ATI RN
Client Safety Alternatives to Restraints Quizlet Questions
Question 1 of 5
The nurse conducting a community health promotion class on sexuality includes that a person's biologic sex is determined by:
Correct Answer: B
Rationale: The correct answer is B because biologic sex is determined by both external and internal genitalia, which are physical characteristics present at birth. This is based on chromosomal and hormonal factors that dictate the development of male or female reproductive organs. Choice A is incorrect as sexual intercourse does not determine biologic sex. Choice C refers to gender identity, not biologic sex. Choice D pertains to sexual orientation, not biologic sex. In summary, the physical characteristics of external and internal genitalia are the key factors in determining a person's biologic sex.
Question 2 of 5
A nurse conducted an assessment of a new patient who came to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the assessment. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing:
Correct Answer: B
Rationale: The correct answer is B: Depression. The patient's symptoms such as being easily distracted, recent life changes, and the loss of his pet suggest a mood disorder rather than a cognitive impairment like dementia (A) or delirium (C). The patient's alertness and ability to engage in conversation indicate that he is not experiencing delirium. Additionally, the patient's medical history of diabetes makes a hypoglycemic reaction (D) less likely, as he is alert during the assessment. Depression is a common comorbidity in patients with chronic illnesses like osteoarthritis and diabetes, and the recent life stressors could exacerbate his depressive symptoms.
Question 3 of 5
When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. Which principle is used to encourage the nurse to monitor the patient's response to the pain?
Correct Answer: A
Rationale: Correct Answer: A: Fidelity Rationale: 1. Fidelity refers to the nurse's duty to uphold the patient's best interests and maintain trust. 2. By continually reviewing the pain management plan with the patient, the nurse demonstrates fidelity by ensuring the patient's priority of being free of pain is met. 3. Monitoring the patient's response to pain aligns with fidelity as it shows the nurse's commitment to the patient's well-being and trust. 4. Fidelity promotes a therapeutic nurse-patient relationship based on honesty and loyalty. Summary of Incorrect Choices: B: Beneficence - Focuses on doing good for the patient, but does not specifically address the nurse's duty to monitor and uphold the patient's priority of pain management. C: Nonmaleficence - Focuses on avoiding harm, but does not specifically address the nurse's role in monitoring and ensuring the patient's priority of pain management. D: Respect for autonomy - Focuses on respecting the patient's right to make
Question 4 of 5
The health-care provider ordered STAT arterial blood gases for the client diagnosed with ARDS. The ABG results are pH 7.38, PaO2 92, PaCO2 38, HCO3 24. Which action should the nurse implement?
Correct Answer: A
Rationale: The correct answer is A: Continue to monitor the client without taking any action. The ABG results indicate a pH within the normal range (7.35-7.45), PaO2 is slightly lower than normal but still adequate for tissue oxygenation, PaCO2 is within the normal range (35-45), and HCO3 is normal (22-26). These values indicate that the client's acid-base balance is within normal limits, and no immediate intervention is needed. Encouraging deep breaths and coughing (B) may be beneficial for some respiratory conditions but is not indicated here. Administering sodium bicarbonate IVP (C) is unnecessary as the client's pH and HCO3 levels are normal. Notifying the respiratory therapist (D) is not warranted since the ABG results do not indicate any acute respiratory distress. Monitoring the client (A) is the appropriate action as the ABG results are stable.
Question 5 of 5
A patient with ARDS is being mechanically ventilated. The physician has ordered prone positioning. What is the primary reason for this intervention?
Correct Answer: D
Rationale: The correct answer is D. Prone positioning helps recruit collapsed alveoli by redistributing ventilation to dependent lung regions, improving oxygenation in ARDS. It enhances lung homogeneity and reduces stress on the dorsal lung regions. Choices A, B, and C are incorrect because prone positioning primarily aims to optimize oxygenation by improving lung ventilation and perfusion, rather than solely reducing diaphragm workload, enhancing perfusion to anterior lung segments, or mobilizing secretions.