ATI RN
Adult Health Nursing Study Guide Answers Questions
Question 1 of 5
A patient is prescribed an anticoagulant for the prevention of venous thromboembolism (VTE). Which laboratory parameter should the nurse monitor closely during anticoagulant therapy?
Correct Answer: B
Rationale: The nurse should monitor the International Normalized Ratio (INR) closely during anticoagulant therapy for the prevention of VTE. The INR measures the clotting ability of the blood and is used to monitor the effectiveness of anticoagulant therapy, such as warfarin. Maintaining the INR within the target therapeutic range is crucial to prevent both excessive bleeding due to over-anticoagulation and clotting events due to under-anticoagulation. Close monitoring of the INR helps healthcare providers adjust the anticoagulant dosage as needed to ensure optimal therapeutic outcomes and minimize risks. Platelet count, serum sodium levels, and blood urea nitrogen (BUN) are important laboratory parameters to monitor for other medical conditions but are not specific to anticoagulant therapy.
Question 2 of 5
While preparing the surgical instruments for sterilization, the nurse notices visible residue on some of the instruments. What action should the nurse take?
Correct Answer: A
Rationale: If visible residue is noticed on the surgical instruments, it is crucial to re-sterilize them before using them for any procedure. Visible residue may indicate that the instruments are not sterile and could potentially introduce contaminants into the patient during the procedure, leading to infection or other complications. It is essential to maintain the highest standards of cleanliness and sterility in healthcare settings to ensure patient safety. Therefore, the nurse should take immediate action to re-sterilize the instruments before proceeding with any surgical procedure.
Question 3 of 5
While preparing the surgical instruments for sterilization, the nurse notices that the autoclave is not reaching the required temperature. What should the nurse do?
Correct Answer: C
Rationale: It is crucial to ensure that the autoclave is functioning properly to achieve proper sterilization of surgical instruments. If the autoclave is not reaching the required temperature, it signifies a technical issue that needs to be addressed promptly. The nurse should notify the sterile processing department immediately and request maintenance to investigate and resolve the problem. Continuing with sterilization without addressing the temperature issue can compromise the effectiveness of sterilization and pose a risk of infection to patients. Adjusting the settings on the autoclave or using an alternative method of sterilization are not appropriate actions in this situation.
Question 4 of 5
While preparing the operating room (OR) for a surgical procedure, the nurse notices that the surgical instrument tray is incomplete. What should the nurse do?
Correct Answer: C
Rationale: It is crucial to have a complete set of surgical instruments for any surgical procedure to ensure patient safety and the success of the surgery. If the nurse notices that the surgical instrument tray is incomplete, the best course of action is to inform the sterile processing department immediately. By doing so, the missing instruments can be promptly provided, ensuring that the surgical team has all the necessary tools for the procedure. Proceeding with the procedure using incomplete instruments can compromise patient safety and the quality of care provided. Documenting the missing instruments in the surgical count log is important for record-keeping purposes but should not delay the immediate action of requesting additional instruments. Borrowing instruments from another OR is not recommended as it can create confusion, potential cross-contamination, and disrupt the workflow of another surgical team.
Question 5 of 5
A nurse is caring for a patient who is experiencing conflicting emotions about a recent diagnosis. What therapeutic communication technique should the nurse use to help the patient explore their feelings?
Correct Answer: C
Rationale: Reflecting the patient's feelings and expressions is a therapeutic communication technique that involves mirroring back the patient's emotions and thoughts. By doing this, the nurse validates the patient's experiences and helps them explore their feelings further. This technique can enhance the patient's self-awareness and promote emotional expression, leading to a deeper understanding of their conflicting emotions. Offering advice (Option A) may not be as effective because the focus should be on helping the patient process their own emotions. Providing reassurance and false hope (Option B) can hinder the patient's emotional exploration and may lead to trust issues if the reality does not align with the false reassurance. Redirecting the conversation to a different topic (Option D) avoids addressing the patient's conflicting emotions, which is crucial for therapeutic communication and support.