encourage bed rest
Correct answer: B
Rationale: The priority nursing action for a client with dehydration is to monitor electrolyte levels. Dehydration can cause imbalances in electrolytes such as sodium and potassium, affecting essential bodily functions. Monitoring electrolyte levels is crucial to promptly identify and correct any imbalances. While administering oral fluids (Choice A) is vital in treating dehydration, monitoring electrolyte levels takes precedence as it directly addresses the underlying imbalance. Administering antiemetics (Choice C) may be necessary for nausea and vomiting but is not the priority over electrolyte monitoring. Encouraging bed rest (Choice D) can conserve energy but is not as critical as monitoring electrolyte levels to prevent complications related to electrolyte imbalances.
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