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ATI Comprehensive Predictor Part 2

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This flashcard set focuses on post-operative care and discharge teaching for clients who have undergone a partial gastrectomy with vagotomy (Billroth I). It emphasizes dietary precautions to prevent complications like dumping syndrome, including avoiding large, high-sugar meals and managing fluid intake.

A client with a peptic ulcer had a partial gastrectomy and vagotomy
(Billroth I). In planning the discharge teaching, the client should be
cautioned by the nurse about which of the following?
1. Sit up for at least 30 minutes after eating.
2. Avoid fluids between meals.
3. Increase the intake of high-carbohydrate foods.
4. Avoid eating large meals that are high in simple sugars and liquids.

4

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Key Terms

Term
Definition

A client with a peptic ulcer had a partial gastrectomy and vagotomy
(Billroth I). In planning the discharge teaching, the client should be
cautioned by the nurse about which of the following?
1. Sit up for at least 30 minutes after eating.
2. Avoid fluids between meals.
3. Increase the intake of high-carbohydrate foods.
4. Avoid eating large meals that are high in simple sugars and liquids.

4

A nurse is caring for a 37-year-old woman with metastatic ovarian
cancer admitted for nausea and vomiting. The physician orders total
parenteral nutrition (TPN), a nutritional consult, and diet recall. Which of the following is the BEST indication that the patient's nutritional status has improved after 4 days?
1. The patient eats most of the food served to her.
2. The patient has gained 1 pound since admission.
3. The patient's albumin level is 4.0mg/dL.
4. The patient's hemoglobin is 8.5g/dL.

3

A 23-year-old woman at 32-weeks gestation is seen in the outpatient clinic. Which of the following findings, if assessed by the nurse, would indicate a possible complication?
1. The client's urine test is positive for glucose and acetone.
2. The client has 1+ pedal edema in both feet at the end of the day.
3. The client complains of an increase in vaginal discharge.
4. The client says she feels pressure against her diaphragm when the baby moves.

1

After abdominal surgery, a client has a nasogastric tube attached to low suctioning. The client becomes nauseated, and the nurse observes a decrease in the flow of gastric secretions. Which of the following nursing interventions would be MOST appropriate?
1. Irrigate the nasogastric tube with distilled water.
2. Aspirate the gastric contents with a syringe.
3. Administer an antiemetic medicine.
4. Insert a new nasogastric tube.

2

After sustaining a closed head injury and numerous lacerations and
abrasions to the face and neck, a five-year-old child is admitted to the emergency room. The client is unconscious and has minimal response to noxious stimuli. Which of the following assessments, if observed by the nurse three hours after admission, should be reported to the physician?
1. The client has slight edema of the eyelids.
2. There is clear fluid draining from the client's right ear.
3. There is some bleeding from the child's lacerations.
4. The client withdraws in response to painful stimuli.

2

The nurse is caring for a manic client in the seclusion room, and it is
time for lunch. It is MOST appropriate for the nurse to take which of the following actions?
1. Take the client to the dining room with 1:1 supervision.
2. Inform the client he may go to the dining room when he controls his behavior.
3. Hold the meal until the client is able to come out of seclusion.
4. Serve the meal to the client in the seclusion room.

4

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TermDefinition

A client with a peptic ulcer had a partial gastrectomy and vagotomy
(Billroth I). In planning the discharge teaching, the client should be
cautioned by the nurse about which of the following?
1. Sit up for at least 30 minutes after eating.
2. Avoid fluids between meals.
3. Increase the intake of high-carbohydrate foods.
4. Avoid eating large meals that are high in simple sugars and liquids.

4

A nurse is caring for a 37-year-old woman with metastatic ovarian
cancer admitted for nausea and vomiting. The physician orders total
parenteral nutrition (TPN), a nutritional consult, and diet recall. Which of the following is the BEST indication that the patient's nutritional status has improved after 4 days?
1. The patient eats most of the food served to her.
2. The patient has gained 1 pound since admission.
3. The patient's albumin level is 4.0mg/dL.
4. The patient's hemoglobin is 8.5g/dL.

