a nurse is receiving a change of shift report for an adult female client who is postoperative which of the following client information should the nur
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Nursing Elites

ATI RN

ATI Fundamentals Proctored Exam

1. During a shift change, a nurse is receiving a report for an adult female client who is postoperative. Which of the following client information should the nurse report?

Correct answer: C

Rationale: Lower platelets can indicate a potential risk of bleeding in a postoperative client. Thrombocytopenia, or low platelet count, can lead to increased bleeding tendencies and should be promptly reported to the healthcare team for appropriate management. Monitoring platelet levels is crucial in postoperative care to prevent complications related to inadequate clotting ability.

2. What is the most common cause of dementia among elderly persons?

Correct answer: D

Rationale: Alzheimer’s disease is the most common cause of dementia among elderly persons. It is a progressive neurodegenerative disorder that affects memory, thinking, and behavior. While Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis are serious conditions, they are not typically associated with dementia in the same way Alzheimer’s disease is. Therefore, the correct answer is D.

3. A nurse is providing teaching about gastrostomy tube feedings to the parents of a school-age child. Which of the following instructions should the nurse give?

Correct answer: B

Rationale: Administering the feeding over 30 minutes helps prevent complications such as aspiration. Placing the child in an upright position after the feeding is recommended to reduce the risk of aspiration. It is essential to change the feeding bag and tubing every 3 days to maintain asepsis and prevent infections. Warming the formula in a warm water bath is the correct method as using a microwave can create hot spots that may burn the child's mouth or throat.

4. What is the best description of Back Care?

Correct answer: A

Rationale: The correct answer is A: Caring for the back by means of massage. Back Care involves activities like massage, exercises, maintaining proper posture, and using ergonomic practices to keep the spine healthy and prevent injuries. While washing the back is a hygiene practice, applying cold or hot compresses may provide relief for back pain but do not encompass the comprehensive approach of back care like massage does.

5. Which of the following is a sign or symptom of a hemolytic reaction to a blood transfusion?

Correct answer: A

Rationale: Hemoglobinuria is a characteristic sign of a hemolytic reaction to a blood transfusion. Hemolytic reactions can lead to the destruction of red blood cells, causing the release of hemoglobin into the urine, which presents as hemoglobinuria. Chest pain, urticaria, and distended neck veins are not specific signs of a hemolytic reaction and may be associated with other conditions or reactions.

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