ATI_NUR 275 Competencies for Contemporary Nursing Practice
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Free ATI_NUR 275 Competencies for Contemporary Nursing Practice Questions
A nurse is assessing a client who has had staples removed from an abdominal wound postoperatively. The nurse notes separation of the wound edges with copious light-brown serous drainage. Which of the following actions should the nurse perform first?
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Check the client's vital signs.
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Obtain a culture and sensitivity of the wound drainage.
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Assess the client's pain level.
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Cover the wound with a moist, sterile gauze dressing.
Explanation
The client is showing signs of wound dehiscence, and the light-brown drainage may indicate possible evisceration (serosanguineous drainage can precede it). The priority is to protect the exposed tissues and prevent drying by immediately covering the wound with moist, sterile gauze. This action reduces the risk of further tissue damage and infection.
A nurse is providing teaching to a client about risk factors for developing glaucoma. Which of the following risk factors should the nurse include in the teaching?
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Exposure to environmental toxins
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Light skin pigmentation
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Overexposure to UV rays
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Severe nearsightedness
Explanation
Severe nearsightedness (myopia) is a known risk factor for glaucoma, particularly open-angle glaucoma. Myopia affects the structure of the eye, increasing susceptibility to damage to the optic nerve due to increased intraocular pressure. Clients with high myopia require routine eye exams to detect early signs.
A client who is alert and oriented makes an informed decision to leave the hospital against medical advice. The nurse applies restraints to the client to prevent him from leaving.
A nurse identifies the absence of peripheral pulsation in a casted extremity in the early morning and reports it to the provider in the early afternoon.
A nurse finds a client who is on a low-sodium diet eating salted potato chips. The nurse tells the client that she will apply wrist restraints if he does not stop eating the potato chips.
A client who is competent refuses an antidepressant medication. The nurse dissolves the medication in food and administers it to her without her knowledge.
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A client who is alert and oriented makes an informed decision to leave the hospital against medical advice. The nurse applies restraints to the client to prevent him from leaving.
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A nurse identifies the absence of peripheral pulsation in a casted extremity in the early morning and reports it to the provider in the early afternoon.
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A nurse finds a client who is on a low-sodium diet eating salted potato chips. The nurse tells the client that she will apply wrist restraints if he does not stop eating the potato chips.
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A client who is competent refuses an antidepressant medication. The nurse dissolves the medication in food and administers it to her without her knowledge.
Explanation
Negligence occurs when a nurse fails to take appropriate action, resulting in harm or risk of harm to the client. Failing to promptly report the absence of peripheral pulses in a casted limb is negligent because it delays treatment for a possible compartment syndrome, a medical emergency requiring immediate action to prevent permanent nerve or tissue damage. Delayed reporting can result in serious complications, including loss of limb function. The other options describe assault, false imprisonment, and battery, not negligence.
A charge nurse is providing an in-service for a group of staff nurses about deep vein thrombosis (DVT). Which of the following information should the nurse include about this condition?
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DVTs cannot be prevented.
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There are always warning signs of a DVT.
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Clients only develop DVTs if they have clotting disorders.
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Approximately half of DVTs occur during a hospitalization.
Explanation
Approximately half of all DVTs occur during or shortly after hospitalization. Hospitalized clients are at increased risk because of immobility, surgery, trauma, certain medications, and acute illnesses. Prevention strategies such as early ambulation, sequential compression devices, and anticoagulants are critical in the inpatient setting. Recognizing hospitalized patients as a high-risk group reinforces the importance of evidence-based DVT prophylaxis in maintaining patient safety and preventing life-threatening pulmonary embolism.
A nurse is caring for a client who is at 32 weeks of gestation.
Medical History
0800:
- Client admitted to antepartum clinic for management of preeclampsia. Client has been on bedrest for 2 weeks and Labetalol PO 100 mg twice daily.
- Gravida 3 Para 2
- 32 weeks of gestation with preeclampsia
- History of preeclampsia during the last pregnancy
Vital Signs
0800:
- Temperature 36.8° C (98.2° F)
- Blood pressure 168/108 mmHg
- Heart rate 87/min
- Respiratory rate 18/min
- O2 saturation 97%
0830:
- Blood pressure 172/104 mm Hg
- Heart rate 89/min
- Respiratory rate 16/min
- O2 saturation 98%
0900:
- Blood pressure 176/102 mm Hg
- Heart rate 86 beats/min
- Respiratory rate 18/min
- O2 saturation 96%
Nurses' Notes
0800:
- Client awake, alert and oriented x 4. Client reports headache that started 2 days ago. Client reports pain as 6 on a scale of 0 to 10.
0830:
- Deep tendon reflexes (DTRs) 3+ with a negative clonus (Pitting pedal edema +2 in lower extremities
- Client reports blurred vision
Diagnostic Results
- Hemoglobin 10 g/dL (> 11g/dL)
- Hematocrit 34% (>33%)
- Platelets 120,000 mm3 (150,000 to 400,000 mm3)
- Creatinine 1.8 mg/dL (0.5 to 1.0 mg/dL)
- BUN 28 mg/dL (10 to 20 mg/dL)
- Uric acid 9 mg/dL (2.7 to 7.3 mg/dL)
- Proteinuria 3+
Which of the following provider prescriptions should the nurse anticipate implementing?
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Collect a urine specimen for culture and sensitivity, administer magnesium sulfate 4 g IV bolus, tell the client to lie in a supine position, and monitor blood pressure and respiratory status every 15 minutes.
