a nurse is planning care for a client who is receiving radiation therapy to the head and neck which of the following interventions should the nurse in a nurse is planning care for a client who is receiving radiation therapy to the head and neck which of the following interventions should the nurse in
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Nursing Elites

ATI RN

ATI RN Exit Exam

1. A client is receiving radiation therapy to the head and neck. Which of the following interventions should the nurse include?

Correct answer: D

Rationale: The correct intervention for a client receiving radiation therapy to the head and neck is to avoid exposure to direct sunlight. Direct sunlight should be avoided to protect the skin from further irritation and damage caused by the radiation therapy. Instructing the client to use an alcohol-free mouthwash is important to prevent irritation and maintain oral hygiene, making choice A incorrect. Applying heat packs to the radiation site is contraindicated as heat can further aggravate the skin, making choice B incorrect. Providing a diet low in carbohydrates is not directly related to radiation therapy to the head and neck, so choice C is also incorrect.

2. A client with chronic kidney disease has arterial blood gas values being reviewed by a nurse. Which of the following sets of values should the nurse expect?

Correct answer: A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg

Rationale: In chronic kidney disease, metabolic acidosis is common due to impaired kidney function leading to reduced bicarbonate excretion. The correct values indicating metabolic acidosis in this scenario are a low pH (acidosis), low bicarbonate (HCO3-) level, and low PaCO2 (compensation through respiratory alkalosis). Therefore, the expected values for a client with chronic kidney disease would be pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg, as depicted in choice A.

3. The complexities of the current health care delivery systems require a variety of leadership styles. Which of the following leadership styles would be most effective in this environment?

Correct answer: D

Rationale: In complex health care environments, transformational leadership is the most effective style. This leadership approach focuses on inspiring and motivating staff towards a shared vision. Autocratic leadership (choice A) is too controlling and may not foster innovation and adaptability needed in complex systems. Laissez-faire leadership (choice B) lacks guidance and may lead to confusion in intricate healthcare settings. Transactional leadership (choice C) focuses on tasks and rewards, but may not be as effective in promoting innovation and change management required in complex health care delivery systems.

4. What is the movement of water from an area of lower solute concentration to one of higher solute concentration called?

Correct answer: D

Rationale: The correct answer is D, Osmosis. Osmosis is the process where water moves from an area of low solute concentration to an area of high solute concentration. This movement equalizes the solute concentration in intracellular and extracellular fluids. Choices A, B, and C are incorrect because they do not describe the movement of water based on solute concentration levels.

5. Which of the following structures, located at the end of the ear canal, vibrates when sound waves strike it?

Correct answer: Tympanic membrane

Rationale: The correct answer is the Tympanic membrane. The tympanic membrane, also known as the eardrum, is located at the end of the ear canal and vibrates when sound waves strike it. This vibration is then transmitted to the ossicles in the middle ear, which amplify and transmit the sound to the inner ear. Choice A, the Acoustic meatus, is incorrect as it is the ear canal itself, not the structure that vibrates. Choice B, the Cochlea, is responsible for translating sound vibrations into electrical signals but is not located at the end of the ear canal. Choice C, the Eustachian tube, is responsible for equalizing pressure between the middle ear and the atmosphere and is not involved in vibration from sound waves.

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