a nurse is assessing a client who has left sided heart failure which of the following should the nurse identify as a manifestation of pulmonary conges
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Nursing Elites

ATI RN

ATI Fundamentals Proctored Exam 2023

1. A healthcare provider is assessing a client who has left-sided heart failure. Which of the following should the healthcare provider identify as a manifestation of pulmonary congestion?

Correct answer: A

Rationale: Pulmonary congestion is a common manifestation of left-sided heart failure. When the left side of the heart fails, blood backs up into the lungs, leading to pulmonary congestion. This can result in symptoms such as frothy, pink-tinged sputum due to the presence of blood in the respiratory secretions. Jugular vein distention, weight gain, and bradypnea are also associated with heart failure, but frothy, pink sputum specifically indicates pulmonary congestion in this scenario.

2. A client is being instructed on how to perform pursed-lip breathing. Which of the following should be included in the plan of care?

Correct answer: C

Rationale: Pursed-lip breathing is a breathing technique that involves inhaling slowly through the nose and exhaling gently through pursed lips. This technique helps improve breathing efficiency and can be beneficial for individuals with respiratory conditions. Instructing the client to take a deep breath in through the nose is essential for proper execution of pursed-lip breathing, making choice C the correct answer.

3. The healthcare professional is preparing to take vital signs in an alert client admitted to the hospital with dehydration secondary to vomiting and diarrhea. What is the best method used to assess the client’s temperature?

Correct answer: A

Rationale: The most accurate method for assessing temperature in an alert client is the oral method. It provides a more reliable reflection of the body's core temperature compared to axillary or radial methods. In cases of dehydration, it is important to get an accurate temperature reading to monitor the client's condition closely. Axillary temperature may be affected by environmental factors, while radial temperature measurement is not a standard method for assessing core body temperature. Heat-sensitive tape is not a recognized method for assessing body temperature in clinical practice.

4. Which of the following patients is at greater risk for contracting an infection?

Correct answer: A

Rationale: Leukopenia, characterized by low white blood cell count, significantly reduces the body's ability to fight infections. Patients with leukopenia are at a higher risk of contracting infections due to compromised immune defenses.

5. When teaching about electrical fire prevention at a community health fair, which of the following information should be included?

Correct answer: A

Rationale: The correct answer is to use three-pronged grounded plugs because they are safer and reduce the risk of electrical fires. Option B is incorrect as covering extension cords with a rug can pose a fire hazard. Option C is incorrect; tingling sensations around a cord indicate an electrical issue, not proper functioning. Option D is unsafe; plugs should be removed from the socket by pulling the plug, not the cord, to prevent damage and reduce the risk of electrical hazards.

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