3

A 23-year-old woman at 32-weeks gestation is seen in the outpatient clinic. Which of the following findings, if assessed by the nurse, would indicate a possible complication?
1. The client's urine test is positive for glucose and acetone.
2. The client has 1+ pedal edema in both feet at the end of the day.
3. The client complains of an increase in vaginal discharge.
4. The client says she feels pressure against her diaphragm when the baby moves.

1

After abdominal surgery, a client has a nasogastric tube attached to low suctioning. The client becomes nauseated, and the nurse observes a decrease in the flow of gastric secretions. Which of the following nursing interventions would be MOST appropriate?
1. Irrigate the nasogastric tube with distilled water.
2. Aspirate the gastric contents with a syringe.
3. Administer an antiemetic medicine.
4. Insert a new nasogastric tube.

2

After sustaining a closed head injury and numerous lacerations and
abrasions to the face and neck, a five-year-old child is admitted to the emergency room. The client is unconscious and has minimal response to noxious stimuli. Which of the following assessments, if observed by the nurse three hours after admission, should be reported to the physician?
1. The client has slight edema of the eyelids.
2. There is clear fluid draining from the client's right ear.
3. There is some bleeding from the child's lacerations.
4. The client withdraws in response to painful stimuli.

2

The nurse is caring for a manic client in the seclusion room, and it is
time for lunch. It is MOST appropriate for the nurse to take which of the following actions?
1. Take the client to the dining room with 1:1 supervision.
2. Inform the client he may go to the dining room when he controls his behavior.
3. Hold the meal until the client is able to come out of seclusion.
4. Serve the meal to the client in the seclusion room.

4

A client is given morphine 6 mg IV push for postoperative pain.
Following administration of this drug, the nurse observes the following:
pulse 68, respirations 8, BP 100/68, client sleeping quietly. Which of the following nursing actions is MOST appropriate?
1. Allow the client to sleep undisturbed.
2. Administer oxygen via facemask or nasal prongs.
3. Administer naloxone (Narcan).
4. Place epinephrine 1:1,000 at the bedside.

3

What type of infectious diseases are required to be reported to the health department?

- severe cases of Staphylococcus aureus infections including methicillin-resistant Staphylococcus aureus (MRSA)

What is the process of taking a telephone order from a provider?

Patient name, drug, dose, route, frequency
read back for accuracy

A nurse is caring for a client who has tuberculosis. Which of the following actions should the nurse take? SATA
a) Place the client in a negative pressure room
b) wear gloves when assisting the client with oral care
c) limit each visitor to 2 hr increments
d) wear a surgical mask when providing care
e) Use antimicrobial sanitizer for hand hygiene

A
B
E

A charge nurse is discussing the responsibility of nurses carig for clients who have C. difficile. Which of the following information should the nurse include in the teaching?
a) Assign the client to a room with a negative air-flow system
b) Use alcohol-based hand sanitizer when leaving the clients room
c) clean contaminated surfaces in the clients room with a phenol solution
d) have family members wear a gown and gloves when visiting

D

A nurse is caring for a client receiving IV fluids. During a routine check, the nurse determines that the client has developed phlebitis and removes the IV catheter. Which of the following actions should the nurse take next?

a) place a warm compress over the IV site
b) record the findings in the client's chart
c) notify the client's primary care provider
d) prepare to insert a new IV catheter

A

A nurse is caring for a client who has dementia. Which of the following interventions should the nurse take to minimize the risk for injury for this client?

a) use a bed exit alarm system
b) raise 4 side rails while client is in bed
c) apply one soft wrist restraint
d) dim the lights in the client's room

A

A nurse is implementing a plan of care for a client who is at risk for falls. Which of the following is an appropriate nursing action?

a) implement a regular toileting schedule
b) encourage the client to wear athletic socks when ambulating
c) place all 4 bed rails in the upright position
c) require a family member to remain at the bedside

A

Which of the following techniques should the nurse use when performing nasotracheal suctioning for a client?

a) insert the suction catheter while the client is swallowing
b) apply intermittent suction when withdrawing the catheter
c) place the catheter in a location that is clean and dry for later use
d) hold the suction catheter with the clean, non-dominant hand

B

A nurse is caring for a client following an acute myocardial infarction. The client is concerned that providing self-care will be difficult due to extreme fatigue. Which of the following strategies should the nurse implement to promote the client's independence?

