ATI RN
Essentials Of Nursing Client Safety Questions
Question 1 of 5
A nurse responds to an IV pump alarm related to increased pressure. Which action should the nurse take first?
Correct Answer: A
Rationale: The correct action is to check for kinking of the catheter first. This is because increased pressure in the IV pump alarm could indicate a blockage, likely caused by a kink in the catheter. By checking for kinking, the nurse can quickly identify and resolve the issue, restoring proper flow and preventing complications. Flushing the catheter with a thrombolytic enzyme (B) is unnecessary and could be harmful without knowing the exact cause. Getting a new infusion pump (C) is premature as the issue may lie with the catheter itself. Removing the IV catheter (D) should be a last resort after troubleshooting other potential causes.
Question 2 of 5
A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately?
Correct Answer: A
Rationale: The correct answer is A: sore throat. Clozapine can cause agranulocytosis, a potentially life-threatening side effect characterized by a low white blood cell count. A sore throat may indicate infection due to decreased white blood cells, necessitating immediate intervention to prevent serious complications. Incorrect options: B: Fever - While fever can indicate infection, a sore throat is a more specific symptom of agranulocytosis related to clozapine. C: Malaise - Generalized discomfort is nonspecific and does not directly correlate with the serious side effect of agranulocytosis. D: Akathisia and hypersalivation - These side effects are common with antipsychotic medications, including clozapine, but they are not indicative of the life-threatening condition of agranulocytosis.
Question 3 of 5
The nurse has been assigned the same patients for the past 3 days. Two of the patients demand a great deal of attention, so the nurse feels anxious and angry about being given this assignment again. How can the nurse cope with this patient care assignment?
Correct Answer: C
Rationale: The correct answer is C. Prioritizing the patients' needs and identifying a specific time period for care for each patient is the most effective way for the nurse to cope with the patient care assignment. By organizing and scheduling care, the nurse can ensure that all patients receive appropriate attention without feeling overwhelmed. Option A is incorrect because sharing complaints with the nurse manager may not directly address the issue of coping with the assignment. Option B is incorrect as it does not provide a structured approach to managing the workload. Option D is incorrect as it does not address the underlying issue of time management and prioritization.
Question 4 of 5
What type of grief is a client experiencing when a wife is still grieving her deceased husband of five years ago?
Correct Answer: A
Rationale: The correct answer is A: Chronic grief. Chronic grief is prolonged and persists over a long period of time, often lasting beyond what is considered normal. In this scenario, the client is still grieving her deceased husband after five years, indicating a prolonged and ongoing grieving process. B: Delayed grief refers to a situation where the individual postpones or suppresses their grief initially, but eventually experiences it. C: Masked grief involves expressing grief through other behaviors or emotions, rather than directly acknowledging the loss. D: Uncomplicated grief is a normal and healthy response to loss without any complicating factors. In this case, the grief has persisted for an extended period, indicating it is not uncomplicated.
Question 5 of 5
The nurse notes on the admission form that the client has indicated 'no religious preference.' What does this indicate to the nurse about the client?
Correct Answer: A
Rationale: Step 1: 'No religious preference' implies the client does not adhere to a specific religious faith. Step 2: This suggests the client does not follow the tenets or beliefs of any particular religion. Step 3: Therefore, choice A is correct as it aligns with the client's lack of affiliation with a specific faith. Summary: Choice A is correct because the client's statement indicates a lack of alignment with a specific religious faith, ruling out choices B, C, and D which make assumptions about the client's beliefs or actions.