a nurse is caring for a client who has a nasogastric tube for gastric decompression which of the following actions should the nurse take
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ATI Exit Exam 180 Questions Quizlet

1. A client has a nasogastric tube for gastric decompression. Which of the following actions should the nurse take?

Correct answer: D

Rationale: The correct answer is to keep the client's head of the bed elevated to 45 degrees. This position helps prevent aspiration in clients with a nasogastric tube for gastric decompression by reducing the risk of reflux and promoting proper drainage. Choice A is incorrect because checking for bowel sounds is not directly related to the care of a nasogastric tube. Choice B is incorrect as flushing the NG tube every 24 hours is not a standard nursing practice and may lead to complications. Choice C is incorrect because providing sips of water may interfere with the purpose of gastric decompression, which is to keep the stomach empty.

2. A nurse is caring for a toddler who has acute lymphocytic leukemia. In which of the following activities should the toddler participate?

Correct answer: B

Rationale: The correct answer is playing with a large plastic truck. This activity is suitable for toddlers as it promotes their development, encourages fine motor skills, and provides an opportunity for imaginative play. Looking at alphabet flashcards may be more suitable for older children who are learning letters and words. Using scissors to cut out paper shapes may pose a safety risk for a toddler, as they may not have the dexterity or understanding required for this activity. Watching a cartoon in the dayroom is a passive activity and does not actively engage the toddler in physical or cognitive development.

3. How should a healthcare provider handle a patient with non-compliance to hypertension medication?

Correct answer: A

Rationale: Providing education about the importance of medication adherence is crucial in managing hypertension. By educating the patient about the significance of taking their medication as prescribed, the healthcare provider can help improve compliance and control the patient's blood pressure. Referring the patient to a specialist (Choice B) may be necessary in some cases but addressing non-compliance should start with education. Exploring alternative treatments (Choice C) could be considered if the current medication is not suitable, but initial steps should focus on improving adherence. Reassessing the patient in 6 months (Choice D) may be too delayed if non-compliance is an issue that needs immediate attention.

4. A nurse is caring for a client who has a prescription for furosemide. The nurse should monitor the client for which of the following electrolyte imbalances?

Correct answer: B

Rationale: The correct answer is B: Hypokalemia. Furosemide, a loop diuretic, can cause potassium loss leading to hypokalemia. Monitoring potassium levels is crucial as low potassium can result in various complications like cardiac dysrhythmias. Choices A, C, and D are incorrect. Hypernatremia is high sodium levels, which are not typically associated with furosemide use. Hypercalcemia is elevated calcium levels and hypomagnesemia is low magnesium levels, which are not the primary electrolyte imbalances associated with furosemide.

5. A nurse is providing discharge teaching to a client who has a wound infection. Which of the following information should the nurse include about home care?

Correct answer: D

Rationale: The correct answer is D: 'Keep the wound covered with a dry dressing.' When providing care for a wound infection, it is essential to keep the wound covered with a dry dressing to prevent further contamination and promote healing. Soaking the wound in warm water (choice A) can introduce moisture and increase the risk of infection. Using hydrogen peroxide (choice B) can be too harsh and may slow down the healing process by damaging healthy tissue. Applying a cold compress (choice C) is not typically recommended for wound infections, as it may not provide the necessary environment for healing.

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