ATI RN
Client Safety Nursing Skill Template Questions
Question 1 of 5
A nurse enters a client's room and finds the client pulseless. The family has requested a do-not-resuscitate (DNR) order from the provider, but he has not written the order yet. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Call the emergency response team. In this situation, the nurse must prioritize the client's immediate medical needs over the family's request for a DNR order. By calling the emergency response team, the nurse initiates potentially life-saving resuscitative measures while respecting the client's best interest. Seeking help from the risk manager (B) or waiting for a stat DNR order from the provider (C) could result in unnecessary delays in providing critical care. Doing nothing and solely respecting the family's wishes (D) may go against the nurse's duty to act in the client's best interest in an emergency situation.
Question 2 of 5
A nurse is supervising a licensed practical nurse (PN) who is providing care to a client who is postoperative. Which of the following statements by the client requires the nurse to follow up with the PN?
Correct Answer: D
Rationale: The correct answer is D because the client not receiving any medications is a critical issue that requires immediate follow-up to ensure the client's safety and well-being. A, B, and C are not urgent concerns and can be addressed by the nurse or PN at a later time. A is related to non-essential comfort, B is a common query about discharge, and C is about routine care already provided. Thus, D stands out as the most concerning statement that necessitates immediate attention.
Question 3 of 5
A client is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. What type of isolation is most appropriate for this client?
Correct Answer: D
Rationale: The correct answer is D: Contact isolation. MRSA is primarily spread through direct contact with infected wounds or contaminated surfaces. Contact isolation is crucial to prevent transmission. Reverse isolation (A) is used to protect immunocompromised patients. Airborne precautions (B) are for diseases transmitted through droplets in the air. Standard precautions (C) are used for all patients to prevent the spread of infections, but specific isolation precautions like contact isolation are necessary for MRSA.
Question 4 of 5
A nurse is reinforcing teaching with a client about compromised host precautions. The client is receiving filgrastim (Neupogen) for neutropenia. Which lunch selection suggests the client has learned about necessary dietary changes?
Correct Answer: B
Rationale: The correct answer is B because roast beef, mashed potatoes, and green beans are all considered safe food choices for a client receiving filgrastim for neutropenia. Roast beef provides protein, mashed potatoes are a good source of carbohydrates, and green beans offer essential vitamins and minerals. Grilled chicken sandwich (A) may contain harmful bacteria if not cooked properly. Peanut butter sandwich (C) and barbecue beef (D) can harbor potential pathogens that may be harmful to a compromised host. Skim milk (A) is generally safe, but the entire meal should be considered.
Question 5 of 5
A school nurse has a 10 year-old child with a history of epilepsy with tonic-clonic seizures attending classes regularly. The school nurse should inform the teacher that if the child experiences a seizure in the classroom, the most important action to take during the seizure would be to
Correct Answer: D
Rationale: The correct answer is D: place the hands or a folded blanket under the head of the child. This action is important during a seizure to prevent injury to the child's head by providing cushioning and support. Placing something soft under the head helps protect the child from hitting the hard surface. It is crucial to ensure the child's safety during a seizure. Moving chairs or desks (Choice A) may not be necessary and could potentially cause unnecessary disruption. Noting the sequence of movements (Choice B) may be helpful for medical professionals but is not the most crucial action during the seizure. Providing privacy (Choice C) is important, but ensuring the child's safety by supporting the head takes precedence.