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Collect a urine specimen for culture and sensitivity and place the client in a supine position; magnesium sulfate and frequent vital signs are not necessary at this time.
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Administer magnesium sulfate 4 g IV bolus and monitor blood pressure and respiratory status every 15 minutes; collect a urine culture if symptoms of infection develop and avoid placing the client supine.
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Tell the client to remain supine and monitor blood pressure every 4 hours; urine culture and magnesium sulfate therapy are unnecessary at this stage.
Explanation
This client is showing signs of severe preeclampsia: severe hypertension, headache, blurred vision, hyperreflexia, thrombocytopenia, elevated creatinine, elevated uric acid, and significant proteinuria. The priority intervention is to initiate magnesium sulfate to prevent seizures and monitor vital signs and respiratory status closely (every 15 min). The client should not be placed supine due to the risk of supine hypotensive syndrome. A urine culture is not routinely indicated unless infection is suspected.
A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment?
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Alcohol use disorder
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Pacemaker
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Breast cancer survivor for 8 years
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65-years of age
Explanation
Active substance use disorder, including alcohol use disorder, is a contraindication to kidney transplantation. Successful transplant requires strict lifelong adherence to immunosuppressive medications and follow-up care; substance misuse increases risk of nonadherence and poor outcomes. Clients must demonstrate sustained sobriety and rehabilitation before being considered candidates. Transplant programs typically require documentation of treatment participation and a period of abstinence prior to listing.
A client who is scheduled for a barium swallow asks the nurse why a laxative is necessary following the procedure. Which of the following responses should the nurse make?
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"The laxative helps eliminate the barium."
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"The laxative is the protocol at this facility."
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"The laxative makes the barium turn brown."
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"The laxative will prevent the absorption of magnesium."
Explanation
After a barium swallow, the laxative is prescribed to assist in expelling the barium from the gastrointestinal tract. Barium can harden and lead to constipation or fecal impaction if not eliminated. Ensuring prompt bowel movement reduces the risk of bowel obstruction and other complications.
A nurse is assessing a client who has a cast in place for a fractured tibia. Which of the following actions should the nurse take first?
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Checking capillary refill
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Discussing cast care
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Managing pain
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Performing range of motion
Explanation
The priority in a client with a newly applied cast is to assess for neurovascular compromise. Compartment syndrome is a serious complication that can occur with fractures and casts, and early signs include decreased circulation, delayed capillary refill, pallor, paresthesia, and increased pain unrelieved by medication. Checking capillary refill assesses perfusion to the affected extremity and must be done first to ensure the limb is receiving adequate blood flow and to detect complications early.
A nurse is caring for an adolescent.
Nurses' Notes
Adolescent presents with pain in right lower quadrant for past 2 days.
Vital Signs
- Temperature 38.6 °C (101.4°F)
- Respiratory rate 26/min
- Pulse rate 112/min
- BP 146/88 mm Hg
- SpO2 95%
Physical Examination
- Awake, alert, and oriented x4. Lung sounds clear bilaterally. Heart rate regular. Bowel sounds hypoactive in all 4 quadrants. Peripheral pulses palpable, 2+. Reports right lower quadrant pain rated as 9 on 0 to 10 pain scale. Adolescent states, "the pain seemed to go away for a while earlier today, but now it's back and really bad." Adolescent noted to grimace and guard abdomen during abdominal assessment. Vomited 480 mL green emesis during assessment and parent reports adolescent has not really eaten for the past 2 days due to nausea. Also reports 3 diarrhea stools and chills that began about 2 hr ago.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Potential Condition
- A. Gastrointestinal bleeding
- B. Ruptured appendix
- C. Intussusception
- D. Meckel diverticulum
Actions to Take
- A. Administer IV antibiotics.
- B. Initiate oxygen at 2 L/min via nasal cannula.
- C. Prepare client for a barium enema.
- D. Insert nasogastric tube.
Parameters to Monitor
- A. Oxygen saturation
- B. Urinary output
- C. White blood cell count
- D. Rectal bleeding
- E. Abdominal distention
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Potential Condition: B. Ruptured appendix
Actions to Take: A. Administer IV antibiotics. & D. Insert nasogastric tube.
Parameters to Monitor: B. Urinary output & C. White blood cell count
Explanation
Actions to Take: A. Administer IV antibiotics. & D. Insert nasogastric tube.
Parameters to Monitor: B. Urinary output & C. White blood cell count
The adolescent's symptoms — severe right lower quadrant pain, guarding, fever, tachycardia, diarrhea, green emesis, pain that "went away then returned," and chills — are consistent with ruptured appendix with peritonitis. Pain that temporarily subsides suggests perforation. IV antibiotics and gastric decompression with an NG tube help treat infection and prevent aspiration. Monitoring urinary output assesses perfusion and kidney function, while WBC count reflects infection severity and response to treatment.
pH 7.22
PaCO2 68 mm Hg
Base excess -2
PaO2 78 mm Hg
Saturation 80%
Bicarbonate 26 mEq/L
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Respiratory acidosis
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Metabolic alkalosis
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Metabolic acidosis
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Respiratory alkalosis
Explanation
The pH is low (7.22), indicating acidemia. PaCO2 is markedly elevated (68 mm Hg), which explains the acidemia and points to a primary respiratory cause. Bicarbonate (26 mEq/L) and base excess (−2) are near normal, showing little to no metabolic compensation. Therefore, the ABG is most consistent with acute respiratory acidosis (with hypoventilation and accompanying hypoxemia).
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