1. A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse expect?

a. Bradycardia- more tachycardia cuz of a failing ventricle , SNS is activated to compensate .

b. Flushed skin- duskly it wIll look like

c. Frothy sputum-Left sided- can be blood tinged

d. Jugular vein distention→ Right

Rationale: ATI MS: pg. 198 ch 32 pdf

Left side: dyspnea, orthopnea, fatigue, pulmonary congestion, frothy sputum, organ failure such as oliguria.

Right Side: Jugular vein distention, ascending dependent edema, abdominal distention, polyuria ar rest, liver enlargement,

2. A nurse is assessing a client who is experiencing renal colic from a calculus in left renal pelvis. Identify the area where the

nurse should expect the client to have referred pain. ( Find “hot spots” in the artwork) Pain travels downward to the inguinal

area and lower back

Renal colic occurs in the kidney area. Referred pain is somewhere that happens in another place other than where the pain should

be felt.

2. A nurse is caring for a client who is receiving peritoneal dialysis and notes a decrease in the dialysate flow rate. Which of the

following actions should the nurse take? (Select all the apply?). Check answer i read pg 644-647 med surg it’s not so specific p.

370 ch 57 pdf

a. monitor the access site for drainage.- to check for sxs of infection.

b. Strip the catheter tubing

c. Measure the amount of the dialysate outflow

d. Raise the client to high fowlers position- they must lie supine

e. Position the client to her other side.

3. A nurse is planning to insert an indwelling catheter for a female client. Which of the following actions should the nurse plan to

take? Ati video tutorials foley

a. Collect urine specimen from the drainage bag 1 hr after insertion

b. Raise the head of the bed to 45 degrees prior to insertion

c. Secure the catheter to the client's inner thigh

d. Attach the bag to the rail of the bed. –under non movable area

6. A nurse is providing teaching for a client who has age-related macular degeneration which of the following information should the

nurse include in the teaching

a. A possible cause of this problem is long-term lack of dietary protein

b. You probably have a Detachment of your retina -vision is like having curtains over eyes

c. You probably have noticed a decline in your central vision

d. The doctor can perform surgery to correct the start paying the folds in your retina

Rationale: ATI MS: PG. 63 Macular degeneration, often called age-related macular degeneration (AMD), is the central loss of

vision that affects the macula of the eye. NO cure , happens alot in old people. Sxs: distorted vision, blurred vision, caused by

smoking, female, HTN, diet lacking carotene.