ATI RN
Introduction to Nursing Chapter 1 Quizlet Questions
Question 1 of 5
Mrs. David is obese. When administering a subcutaneous injection to an obese patient, it is best for Nurse Andrae to:
Correct Answer: D
Rationale: The correct answer is D. When administering a subcutaneous injection to an obese patient, it is best for Nurse Andrae to spread or pinch the skin at the injection site and inject the needle at a 45-90 degree angle. This allows for proper medication absorption due to the thicker layer of subcutaneous fat in obese patients. Pinching the skin helps ensure the medication is injected into the subcutaneous tissue rather than the muscle. Options A and B are not ideal for obese patients as they may not penetrate the thicker layer of fat effectively. Option C, the Z track method, is typically used for intramuscular injections and is not necessary for subcutaneous injections in obese patients.
Question 2 of 5
A client is admitted to the health care facility after 3 days of nausea, vomiting, and fever. Which nursing diagnosis takes highest priority for this client?
Correct Answer: C
Rationale: The correct answer is C: Deficient fluid volume related to nausea and vomiting. Priority is given to addressing fluid volume deficits to prevent dehydration and electrolyte imbalances. Nausea, vomiting, and fever can lead to significant fluid loss. Choice A is incorrect as excessive fluid volume is not indicated. Choice B is incorrect as addressing nutrition would come after addressing fluid volume. Choice D is incorrect as hyperventilation does not typically lead to ineffective cardiopulmonary tissue perfusion in this scenario.
Question 3 of 5
While caring for a client who's immobile, the nurse documents the following information in the client's chart: Turned client from side to back every 2 hours." "Skin intact; no redness noted." "Client up in chair three times today." "Improved skin turgor noted." This nursing diagnosis accurately reflects the potential of:"
Correct Answer: A
Rationale: The correct answer is A: Risk for impaired skin integrity related to immobility. The nurse's documentation indicates preventive measures taken to maintain skin integrity due to immobility, such as turning the client every 2 hours. The absence of redness and improved skin turgor show proactive skin assessment and care. Choice B is incorrect as there is no evidence of actual skin breakdown. Constipation (choice C) and disturbed body image (choice D) are not supported by the information provided. Therefore, choice A is the most appropriate nursing diagnosis based on the documented care and assessment findings.
Question 4 of 5
A 60-year old client reports to the nurse that he has a rash on his back and right flank. The nurse observes elevated, round, blister like lesions that are filled with clear fluid. When documenting the findings, what medical term should the nurse use to describe these lesions?
Correct Answer: D
Rationale: The correct answer is D: Vesicles. Vesicles are small, elevated lesions filled with clear fluid, typically less than 0.5 cm in diameter. In this case, the client's presentation of elevated, round, blister-like lesions filled with clear fluid matches the description of vesicles. Pustules (A) are similar in appearance but contain pus, while papules (B) are raised, solid lesions without fluid-filled cavities. Plaques (C) are flat, raised lesions typically larger than 1 cm in diameter. Therefore, based on the specific characteristics of the lesions described in the scenario, the appropriate term to use would be vesicles.
Question 5 of 5
All of the following are correct methods in the assessment of blood pressure except:
Correct Answer: D
Rationale: The correct answer is D because pumping the cuff to around 50 mmHg above the point where the pulse is obliterated is incorrect. The correct method is to pump the cuff to about 30 mmHg above the point where the pulse disappears. Pumping too high can lead to inaccurate readings. Observing procedures for infection control (A), taking BP on both arms for comparison (B), and listening to identify Korotkoff sounds (C) are all correct methods in the assessment of blood pressure, ensuring accuracy and reliability.