ATI RN
Client Safety Alternatives to Restraints Quizlet Questions
Question 1 of 5
The nurse cares for a client who just had a massive myocardial infarction (MI). Which of the following stress reduction techniques would be applicable to this client? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A: Promote a heart healthy diet. Following a heart-healthy diet can help manage risk factors for further cardiac events. A diet high in fruits, vegetables, whole grains, lean proteins, and low in saturated fats can help reduce cholesterol levels and blood pressure. Choices B, C, and D are incorrect. B: Encouraging cigarette cessation is crucial as smoking increases the risk of further cardiovascular issues. C: While sleep is important, the immediate focus should be on heart health interventions. D: After a massive MI, low-intensity exercise may not be safe until the client's condition stabilizes.
Question 2 of 5
The nurse cares for a patient, who has been taking ibuprofen for back pain x 3 weeks, was admitted to the hospital for abdominal pain. Which assessment data takes priority?
Correct Answer: C
Rationale: Rationale: 1. Occult blood in stool can indicate gastrointestinal bleeding, a serious complication of prolonged ibuprofen use. 2. Gastrointestinal bleeding can lead to anemia, hypovolemia, and shock. 3. Promptly addressing bleeding is crucial to prevent further complications. 4. Diarrhea, Hematuria, and Ova & Parasites are less likely related to ibuprofen use for back pain and are not immediate priorities.
Question 3 of 5
the environment is warm
Correct Answer: A
Rationale: The correct answer is A because in a warm environment, the body needs to cool itself to maintain a stable internal temperature. This process is called thermoregulation. Sweating and vasodilation are mechanisms the body uses to release heat and cool down. Choice B is incorrect as the body does not need to warm itself in a warm environment. Choices C and D are incomplete and do not offer a logical explanation related to the situation given.
Question 4 of 5
The older the person
Correct Answer: A
Rationale: The correct answer is A: The slower the pulse. As people age, their heart muscles may weaken, causing the heart to pump less efficiently, resulting in a slower pulse rate. This physiological change is a common part of the aging process. Choice B is incorrect as aging typically leads to a decrease, not an increase, in pulse rate. Choices C and D are left blank as they are irrelevant to the question.
Question 5 of 5
A nurse is planning client care for herself and an assistive personnel (AP). Which task should the nurse plan to perform?
Correct Answer: C
Rationale: The correct answer is C: Assessing a client's sacrum for edema. The nurse should plan to perform this task as it requires clinical judgment and assessment skills, which are within the scope of nursing practice. The nurse can identify early signs of skin breakdown and provide appropriate interventions. Explanation of other choices: A: Administration of an enema - This task can be safely delegated to an assistive personnel as long as the client's condition is stable. B: Application of antiembolic stockings - This task does not require clinical judgment and can be delegated to an assistive personnel. D: Assisting a client to cough and deep breathe - This task can be delegated to an assistive personnel as long as the client's condition is stable.