ATI Practice test

A nurse is for a client who has a prescription for a high protein diet to promote wound healing following surgery. The client's religion prohibits eating meat on particular days. Which of the following actions should the nurse take?

• Encourage the client to eat meat during this time to promote healing

• Advice the client to eat everything on the tray except the meat

• Suggest the client receive high protein enteral feedings

• Ask the dietitian to recommend alternative food choices for the client.

A nurse is collecting data from a client who requires bed rest and reports abdominal discomfort. The nurse notes abdominal distention. Which of the following conditions should the nurse identify as an adverse effect of bed rest?

• Heartburn

• Anorexia

• Constipation

• Urinary Urgency

A nurse is collecting data from a client who is 1 day postoperative following abdominal surgery. Which of the following findings is the priority for the nurse to report to the provider?

• The client reports an incisional pain level 7 on a scale of 0 to 10

• The client reports increased nausea and chills

• The client has an oral temperature of 39^o C (102.2^o F)

• The client has redness and warmth in his calf

A nurse is contributing to the plan of care for four clients. For which of the following clients should the nurse initiate airborne precautions?

• A client who has pneumonia

• A client who has measles

• A client who has pertussis

• A client who has MRSA

A nurse is contributing to the plan of care for a client who is at risk for developing foot drop due to immobility. Which of the following actions should the nurse recommend to include in the pain?

• Flex the client's feet using pillows

• support the clients feet with foot boots

• Place a hand roll under the client's heel

• Remove ankle-foot orthotic devices at bedtime

A nurse is caring for a client who has dysphagia following a stroke. Which of the following interventions should the nurse use when feeding the client?

• Offer the client a straw to drink liquids

• Place food toward the back of the clients mouth

• Encourage the client to lie down and rest for 30 min after meals

• Instruct the client to tilt her head forward while eating

A nurse is evaluating the crutch-walking technique of a client who is required to keep weight off her right leg.Which of the following is the proper crutch gait for this client?

• four-point

• three-point

• two-point

• swing-through

A nurse is caring for an older adult client and is concerned that the client may have a fecal impaction. Which of the following is the most important question for the nurse to ask.

• "What types of foods have you been eating?"

• "Are you using stool softeners or laxatives?"

• " Have you been passing gas?"

• "Have you had small liquid stools?"

A nurse is caring for a client who has been vomiting excessively and has diarrhea. Which of the following findings should the nurse identify as an indication of fluid volume deficit?

• BUN 18 mg/dL

• A bounding pulse

• Urine specific gravity 1.045

• Prominent neck veins

A nurse is caring for a client who has a new diagnosis of cancer. Which of the following actions should the nurse take to maintain the client's confidentiality while providing care?

• Share the client's prognosis with a member of the client's family

• Discuss the client's status with a member of pastoral care

• Offer information to a friend of the client over the phone

• Provide information to another nurse at change of shift