a) request an occupational therapy consult to determine the need for assistive devices
b) assign assistive personnel to perform self-care tasks for client
c) instruct the client to focus on gradually resuming self-care tasks
d) ask the client if a family member is available to assist with his care

C

A nurse is reviewing the medical records of a client who has a pressure ulcer. Which of the following is an expected finding?
a) serum albumin level of 3 g/dL
b) HDL level of 90 mg/dL
c) Norton scale score of 18
d) Braden scale score of 20

A

A nurse is caring for a client who needs a 24-hr urine collection initiated. Which of the following client statements indicates an understanding of the procedure?
a) "I had a bowel movement, but I was able to save the urine"
b) "I have a specimen in the bathroom from about 30 minutes ago"
c) "I flushed what I urinated at 7 am and have saved the rest since"
d) "I drink a lot, so I will fill up the bottle and complete the test quickly"

C

A nurse is caring for a client who has an NG tube that is to be irrigated every 8 hr. Which of the following should be used to irrigate the tube in order to maintain fluid and electrolyte balance?
a) tap water
b) sterile water
c) 0.9% sodium chloride
d) 0.45% sodium chloride

C

A nurse is reinforcing teaching regarding the use of a cane to a client who has left-leg weakness. Which of the following should the nurse include in the teaching?
a) use the cane on the weak side of the body
b) advance the cane and the atrong leg simultaneously
c) maintain two points of support on the floor
d) advance the cane 30 to 45 cm (12-18 in) with each step

C

Which of the following should indicate to a nurse the need to suction a client's tracheostomy?

a) irritability
b) hypotension
c) flushing
d) bradycardia

A

A nurse is caring for a client who has a prescription for wound irrigation. Which of the following actions should the nurse take?

a) wear sterile gloves when removing the old dressing
b) warm the irrigation solution to 40.5C (105F)
c) cleanse the wound from the center outwards
d) use a 20 mL syringe to irrigate the wound

C

A nurse is providing teaching about a clear liquid diet. Which of the following should the nurse instruct the client to avoid?

a) lemon-lime sports drinks
b) ginger ale
c) black coffee
d) orange sherbet

D

A nurse is caring for a client who is having difficulty voiding following the removal in an indwelling urinary catheter. Which of the following interventions should the nurse take?

a) assess for bladder distention after 6 hr
b) encourage the client to use a bed pan in the supine position
c) restrict the clients intake of oral fluids
d) pour warm water over the clients perineum

D

When caring for the client diagnosed with delirium, which condition is the most important for the nurse to investigate?
1. Cancer of any kind.
2. Impaired hearing.
3. Prescription drug intoxication.
4. Heart failure.

3

Which of the following is essential when caring for a client who is experiencing delirium?
1. Controlling behavioral symptoms with low-dose psychotropics.
2. Identifying the underlying causative condition or illness. 3. Manipulating the environment to increase orientation.
4. Decreasing or discontinuing all previously prescribed medications.

2

Which of the following is a realistic short-term goal to be accomplished in 2 to 3 days for a client with delirium?
1. Explain the experience of having delirium.
2. Resume a normal sleep-wake cycle.
3. Regain orientation to time and place.
4. Establish normal bowel and bladder function.

3

A client diagnosed with dementia wanders the halls of the locked nursing unit during the day. To ensure the client's safety while walking in the halls, the nurse should do which of the following?
1. Administer PRN haloperidol (Haldol) to decrease the need to walk.
2. Assess the client's gait for steadiness.
3. Restrain the client in a geriatric chair.
4. Administer PRN lorazepam (Ativan) to provide sedation.

2

During a home visit to an elderly client with mild dementia, the client's daughter reports that she has one major problem with her mother. She says, "She sleeps most of the day and is up most of the night. I can't get a decent night's sleep anymore." Which suggestions should the nurse make to the daughter? Select all that apply.
1. Ask the client's physician for a strong sleep medicine. 2. Establish a set routine for rising, hygiene, meals, short rest periods, and bedtime.
3. Engage the client in simple, brief exercises or a short walk when she gets drowsy during the day.
4. Promote relaxation before bedtime with a warm bath or relaxing music.
5. Have the daughter encourage the use of caffeinated beverages during the day to keep her mother awake.

