ATI RN Custom Exams Set 3

Correct Answer: D

Rationale: Assisting the client to sit in a chair is an essential nursing intervention postoperatively as it helps promote circulation, prevent complications like blood clots, and aids in the recovery process. Changing the infusion rate of intravenous fluid (Choice A) requires a physician's order and is not an independent nursing intervention. Encouraging the client to discuss feelings (Choice B) is important for emotional support but not as crucial as physical care immediately postoperatively. Administering opioid narcotic medications (Choice C) for pain management should be based on a prescribed schedule and assessment rather than being an independent nursing action.

Correct Answer: D

Rationale: When palpating the client's neck for lymphadenopathy, the nurse should position himself in front of a sitting client. This positioning allows for easier access to the neck area and better visualization of any swelling or abnormalities in the lymph nodes. Being in front of the client ensures proper alignment and comfort for both the nurse and the client during the assessment. Choices A, B, and C are incorrect because positioning at the client's back or sides would make it challenging to adequately palpate the neck area and assess for lymphadenopathy.

Correct Answer: A

Rationale: The correct answer is to instruct the client to walk 15 to 20 minutes three times a day. Walking is beneficial as it helps improve circulation and reduces the risk of complications following sclerotherapy. Choice B is incorrect because keeping the legs in the dependent position when sitting can lead to increased venous pressure, worsening varicose veins. Choice C is incorrect as compression bandages should typically be worn continuously, especially during the initial healing phase. Choice D is incorrect as Berger-Allen exercises are not commonly associated with post-sclerotherapy care.

Correct Answer: A

Rationale: The correct response is to assess the intravenous fluids for rate and volume. In this situation, the client is seeking guidance on fertility issues, not related to intravenous fluids, surgical dressing changes, medication levels, or meal monitoring. The nurse should provide supportive and empathetic guidance, suggesting further options like consulting fertility specialists or exploring additional treatments.

Correct Answer: C

Rationale: The correct answer is C: Increased fiber intake. A diet high in fiber is beneficial for patients with hypertension as it helps lower blood pressure. Increased sodium intake (choice A) is not recommended as it can raise blood pressure. Decreasing potassium intake (choice B) is not advisable as potassium helps regulate blood pressure. Increased cholesterol intake (choice D) is also not recommended as high cholesterol levels can contribute to cardiovascular issues, including hypertension.