ATI RN
Introduction to Nursing 203 Quizlet Questions
Question 1 of 5
A physician’s order reads Potassium chloride (KCl) 30mEq to be added to 1L ml normal saline and to be given over 10-hour period. The available potassium chloride is 40mEq per 20ml. Nurse Corazon should prepare how many milliliters of Potassium Chloride to administer the correct dose of medication?
Correct Answer: A
Rationale: To calculate the correct amount of Potassium Chloride needed, we first find the total amount needed in 1L of normal saline: 30mEq. Then, we determine the concentration of KCl solution: 40mEq in 20ml. Next, we set up a proportion to find how many milliliters of KCl are needed to provide 30mEq. By cross-multiplying and solving, we find that 15ml of KCl is required. Therefore, choice A (15ml) is the correct answer. Choices B, C, and D are incorrect as they do not match the calculated amount needed based on the given information.
Question 2 of 5
The nurse is providing care for a client who underwent mitral valve replacement. The best example of a measurable client outcome goal is to:
Correct Answer: C
Rationale: The correct answer is C because it is a specific, measurable, achievable, relevant, and time-bound (SMART) goal. Walking from his room to the end of the hall and back before discharge is specific in distance, measurable in terms of achievement, achievable based on the client's condition, relevant to his recovery, and time-bound before discharge. Choice A is not measurable in terms of progress. Choice B is vague and not specific. Choice D is not directly related to the client's recovery from mitral valve replacement. Therefore, choice C is the best example of a measurable client outcome goal.
Question 3 of 5
When assessing a client's skin, the nurse notes a deep, irregular-shaped area of skin loss that extends below the dermis. What term would the nurse use when documenting this?
Correct Answer: A
Rationale: The correct term for a deep, irregular-shaped area of skin loss that extends below the dermis is an ulcer. Ulcers are characterized by tissue loss extending beyond the epidermis and dermis. A fissure is a linear crack in the skin, not a deep irregular shape. Keloid is an overgrowth of scar tissue, not skin loss. Erosion is superficial loss of the epidermis, not extending below the dermis. Therefore, the correct term in this scenario would be an ulcer.
Question 4 of 5
The nurse documents the client’s pulse as weak and thready. This pulse characteristic refers to:
Correct Answer: C
Rationale: Step-by-step rationale: 1. Weak and thready pulse refers to the volume of the pulse. 2. Pulse volume indicates the strength or force of the heartbeat. 3. A weak and thready pulse suggests a low volume of blood being ejected with each heartbeat. 4. This characteristic is important in assessing the client's perfusion status. Summary: A. Pulse rhythm: Refers to the regularity of the pulse pattern, not the strength. B. Pulse deficit: Refers to a difference between the apical and radial pulse rates, not the strength. C. Pulse volume: Correct answer. Reflects the strength or force of the heartbeat. D. Pulse rate: Refers to the number of heartbeats per minute, not the strength.
Question 5 of 5
The nurse is planning care for a client with a CVA. Which of the following measures planned by the nurse would be most effective in preventing skin breakdown?
Correct Answer: C
Rationale: The correct answer is C: Reposition every 2 hours. Repositioning every 2 hours helps to relieve pressure on bony prominences, reducing the risk of skin breakdown. This measure promotes circulation and tissue oxygenation. A: Placing the client in a wheelchair for extended periods can increase pressure on bony areas, leading to skin breakdown. B: Padding bony prominences may provide some protection but does not address the root cause of pressure. D: Massaging reddened areas can cause further damage to fragile skin and should be avoided.