2
3
4

The physician orders risperidone (Risperdal) for a client with Alzheimer's disease. The nurse anticipates administering this medication to help decrease which of the following behaviors?
1. Sleep disturbances.
2. Concomitant depression.
3. Agitation and assaultiveness.
4. Confusion and withdrawal.

3

The nurse is making a home visit with a client diagnosed with Alzheimer's disease. The client recently started on lorazepam (Ativan) due to increased anxiety. The nurse is cautioning the family about the use of lorazepam (Ativan). The nurse should instruct the family to report which of the following significant side effects to the health care provider?
1. Paradoxical excitement.
2. Headache.
3. Slowing of reflexes.
4. Fatigue.

1

When providing family education for those who have a relative with Alzheimer's disease about minimizing stress, which of the following suggestions is most relevant?
1. Allow the client to go to bed four to five times during the day.
2. Test the cognitive functioning of the client several times a day.
3. Provide reality orientation even if the memory loss is severe.
4. Maintain consistency in environment, routine, and caregivers

4

What are some ways to identify a patient before giving a medication?

The Joint Commission requires 2 client identifiers be used when administering medications.
- clients name
- assigned identification number
- telephone number
- birth date or other personal-specific identifiers. Bar code scanners may be used to identify clients

What are some things to teach about home safety with elderly patients?

- Removing items that could cause the client to trip, such as throw rugs and loose carpets
- Placing electrical cords and extension cords that against a wall behind furniture
- Making sure that steps and sidewalks are in good repair
- Placing grab bars near the toilet and in the tub or shower and installing a stool riser
- Using a non-skid mat in the tub or shower
- Placing a shower chair in the shower
- Ensuring that lighting is adequate both inside and outside of the home

A nurse is providing discharge instructions to a client who has a prescription for the use of oxygen in
his home. Which of the following should the nurse teach the client about using oxygen safely in his
home? (Select all that apply.)
A. Family members who smoke must be at least 10 ft from the client when oxygen is in use.
B. Nail polish should not be used near a client who is receiving oxygen.
C. A "No Smoking" sign should be placed on the front door.
D. Cotton bedding and clothing should be replaced with items made from wool.
E. A fire extinguisher should be readily available in the home.

B
C
E

A nurse is providing home safety instructions to a group of older adult clients. Match the safety risk
with the appropriate instruction.
____ Passive smoking
____ Carbon monoxide poisoning
____ Food poisoning
A. Have water heaters inspected on an annual
basis.
B. Cook all meat at an appropriate temperature.
C. Avoid enclosed areas with others who may be
smoking.

C
A
B

When performing nasotracheal suctioning what technique should be used?

Sterile asepsis bc the trachea is considered sterile and prevents infections

A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The nurse educator evaluates the teaching as effective when the newly licensed nurse states the client who has heat stroke will have which of the following?
A. Hypotension
B. Bradycardia
C. Clammy skin
D. Bradypnea

A

What do you do when a client has a seizure

- lower to bed/floor
- protect head, move nearby furniture, provide privacy, - - put on side with head flexed slightly forward, and loosen clothing to prevent injury
-in event of seizure, stay with client and call for help
-admin meds as ordered
-note duration of seizure and sequence and type of movement

seclusion and restraints

-must be ordered
-should be ordered for the shortest duration necessary and only if less restrictive measures are not sufficient
-a client may voluntarily request temp seclusion
-restraints can be physical or chemical
-if used, frequency of client assessments in regards to food, fluid, comfort, and safety should be performed and documented every 15-30 min

What position is good to use for a patient who is at high risk for a pressure ulcer

30 degree lateral position is recommended for clients at risk for pressure ulcers

health promotion (injury prevention-suffocation): infant (birth-1 yr)

-avoid plastic bags
-keep balloons out of reach
-ensure crib mattress fits snugly
-ensure crib slats are no more than 6 cm (2.4 in) apart
-remove crib mobiles and gyms by 4-5 months
-do not use pillows in crib
-place infant on back for sleep
-keep toys with small parts out of reach
-remove drawstrings from jackets and other clothing

hypotension is classified with a reading below normal;

systolic < 90 mm Hg; can be a result of fluid depletion, heart failure, or vasodilation

What temperature should pork be cooked at

160 degrees

What is the safest way to thaw out frozen foods

In the refrigerator

What are the precautions for vancomycin resistant enterococcus

Standard precautions including hand washing and gloving should be followed

What does a newborns poop look like

If your baby is exclusively breastfed, her poop will be yellow or slightly green and have a mushy or creamy consistency

What is appropriate for an adolescent in the hospital?

