ATI PN Fundamentals 2023 Exam 4

Extract:

Question 1 of 5

A nurse is reinforcing teaching with a client who has crutches regarding the use of the three-point gait. Which of the following instructions should the nurse include?

A. Stand with the crutch tips against the feet.B. Bear weight on the unaffected leg.C. Keep the crutches at the level of the axillae.D. Hold the arms straight when walking.

Correct Answer: B

Rationale: Weight on the unaffected leg is key to the three-point gait for stability.

Question 2 of 5

A nurse is planning to provide postmortem care for a client who requires an autopsy. Which of the following actions should the nurse plan to take?

A. Place an identification tag on the outside of the client's shroud.B. Ask the assistive personnel to document the client's time of death.C. Wear sterile gloves when cleaning the client's body.D. Remove the client's dentures and give them to the client's family.

Correct Answer: A

Rationale: An ID tag ensures proper identification for autopsy purposes.

Question 3 of 5

A nurse is assisting in the transfer of a client who has left-sided weakness from a bed to a chair. Which of the following actions should the nurse take?

A. Flex hips and knees when assisting the client to a standing position.B. Pivot on the foot farthest from the bed when assisting the client into the chair.C. Stand on the client's stronger side when moving the client into the chair.D. Raise the bed to waist level before moving the client.

Correct Answer: A

Rationale: Flexing hips and knees ensures stability and safety during the transfer process.

Question 4 of 5

A nurse on a medical-surgical unit is collecting data from a client who is postoperative following abdominal surgery. The client's BP was 126/72 mm Hg 15 min ago. The nurse now finds that the client's BP is 176/96 mm Hg. Which of the following actions should the nurse take?

A. Use a narrower cuff to repeat the BP measurement.B. Request a prescription for an antihypertensive medication.C. Measure the client's BP in the other arm.D. Deflate the cuff faster when repeating the BP measurement.

Correct Answer: C

Rationale: Measuring in the other arm confirms accuracy of the elevated reading.

Question 5 of 5

A nurse is reinforcing discharge teaching about fecal occult blood testing with a client. Which of the following instructions should the nurse include in the teaching?

A. Place a thick layer of stool on the specimen card.B. Urinate prior to collecting the stool specimen.C. Discontinue supplements containing vitamin C 24 hours before the test.D. Refrain from consuming pork 7 days before the test.

Correct Answer: C

Rationale: Vitamin C can cause false negatives, so discontinuing it ensures accuracy.

ATI PN Fundamentals 2023 Exam 4 | Nurselytic

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