a nurse is planning care for a client who is postoperative following a bowel resection which of the following interventions should the nurse include
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Nursing Elites

ATI RN

ATI Comprehensive Exit Exam

1. A nurse is planning care for a client who is postoperative following a bowel resection. Which of the following interventions should the nurse include?

Correct answer: C

Rationale: The correct intervention for a client post-bowel resection is to instruct the client to splint the incision with a pillow. This technique helps prevent dehiscence, which is the separation of wound edges, and reduces pain when coughing or moving. Splinting supports the incision site, decreasing tension on the wound. Encouraging the client to drink adequate fluids promotes hydration and aids in recovery, but a specific volume like 1,000 mL mentioned in choice A is not essential. Pain medication should be administered as needed for adequate pain control, not necessarily before every meal. Instructing the client to eat a balanced diet, including adequate protein, is crucial for wound healing and overall recovery, rather than limiting protein intake.

2. A nurse is caring for a client who has cirrhosis. Which of the following findings should the nurse expect?

Correct answer: D

Rationale: In clients with cirrhosis, the liver is unable to produce clotting factors efficiently, leading to impaired clotting function. Therefore, an increased prothrombin time is expected in cirrhosis. Choices A, B, and C are incorrect. Decreased bilirubin levels are not typically seen in cirrhosis; prothrombin time is usually increased, not decreased; and albumin levels are often decreased in cirrhosis due to reduced synthetic liver function.

3. A client with iron-deficiency anemia is being taught about dietary management by a nurse. Which of the following foods should the nurse recommend?

Correct answer: B

Rationale: The correct answer is B: Red meat. Red meat is a good dietary source of heme iron, which is easily absorbed by the body and beneficial for individuals with iron-deficiency anemia. Oatmeal, bananas, and whole grains are not as rich in iron compared to red meat and may not provide sufficient amounts to help manage iron-deficiency anemia effectively.

4. A client with a new diagnosis of hypertension is receiving teaching from a nurse. Which of the following statements by the client indicates an understanding of the teaching?

Correct answer: C

Rationale: The correct answer is C. Regular exercise is an essential component in managing hypertension. Exercising for at least 30 minutes a day, at least 5 days a week, can help control blood pressure. Checking blood pressure regularly (choice A) is important, but not as indicative of understanding the teaching as the commitment to regular exercise. Avoiding foods high in potassium (choice B) is not a typical recommendation for managing hypertension. Taking medication only when feeling dizzy (choice D) is incorrect and potentially dangerous; medications should be taken as prescribed by the healthcare provider.

5. What is the most effective intervention for a patient experiencing acute pain?

Correct answer: A

Rationale: Administering analgesics is the most effective intervention for a patient experiencing acute pain as it directly targets the pain receptors and provides relief. Repositioning the patient may help in some cases, but it is not the primary intervention for managing acute pain. Non-pharmacological interventions can be beneficial as adjuncts to pain management but might not provide immediate relief. Administering IV fluids is not a standard intervention for acute pain unless dehydration is contributing to the pain.

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