in planning the turning schedule for a bedfast client it is most important for the nurse to consider what assessment finding
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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 patient with type 2 diabetes is prescribed metformin. What instruction should the nurse provide regarding this medication?

Correct answer: C

Rationale: The correct instruction for a patient prescribed metformin is to take the medication with meals. This helps reduce gastrointestinal side effects commonly associated with metformin. Patients should also be educated about the signs of lactic acidosis, a rare but serious side effect associated with metformin use.

3. A client who is 2 days postoperative reports severe pain and swelling in the right leg. The nurse notes that the leg is warm and red. What is the nurse's priority action?

Correct answer: D

Rationale: The nurse's priority action in this situation is to notify the healthcare provider immediately. These symptoms, including severe pain, swelling, warmth, and redness in the leg, are indicative of deep vein thrombosis (DVT), a potentially serious condition. Prompt notification of the healthcare provider is crucial to initiate appropriate diagnostic tests and interventions to prevent complications associated with DVT. Applying a warm compress (Choice A) could worsen the condition by increasing blood flow. Elevating the leg (Choice B) might be contraindicated in DVT as it can dislodge a clot. Measuring the circumference of the leg (Choice C) is not the priority at this time compared to promptly involving the healthcare provider.

4. A client with heart failure is prescribed furosemide (Lasix). Which instruction should the nurse include in the client's teaching plan?

Correct answer: B

Rationale: In heart failure, fluid retention is a concern. Furosemide helps manage this by promoting diuresis. Instructing the client to report weight gain exceeding 2 pounds in a day is crucial as it can indicate fluid accumulation, prompting timely intervention to prevent worsening heart failure symptoms and complications.

5. What should the nurse include in patient teaching for a patient prescribed ceftriaxone for bacterial pneumonia?

Correct answer: C

Rationale: When educating a patient prescribed ceftriaxone for bacterial pneumonia, it is crucial to emphasize completing the full course of the antibiotic. Completing the full course helps ensure the infection is completely eradicated and reduces the risk of antibiotic resistance. Incomplete courses of antibiotics can lead to treatment failure and the development of resistant bacterial strains. Therefore, it is essential for patients to adhere to the prescribed treatment regimen to achieve optimal outcomes.

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