which intervention would be the most important for the nurse to implement for the client with a left nephrectomy
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Nursing Elites

ATI RN

ATI RN Custom Exams Set 2

1. What intervention would be the most important for the nurse to implement for the client with a left nephrectomy?

Correct answer: A

Rationale: The most important intervention for a client with a left nephrectomy is to assess the intravenous fluids for rate and volume. After nephrectomy, monitoring intravenous fluids is crucial to ensure proper hydration and kidney function. Changing the surgical dressing daily, monitoring medication levels, and tracking meal intake are also important aspects of care but not as critical as ensuring adequate intravenous fluid management post-surgery.

2. The client is complaining of painful swallowing secondary to mouth ulcers. Which statement by the client indicates appropriate management?

Correct answer: D

Rationale: The correct answer is D. Avoiding irritants like spicy foods, tobacco, and alcohol is crucial in managing mouth ulcers as they can further irritate the ulcers and delay healing. Choices A, B, and C could potentially worsen the condition. Brushing with a soft-bristle toothbrush may cause discomfort, rinsing with Listerine mouthwash can be too harsh on the ulcers, and swallowing antifungal solution is not recommended unless specified by a healthcare provider.

3. The nurse is preparing a teaching care plan for the client diagnosed with nephritic syndrome. Which intervention should the nurse include?

Correct answer: D

Rationale: The correct intervention for the nurse to include in the care plan for a client diagnosed with nephritic syndrome is to instruct the client to report any decrease in daily weight during treatment to the healthcare provider. A decrease in weight could indicate worsening of the nephritic syndrome or dehydration, making it crucial information for the healthcare provider to assess the client's condition. Option A is incorrect because discontinuing steroid therapy should be done under medical guidance rather than immediately if symptoms develop. Option B is incorrect because diuretics should not be taken without healthcare provider's guidance due to the risk of electrolyte imbalances. Option C is incorrect as increasing dietary sodium would exacerbate fluid retention, which is undesirable in nephritic syndrome.

4. AND Answers

Correct answer: B

Rationale: When collecting a stool specimen, the nurse should usually take about 1 inch of the specimen or a teaspoonful for testing purposes. This amount is sufficient for laboratory analysis and helps ensure accurate results. It is important for the nurse to follow the proper procedure for specimen collection to maintain accuracy in diagnostic testing.

5. A patient on long-term steroid therapy should be monitored for which condition?

Correct answer: D

Rationale: Corrected Rationale: Patients on long-term steroid therapy should be monitored for osteoporosis due to the medication's potential to decrease bone density. Choices A, B, and C are incorrect. While long-term steroid therapy can also lead to hyperglycemia, hypothyroidism, and hypertension, the primary concern and most common risk associated with prolonged steroid use is osteoporosis.

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