a client has a transient ischemic attack tia what should the nurse teach
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Nursing Elites

ATI RN

ATI Capstone Adult Medical Surgical Assessment 2

1. A client has a Transient Ischemic Attack (TIA). What should the nurse teach?

Correct answer: A

Rationale: The correct answer is A: Avoid eating within 3 hours of bedtime. For a client with a Transient Ischemic Attack (TIA), it is crucial to avoid eating within 3 hours of bedtime to reduce reflux that can worsen symptoms. Choice B is incorrect because consuming liquids between meals is not specifically related to managing TIA. Choice C is incorrect as eating large meals may not be recommended, especially if the client needs to watch their caloric intake. Choice D is incorrect because avoiding liquids entirely can lead to dehydration and is not a standard recommendation for TIA management.

2. What is the preferred electrical intervention for a patient with ventricular tachycardia with a pulse?

Correct answer: B

Rationale: Synchronized cardioversion is the preferred electrical intervention for ventricular tachycardia with a pulse. In this scenario, the heart still has an organized rhythm, so synchronized cardioversion is used to deliver a shock at a specific point in the cardiac cycle, aiming to restore a normal rhythm. Defibrillation (Choice A) is used for pulseless ventricular tachycardia or ventricular fibrillation. Pacing (Choice C) may be used for bradycardias or certain types of heart blocks. Medication administration (Choice D) can be considered for stable ventricular tachycardia, but synchronized cardioversion is the primary intervention for ventricular tachycardia with a pulse.

3. A patient has been diagnosed with a thrombotic stroke. What are the expected manifestations?

Correct answer: A

Rationale: The correct answer is A: 'Gradual loss of function on one side of the body.' Thrombotic strokes lead to slow and progressive symptoms as a result of decreased blood flow to a specific area of the brain. Choices B, C, and D are incorrect because sudden loss of consciousness, seizures, confusion, and loss of sensation in the affected limb are not typical manifestations of a thrombotic stroke.

4. What intervention is needed when continuous bubbling is seen in the chest tube water seal chamber?

Correct answer: A

Rationale: When continuous bubbling is observed in the chest tube water seal chamber, the appropriate intervention is to tighten the connections of the chest tube system. This action can help resolve an air leak, which is often the cause of continuous bubbling in the water seal chamber. Clamping the chest tube (choice B) is not recommended as it can lead to a dangerous increase in pressure within the chest. Replacing the chest tube (choice C) is not the initial intervention unless there are other indications to do so. Simply monitoring the chest tube (choice D) without taking corrective action will not address the underlying issue of the air leak causing continuous bubbling.

5. What should be taught to a patient following cataract surgery?

Correct answer: A

Rationale: The correct answer is to avoid NSAIDs after cataract surgery to reduce the risk of bleeding. Choice B, wearing dark glasses when outdoors, is generally recommended after cataract surgery to protect the eyes from bright sunlight, but it is not the most critical instruction. Choice C, reporting green or yellow drainage immediately, is important to monitor for signs of infection, but it is not specific to cataract surgery. Choice D, itching is normal unless accompanied by pain and nausea, is not the most crucial advice post-cataract surgery. Therefore, the key instruction is to avoid NSAIDs to minimize bleeding risk.

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