the nurse is caring for the client one 1 day postoperative sigmoid colostomy operation which independent nursing intervention should the nurse implem
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Nursing Elites

ATI RN

ATI RN Custom Exams Set 3

1. The nurse is caring for the client one day postoperative sigmoid colostomy operation. Which independent nursing intervention should the nurse implement?

Correct answer: D

Rationale: Assisting the client to sit in a chair is an essential nursing intervention postoperatively as it helps promote circulation, prevent complications like blood clots, and aids in the recovery process. Changing the infusion rate of intravenous fluid (Choice A) requires a physician's order and is not an independent nursing intervention. Encouraging the client to discuss feelings (Choice B) is important for emotional support but not as crucial as physical care immediately postoperatively. Administering opioid narcotic medications (Choice C) for pain management should be based on a prescribed schedule and assessment rather than being an independent nursing action.

2. The nurse is caring for the client recovering from intestinal surgery. Which assessment finding would require immediate intervention?

Correct answer: D

Rationale: Complaints of chills and feeling feverish may indicate infection, which requires immediate intervention. This finding suggests a systemic response to infection, which can be life-threatening if not promptly addressed. Options A, B, and C are common postoperative findings and may not necessarily require immediate intervention unless accompanied by other concerning signs or symptoms.

3. During the admission interview, which question should the nurse ask the male client diagnosed with aorto-iliac disease?

Correct answer: D

Rationale: The correct answer is D: “Have you experienced any problems having sexual intercourse?” Aorto-iliac disease can lead to impaired blood flow to the pelvis and lower extremities, potentially causing sexual dysfunction. The other choices (A, B, and C) are less relevant to the specific effects of aorto-iliac disease on the client's health. While choice A may relate to discomfort, it does not directly address the impact of the disease on sexual function. Choices B and C are more general and do not specifically target the potential issues related to aorto-iliac disease.

4. Whenever possible, patients evacuated from the theater of operations who are expected to return within 60 days are admitted to which of the following?

Correct answer: B

Rationale: Patients evacuated from the theater of operations and expected to return within 60 days are admitted to DOD tri-service hospitals. These hospitals are well-equipped to handle military personnel and are strategically placed for operational efficiency. Choice A, civilian hospitals participating in the National Disaster Medical System, may not have the specialized care and resources required for military personnel. Choice C, Department of Veterans Affairs hospitals, cater to veterans rather than active-duty personnel in theater. Choice D, temporary field hospitals, might not provide the comprehensive care and resources needed for an extended period of treatment.

5. A client who _____ diet requires _____ amounts of vitamin C.

Correct answer: B

Rationale: Clients who smoke require more vitamin C due to increased oxidative stress and depletion of vitamin C. Smoking leads to the generation of free radicals in the body, causing oxidative stress and consuming higher levels of antioxidants like vitamin C. Choices A, C, and D are incorrect as they do not directly relate to the increased need for vitamin C as seen in smokers.

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