in planning the turning schedule for a bedfast client it is most important for the nurse to consider what assessment finding
Logo

Nursing Elites

ATI LPN

ATI Medical Surgical Proctored Exam 2019 Quizlet

1. In planning the turning schedule for a bedfast client, it is most important for the nurse to consider what assessment finding?

Correct answer: B

Rationale: A low Braden score indicates a high risk for pressure ulcers, making regular turning crucial to prevent skin breakdown.

2. A client with liver cirrhosis and ascites is being treated with spironolactone. What is a key nursing consideration for this medication?

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as it helps retain potassium in the body. Therefore, monitoring for signs of hyperkalemia such as muscle weakness, arrhythmias, or ECG changes is crucial to prevent potential complications.

3. A patient with heart failure is prescribed digoxin. What is the most important instruction the nurse should provide?

Correct answer: C

Rationale: The correct answer is C: 'Report any visual disturbances.' Patients taking digoxin should be instructed to report any visual disturbances, as this can be a sign of digoxin toxicity. Visual disturbances like changes in color vision, blurred vision, or seeing halos around lights can indicate an overdose of digoxin. Choices A, B, and D are incorrect. Instructing a patient to take an extra dose if they miss one can lead to overdose. Avoiding high-potassium foods is important for patients on potassium-sparing diuretics, not digoxin. Stopping the medication if the pulse is normal is incorrect, as the pulse rate alone is not an indicator of digoxin effectiveness or toxicity.

4. In evaluating a 10-year-old child with meningitis suspected of having diabetes insipidus, which finding is indicative of diabetes insipidus?

Correct answer: A

Rationale: Diabetes insipidus is characterized by the kidneys' inability to concentrate urine, leading to decreased urine specific gravity. This results in the excretion of large volumes of dilute urine, causing a decrease in urine specific gravity. Therefore, when evaluating a suspected case of diabetes insipidus, a finding of decreased urine specific gravity is indicative of this condition.

5. A patient with cirrhosis of the liver and ascites is scheduled for a paracentesis. What should the nurse do to prepare the patient for the procedure?

Correct answer: A

Rationale: The correct preparation for a paracentesis in a patient with cirrhosis and ascites includes having the patient void immediately before the procedure. This is important to reduce the risk of bladder puncture during the paracentesis. Positioning for a paracentesis is typically upright or semi-Fowler's, not flat in bed. Administering a full liquid diet or encouraging ambulation for 30 minutes are not directly related to preparing a patient for a paracentesis procedure.

Similar Questions

The mother of a 9-month-old who was diagnosed with respiratory syncytial virus (RSV) yesterday calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friend's child the following day. What response should the nurse provide this mother?
The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified?
What physical assessment data should the nurse consider a normal finding for a primigravida client who is 12 hours postpartum?
A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?
A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She has a history of recurrent mouth ulcers and a perianal fistula. What is the most likely diagnosis?

Access More Features

ATI LPN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

ATI LPN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

Other Courses