ATI RN
Introduction to Critical Care Nursing 8th Edition Questions
Question 1 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 2 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.
Question 3 of 5
When using a cane for maximal support, the nurse is aware that the client should:
Correct Answer: A
Rationale: The correct answer is A: Hold the cane on the weaker side. This is correct because it provides maximal support and stability for the client. By holding the cane on the weaker side, the client can shift weight off the weaker leg, reducing strain and improving balance. Choice B is incorrect because weight should be shifted to the stronger side, not evenly distributed. Choice C is incorrect as keeping the elbow stiff can lead to discomfort and limited mobility. Choice D is incorrect as the stronger foot should advance ahead of the cane for stability.
Question 4 of 5
Mr. Tony is nervous about a colonoscopy scheduled for tomorrow. The nurse describes the test explaining that:
Correct Answer: B
Rationale: The correct answer is B because a colonoscopy is a procedure that allows visual examination of the large intestine. During a colonoscopy, a flexible tube with a camera is inserted through the rectum to examine the colon for abnormalities like polyps or cancer. The other choices are incorrect because: A: Visual examination of the esophagus and stomach is typically done using an upper endoscopy. C: A radiographic examination uses X-rays, not a camera, to visualize structures. D: A fluoroscopic examination involves real-time X-ray images and is often used for examining the small intestine, not the large intestine like in a colonoscopy.
Question 5 of 5
A patient with a systemic bacterial infection feels cold and has a shaking chill. Which assessment finding will the nurse expect next?
Correct Answer: C
Rationale: The correct answer is C: Rising body temperature. When a patient with a systemic bacterial infection experiences a shaking chill, it indicates that the body is trying to generate heat to combat the infection. The next assessment finding the nurse would expect is a rising body temperature as the body's immune response kicks in to fight off the infection. Skin flushing (choice A) is less likely as the patient is feeling cold initially. Muscle cramps (choice B) are not typically associated with this scenario. Decreasing blood pressure (choice D) may be a later complication but is not the immediate next assessment finding after a shaking chill.