a nurse is planning care for a client who has pneumonia which of the following actions should the nurse take to promote airway clearance
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Nursing Elites

ATI RN

ATI RN Comprehensive Exit Exam 2023

1. A nurse is planning care for a client who has pneumonia. Which of the following actions should the nurse take to promote airway clearance?

Correct answer: C

Rationale: Encouraging the client to increase fluid intake is essential in promoting airway clearance for a client with pneumonia. Increased fluid intake helps thin secretions, making it easier for the client to clear their airways. Chest physiotherapy (Choice A) is more focused on mobilizing secretions and may not be suitable for all clients with pneumonia. Suctioning (Choice B) is indicated for clients who have excessive secretions that they cannot manage effectively themselves. Administering oxygen via nasal cannula (Choice D) is important for clients with pneumonia to maintain adequate oxygenation, but it does not directly promote airway clearance.

2. A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. Which of the following instructions should the nurse include?

Correct answer: A

Rationale: The correct instruction for a client prescribed ferrous sulfate is to take the medication with orange juice to enhance absorption. Orange juice is recommended because of its vitamin C content, which aids in the absorption of iron. Choice B, taking the medication on an empty stomach, is incorrect because ferrous sulfate is better absorbed with food. Choice C, taking the medication with milk if it causes stomach upset, is incorrect as calcium in milk can interfere with iron absorption. Choice D, taking the medication at bedtime, is incorrect as it is usually recommended to take iron supplements between meals or with food to enhance absorption.

3. What is the best intervention for a patient experiencing respiratory distress?

Correct answer: A

Rationale: Administering oxygen is the best intervention for a patient experiencing respiratory distress because it helps improve oxygenation and alleviate respiratory distress. Oxygen therapy is a critical and priority intervention in such cases as it aims to increase oxygen levels in the blood. Administering bronchodilators may be beneficial for specific respiratory conditions like asthma or COPD, but oxygen should be the initial priority. Administering IV fluids and providing humidified air, while important in certain situations, are not the primary interventions for respiratory distress.

4. A healthcare provider is providing dietary teaching to a client who has a new diagnosis of irritable bowel syndrome (IBS). Which of the following foods should the healthcare provider instruct the client to avoid?

Correct answer: D

Rationale: The correct answer is D, oatmeal. Oatmeal contains insoluble fiber, which can exacerbate the symptoms of irritable bowel syndrome. Choices A, B, and C are not typically problematic for individuals with IBS. Lean cuts of pork, low-fat yogurt, and white bread are generally well-tolerated and may even be recommended as part of a balanced diet for individuals with IBS.

5. A client has a new prescription for metformin. Which of the following client statements indicates an understanding of the teaching?

Correct answer: B

Rationale: The correct answer is B. Metformin should be taken with a full glass of water in the morning to improve absorption and prevent gastrointestinal upset. Choice A is incorrect because metformin is not typically taken at bedtime. Choice C is unrelated to metformin therapy. Choice D is incorrect because metformin is actually better absorbed when taken with or after meals.

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