what is the appropriate action for a nurse to take when a patient has a high fever and is disoriented
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Nursing Elites

ATI RN

ATI RN Comprehensive Exit Exam

1. What is the appropriate action for a healthcare provider to take when a patient has a high fever and is disoriented?

Correct answer: C

Rationale: Administering fluids is the appropriate action for a healthcare provider to take when a patient has a high fever and is disoriented. Dehydration can worsen confusion and other symptoms in such a situation. Administering acetaminophen or cooling the patient with cold compresses may help reduce the fever but does not address the underlying issue. Administering antibiotics is not indicated for a high fever and disorientation without knowing the cause.

2. A healthcare provider is teaching a client who has a new diagnosis of hypertension about dietary management. Which of the following foods should the healthcare provider recommend?

Correct answer: C

Rationale: The correct answer is 'Lean beef.' Lean beef is a good source of protein, which is essential for a balanced diet. While carrots and bananas are healthy food choices, they are not specifically recommended for clients with hypertension. Whole grains are a better alternative to refined grains for individuals with hypertension, but lean beef is a more suitable recommendation due to its protein content.

3. What is the most important nursing action for a patient presenting with confusion after surgery?

Correct answer: A

Rationale: Administering oxygen is crucial for a patient presenting with confusion after surgery because it helps alleviate potential hypoxia, which can be a common cause of confusion in the postoperative period. While repositioning the patient, administering IV fluids, and performing a neurological assessment are important nursing interventions in certain situations, addressing hypoxia by administering oxygen takes priority in this case to ensure an adequate oxygen supply to the brain and other vital organs.

4. A nurse is providing discharge teaching to a client who has chronic kidney disease and is receiving hemodialysis. What dietary instruction should the nurse provide?

Correct answer: C

Rationale: For a client with chronic kidney disease receiving hemodialysis, consuming 1g/kg of protein per day is important. This amount helps manage the condition without overburdening the kidneys. Choice A is incorrect because magnesium hydroxide is not specifically recommended for clients with chronic kidney disease. Choice B is not accurate as fluid intake needs to be individualized based on the client's condition and dialysis status. Choice D is incorrect because foods high in potassium should generally be limited for individuals with kidney disease undergoing hemodialysis to prevent hyperkalemia.

5. A client with diabetes mellitus is being taught by a nurse about managing blood glucose levels. Which of the following client statements indicates an understanding of the teaching?

Correct answer: A

Rationale: Choice A is the correct answer because consuming a snack when the blood glucose level is below 70 mg/dL helps prevent hypoglycemia in clients with diabetes mellitus. Choice B is incorrect because taking insulin when blood glucose is high (above 200 mg/dL) helps manage hyperglycemia, not hypoglycemia. Choice C is incorrect as checking blood glucose levels once a week is insufficient for proper diabetes management, which typically requires more frequent monitoring. Choice D is incorrect because waiting for symptoms of hyperglycemia to take insulin can lead to uncontrolled blood glucose levels.

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