Puzzles and books

What is the proper nutrition during pregnancy

- Folic acid is important for pregnancy, as it can help to prevent birth defects known as neural tube defects, including spina bifida
- green leafy vegetables and brown rice

What should be avoided during pregnancy

Do not take vitamin A supplements, or any supplements containing vitamin A (retinol), as too much could harm your baby

What is the most appropriate method for contraception for an adolescent

IUD or implant

If a patient has anorexia nervosa and works out constantly

Allow them to workout and continue their regimen

What medications can be taken to help with smoking cessation

Bupropion hydrochloride is a medicine for depression, but it also helps people quit smoking. Brand names include Zyban®, Wellbutrin®, Wellbutrin SR® and Wellbutrin XL® but this medication is also available as a generic. Varenicline (chantix)

What are the five stages of grief

denial
anger
bargaining
depression
acceptance

discrete and applies the letting go of an object or person before the loss as in the case of terminal illness
individuals have the opportunity to greet before the actual loss

anticipatory grief

involves difficult progression through the expected stages of the grieving process
grief work is prolonged and manifestations more severe
client may develop suicidal ideation, intense feelings of guilt and lowered self-esteem
somatic complaints persist for an extended period of time

dysfunctional grief

Signs for meningococcemia

Vomiting, febrile, petechial rash
(unstable)

Levothyroxine effects

Used to restore client's metabolic rate
* Toxic effects = heat intolerance, Tachycardia, Weight loss, Hypertension

Multiple Sclerosis Patient

Mitoxantrone SE's Mitoxantrone IV every 3 months (chemo drug)
* Report Sore Throat
(greatest risk for client is severe infection due to myelosuppression from mitoxantrone)
* Vomiting = causes dehydration
* Hair Loss = emotional distress
* Amenorrhea = emotional distress

Malnourished COPD patients

(1) Limit liquid intake at meal times
(2) Consume foods w/ protein (like eggs)
(3) Maintain an upright position (High Fowler's position) to promote ventilation
(4) Use milk instead of water when making soup

Which grief process is it when Client exhibits increased anxiety + may project anger toward self + others
"I don't deserve to die, this isn't fair"

Anger stage

Which Grief Process when Client acknowledges the impending loss while remaining hopeful
"If I could just make it through this, I'd never smoke again"

Bargaining Stage

How should you respond when client wants to discontinue dialysis

"What has changed to make you decide this?"
= Seek clarification from client to establish mutual understanding while staying therapeutic

What should the nurse do when one member of a support group expresses anger repeatedly?

Focus more on the group members who have a positive outlook
(Speak to group member privately to uncover source of anger)

What immunizations are CONTRAINDICATED for pregnant women + which SHOULD be given?

Contraindicated = Herpes Zoster + Varicella + MMR (measles, mumps, rubella)
Should give = TDaP (Tetanus, Diphtheria, Pertussis)

Long term effects of NSAIDS (Ibuprofen)

Gastric Ulcerations, perforations, hemorrhage, hypertension

Alcohol Use Manifestations of Withdrawal

Body burns 0.5 oz of alcohol per hour
* Withdrawal appears within 4-12 hours
* Irritability + Tremors + Anxiety
* Nausea + Vomiting + HA
* Diaphoresis
* Sleep Disturbances
* TACHYCARDIA + HTN

Use Benzodiazepines = tx
Diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium)

When does Discharge planning begin?

At Admission

Case Management nursing involves:

Decreasing cost by improving client outcomes
Providing education to optimize health participation
* Advocating for services + client's rights

What is bipolar disorder?

Bipolar disorder is a mood disorder with recurrent episodes of depression and mania.