which outcome should the nurse identify for the client diagnosed with fluid volume excess
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Nursing Elites

ATI RN

ATI RN Custom Exams Set 4

1. Which outcome should the nurse identify for the client diagnosed with fluid volume excess?

Correct answer: C

Rationale: The correct answer is C. Absence of adventitious breath sounds indicates that fluid is not accumulating in the lungs, a key outcome in managing fluid volume excess. Choices A, B, and D are incorrect. A client with fluid volume excess may not necessarily void a minimum of 30 mL per hour, have elastic skin turgor, or have a specific serum creatinine level. The absence of adventitious breath sounds is a more direct indicator of managing fluid volume excess.

2. Where do most peptic ulcers occur?

Correct answer: C

Rationale: Most peptic ulcers occur in the duodenum, particularly in cases of duodenal ulcers. Peptic ulcers are most commonly found in the duodenum or the first part of the small intestine. While ulcers can also occur in the esophagus and stomach, they are predominantly located in the duodenum. Therefore, options A, B, and D are incorrect.

3. The client diagnosed with Type 2 diabetes mellitus is being taught about diet by the nurse. Which diet selection indicates the client understands the teaching?

Correct answer: C

Rationale: The correct answer is C because a smoked turkey sandwich with celery sticks and unsweetened tea reflects a balanced and healthy choice suitable for a client with Type 2 diabetes mellitus. Turkey is a lean protein choice, celery sticks offer fiber and low calories, and unsweetened tea is a sugar-free beverage. Choices A, B, and D are incorrect as they include high-carb, high-fat, and sugary options that are not recommended for individuals with diabetes as they can spike blood sugar levels.

4. Why may patients with hiatal hernia develop anemia?

Correct answer: B

Rationale: The correct answer is B: Gastritis may cause bleeding. In patients with hiatal hernia, gastritis can lead to gastrointestinal bleeding, resulting in anemia due to blood loss. Choice A is incorrect because hiatal hernia does not directly affect iron absorption. Choice C is incorrect as iron stores turning over more quickly is not a typical reason for anemia in hiatal hernia patients. Choice D is incorrect as an aversion to iron-rich foods does not directly cause anemia in this context.

5. The system used at the division level and forward comprises six basic modules. Which module is composed of practical nurses, medical specialists, and equipment to provide medical support for minimal care patients?

Correct answer: B

Rationale: The Patient Holding Squad is the module composed of practical nurses, medical specialists, and equipment to provide medical support for minimal care patients. The other choices are incorrect because a 'Treatment squad' would typically involve a broader range of medical care, an 'Area support squad' is more general and focuses on providing overall support in a specific area, and a 'Surgical squad' would be specifically focused on surgical procedures rather than general medical care for minimal care patients.

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