ATI RN
Introduction to Critical Care Nursing 8th Edition Questions
Question 1 of 5
A 3 year-old child is brought to the clinic by his grandmother to be seen for scratching his bottom and wetting the bed at night." Based on these complaints
Correct Answer: D
Rationale: The correct answer is D: Regression. In this scenario, the child is showing behaviors such as scratching his bottom and bedwetting, which are common signs of regression in young children. Regression often occurs in response to stress or changes in the child's environment. By selecting this answer, the nurse can explore potential stressors in the child's life and provide appropriate support. A: Not the initial assessment as the symptoms are indicative of a psychological issue rather than a physical problem. B: Allergies are unlikely to cause both scratching bottom and bedwetting. C: Scabies may cause itching but is less likely to cause bedwetting.
Question 2 of 5
When performing oral care to an unconscious client, which of the following is a special consideration to prevent aspiration of fluids into the lungs?
Correct Answer: D
Rationale: The correct answer is D: Put the client in a side-lying position with the head of the bed lowered. This position helps prevent aspiration of fluids into the lungs by allowing gravity to assist in draining fluids out of the mouth and reducing the risk of them entering the airway. It also helps in preventing choking and aspiration pneumonia. A: Washing hands and observing infection control are important but do not directly address the risk of aspiration. B: Keeping the client dry with a towel does not specifically prevent aspiration and may not be effective in managing oral care for an unconscious client. C: Cleaning the mouth with oral swabs is important, but the technique does not directly address the risk of aspiration compared to positioning the client correctly.
Question 3 of 5
A nurse must verify the client's identity before administering medication. The safest way to verify identity is to:
Correct Answer: B
Rationale: The correct answer is B: Check the client's identification band. This method is the safest way to verify the client's identity because it directly links the client to a unique identification band that is specifically assigned to them. This ensures accuracy and minimizes the risk of error. A: Asking the client his name may not be reliable as the client could provide incorrect information. C: Stating the client's name aloud and having them repeat it relies on the client's memory and verbal confirmation, which may not be foolproof. D: Checking the room number and the client's name on the bed is not as direct and specific as checking the client's identification band, which could lead to confusion if there are multiple clients in the same room.
Question 4 of 5
The medication order is chlorate hydrate 400mg. The bottle reads chlorate hydrate 0.1 g / capsules. How many capsules should be given?
Correct Answer: D
Rationale: To find the number of capsules needed, convert 400mg to grams (400mg = 0.4g). Then divide the total amount required (0.4g) by the strength of each capsule (0.1g/capsule). This results in 4 capsules needed (0.4g / 0.1g/capsule = 4 capsules). Choice D is correct as it aligns with the calculation. Choices A, B, and C are incorrect as they do not match the calculated amount required based on the medication strength and dosage.
Question 5 of 5
What action should a nurse take if a pleur-evac attached to a chest tube breaks?
Correct Answer: C
Rationale: The correct answer is C: Place the end of the tube in sterile water. This action prevents air from entering the pleural space and causing a pneumothorax. Clamping the chest tube (Option A) can lead to tension pneumothorax. Notifying the physician (Option B) is important but should be done after securing the chest tube. Repositioning the client in the Fowler's position (Option D) is not relevant in this scenario. By placing the tube in sterile water, the nurse can maintain the integrity of the closed drainage system and prevent complications.