a nurse is teaching a client about preventing infection following chemotherapy which of the following instructions should the nurse include
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Nursing Elites

ATI RN

ATI Exit Exam 2023

1. A client is receiving chemotherapy and is being taught about preventing infection. Which of the following instructions should the nurse include?

Correct answer: B

Rationale: Clients receiving chemotherapy are instructed to avoid fresh fruits and vegetables to lower the risk of infection. Fresh produce may harbor bacteria or other pathogens that could be harmful to individuals with compromised immune systems. Taking the temperature daily may be important but is not directly related to preventing infection. Limiting high-protein foods is not necessary unless there are specific dietary restrictions due to the treatment plan. Increasing the intake of high-fat foods is not recommended during chemotherapy as a high-fat diet may lead to other health issues.

2. A nurse is providing dietary teaching to a client who is at risk for osteoporosis. Which of the following foods should the nurse recommend?

Correct answer: C

Rationale: Cheddar cheese is an excellent source of calcium, which is essential for bone health. Calcium helps strengthen bones and reduces the risk of osteoporosis. Broccoli (choice A) is also a good source of calcium but not as high as cheddar cheese. Bananas (choice B) and whole wheat bread (choice D) do not provide significant amounts of calcium and are not as effective in preventing osteoporosis as cheddar cheese.

3. What is the most important nursing intervention for a patient experiencing an acute asthma attack?

Correct answer: A

Rationale: The correct answer is to administer bronchodilators. During an acute asthma attack, bronchodilators like albuterol are crucial to help dilate the airways and improve breathing. Providing supplemental oxygen (Choice B) may be necessary but is not the priority intervention. Starting IV fluids (Choice C) and monitoring oxygen saturation (Choice D) are important aspects of care but are not the most critical interventions during an acute asthma attack.

4. What is the most important intervention for a patient with suspected DVT?

Correct answer: A

Rationale: The correct answer is to administer anticoagulants. Administering anticoagulants is crucial in the management of deep vein thrombosis (DVT) as it helps prevent the clot from growing larger or dislodging, potentially causing a life-threatening pulmonary embolism. While monitoring oxygen levels, applying compression stockings, and encouraging ambulation are important aspects of DVT management, administering anticoagulants is the most critical intervention to prevent further complications.

5. A nurse is assessing a client who has a history of angina and reports chest pain. Which of the following actions should the nurse take first?

Correct answer: B

Rationale: The correct answer is to obtain a 12-lead ECG. In a client with a history of angina and reporting chest pain, the priority action is to assess for myocardial infarction, which is best done through an ECG. Administering oxygen, nitroglycerin, or notifying the provider can be important actions but obtaining an ECG takes precedence in evaluating the client's condition.

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