a nurse is assessing a client who is postoperative following a thyroidectomy which of the following findings is the priority for the nurse to report
Logo

Nursing Elites

ATI RN

ATI RN Comprehensive Exit Exam 2023

1. A nurse is assessing a client who is postoperative following a thyroidectomy. Which of the following findings is the priority for the nurse to report?

Correct answer: D

Rationale: Stridor is a high-pitched sound that indicates airway obstruction and is the priority finding to report following a thyroidectomy. In this situation, airway compromise is a critical concern that requires immediate intervention to ensure adequate oxygenation. While calcium level (Choice A) and serum sodium level (Choice B) are important assessments post-thyroidectomy, they do not represent an immediate threat to the client's airway. A respiratory rate of 18/min (Choice C) falls within the normal range and does not indicate an immediate risk to the client's airway compared to the presence of stridor.

2. A client is taking sucralfate. Which of the following client statements indicates an understanding of the teaching?

Correct answer: A

Rationale: The correct answer is A. Sucralfate is most effective when taken 1 hour before meals to protect the stomach lining. Option B is incorrect because sucralfate should not be taken after meals. Option C is incorrect because sucralfate is typically taken on a regular schedule, not just when symptoms occur. Option D is incorrect because sucralfate should not be taken with milk, as it can interfere with its effectiveness.

3. A nurse is planning care for a client who has a new prescription for warfarin. Which of the following laboratory values should the nurse monitor to determine the effectiveness of the therapy?

Correct answer: C

Rationale: Corrected Rationale: The nurse should monitor the client's INR to determine the effectiveness of warfarin therapy. INR monitoring is crucial as it reflects the blood's ability to clot properly. Warfarin is commonly used as an anticoagulant, and maintaining the INR within the therapeutic range ensures that the client is protected from both clotting and bleeding events. Monitoring serum calcium levels, platelet count, or WBC count is not directly related to assessing the effectiveness of warfarin therapy.

4. A client with heart failure at risk for pulmonary edema should receive which intervention to improve oxygenation?

Correct answer: D

Rationale: Administering oxygen via a non-rebreather mask is the appropriate intervention for a client at risk for pulmonary edema as it helps improve oxygenation by delivering a high concentration of oxygen. Placing the client in a supine position can exacerbate pulmonary edema by increasing venous return to the heart, leading to fluid overload. Encouraging increased fluid intake is contraindicated in clients with heart failure and at risk for pulmonary edema, as it can worsen fluid accumulation. Elevating the client's legs when in bed is more appropriate for clients with conditions such as venous insufficiency or edema in the lower extremities, not for pulmonary edema.

5. A client with gastroesophageal reflux disease (GERD) is being taught about lifestyle modifications. Which of the following instructions should be included?

Correct answer: B

Rationale: The correct instruction for a client with GERD is to avoid drinking fluids with meals. This is because consuming fluids while eating can exacerbate reflux symptoms by increasing stomach distension and contributing to the reflux of stomach contents into the esophagus. Option A is incorrect as elevating the head of the bed can help prevent reflux during sleep, not while drinking fluids. Option C is incorrect as consuming three large meals a day can worsen GERD symptoms due to increased gastric distension. Option D is incorrect as lying down after eating can also worsen GERD symptoms by promoting the reflux of stomach contents into the esophagus.

Similar Questions

A nurse is providing teaching to a client who has a new prescription for atorvastatin. Which of the following instructions should the nurse include?
A nurse is reviewing the medical record of a client who has a new prescription for potassium chloride. Which of the following findings should the nurse report to the provider?
How should a healthcare professional assess a patient for dehydration?
A nurse is assessing a client who is receiving digoxin for heart failure. Which of the following findings should the nurse report to the provider?
When documenting an incorrect dose of medication administered, which fact related to the incident report should the nurse document in the client's medical record?

Access More Features

ATI RN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

ATI RN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

Other Courses