the nurse is caring for the client one 1 day postoperative sigmoid colostomy operation which independent nursing intervention should the nurse impleme
Logo

Nursing Elites

ATI RN

ATI RN Custom Exams Set 3

1. The nurse is caring for the client one (1) day postoperative sigmoid colostomy operation. Which independent nursing intervention should the nurse implement?

Correct answer: D

Rationale: Assisting the client to sit in a chair is a crucial nursing intervention postoperatively. It helps prevent complications such as thrombosis, pneumonia, and pressure ulcers by promoting circulation and aiding in recovery. Changing the infusion rate of the intravenous fluid would require a physician's order and is not within the nurse's independent scope of practice. Encouraging the client to discuss feelings and administering medications for pain management are important interventions but may not be as immediately necessary as assisting the client in mobilizing early postoperatively.

2. Listed below are five categories that identify the responsibilities of the practical nurse manager in personnel management. Which of these categories is most appropriate for the task 'Know what your soldiers are doing during duty hours'?

Correct answer: A

Rationale: The correct answer is A: Accountability. Accountability involves knowing what individuals are doing during duty hours, ensuring they are responsible and answerable for their actions. Personal/professional development (choice B) refers to enhancing one's skills and knowledge, individual training (choice C) focuses on specific training needs, and military appearance/physical condition (choice D) pertains to the physical presentation and fitness of individuals, not directly related to knowing what they are doing during duty hours.

3. Interacting with the patient and their family to obtain subjective information is part of which of the following steps in determining and fulfilling the nursing care needs of the patient?

Correct answer: D

Rationale: The correct answer is D, Assessment. In the nursing process, assessment is the first step where nurses gather subjective and objective data to understand the patient's needs. Interacting with the patient and their family to obtain subjective information is crucial in this phase. Choice A, Evaluation, comes later in the process and involves judging the effectiveness of the care provided. Choice B, Planning, is where the nurse develops a plan of care based on the assessment findings. Choice C, Implementation, is the phase where the nursing care plan is put into action.

4. A patient is prescribed an oral anticoagulant. What should the nurse monitor for?

Correct answer: C

Rationale: Correct! When a patient is prescribed an oral anticoagulant, the nurse should monitor for signs of bleeding. Oral anticoagulants are medications that prevent blood clot formation but can increase the risk of bleeding. Monitoring for signs such as easy bruising, blood in urine or stool, and prolonged bleeding from minor cuts is essential. Choices A, B, and D are incorrect because oral anticoagulants do not typically affect blood glucose levels, blood pressure, or appetite.

5. Six hours after major abdominal surgery, a male client complains of severe abdominal pain; is pale and perspiring; has a thready, rapid pulse; and states he feels faint. The nurse checks the client’s medication administration record and determines that the client receives another injection of pain medication in an hour. What is the appropriate action by the nurse?

Correct answer: B

Rationale: The correct action for the nurse to take in this situation is option B: Call the practitioner, report the client’s symptoms, and obtain further orders. The client is displaying symptoms that indicate potential complications, such as internal bleeding, which require immediate medical evaluation. Option A is incorrect because the client's condition suggests a more urgent need for assessment. Option C is inappropriate as it does not address the seriousness of the client's symptoms. Option D is dangerous and could exacerbate any underlying issue the client may be experiencing.

Similar Questions

Management experience prepares the practical nurse to be a Clinical NCO or a Senior Clinical NCO. These positions are normally held by which of the following?
Where do most peptic ulcers occur?
Before administering an MMR (measles, mumps, and rubella) vaccine to a 15-month-old, which question should the nurse ask the mother of the child?
Which of the following is a potential side effect associated with the use of nonsteroidal anti-inflammatory drugs?
In patients with heart failure, which type of diet is most recommended?

Access More Features

ATI RN Basic
$69.99/ 30 days

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

ATI RN Premium
$149.99/ 90 days

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

Other Courses