ATI RN
Introduction to Nursing Quizlet Questions
Question 1 of 5
The nurse is caring for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider?
Correct Answer: A
Rationale: The correct answer is A because a low O2 saturation level of 88% indicates hypoxemia, which is a critical condition that requires immediate intervention to prevent further complications. Hypoxemia can occur after thoracentesis due to a pneumothorax or other respiratory issues. Choice B is not the priority because the blood pressure is slightly elevated but not immediately life-threatening. Choice C may indicate respiratory distress but is not as urgent as hypoxemia. Choice D is important for pain management but not as urgent as addressing hypoxemia. In summary, O2 saturation is the priority because hypoxemia can lead to serious complications if not promptly addressed.
Question 2 of 5
A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first?
Correct Answer: B
Rationale: The correct answer is B: Blood cultures from two sites. This should be implemented first to identify the specific bacteria causing the infection and guide appropriate antibiotic therapy. Cultures help determine the most effective treatment and prevent antibiotic resistance. Chest x-ray (A) can wait as it does not provide immediate treatment. Administering antibiotics like Cipro (C) should be based on culture results. Acetaminophen (D) can help with fever but is not the priority in this case.
Question 3 of 5
After teaching a client how to perform diaphragmatic breathing, the nurse assesses the client’s understanding. Which action demonstrates that the client correctly understands the teaching?
Correct Answer: B
Rationale: Correct Answer: B Rationale: 1. Placing hands on the abdomen is key for feeling the rise and fall of the diaphragm during breathing. 2. This action indicates the client is focusing on belly breathing, which is characteristic of diaphragmatic breathing. 3. By placing hands on the abdomen, the client shows an understanding of the technique taught, ensuring proper execution. Summary: A: Lying on the side with knees bent does not directly relate to diaphragmatic breathing. C: Lying in a prone position with straight doesn't specify the focus on abdominal breathing. D: Placing hands above the head is unrelated to diaphragmatic breathing technique.
Question 4 of 5
A client has been admitted with left-sided heart failure. When planning care for the client, interventions should be focused around reduction of which specific problem associated with this type of heart failure?
Correct Answer: C
Rationale: The correct answer is C: Bilateral lung crackles. Left-sided heart failure causes fluid buildup in the lungs, leading to crackles on auscultation. Interventions should focus on reducing pulmonary congestion to improve breathing. Ascites (A) is associated with right-sided heart failure. Pedal edema (B) is a symptom of right-sided heart failure due to fluid retention in the lower extremities. Jugular vein distention (D) is a sign of right-sided heart failure. Focusing on reducing bilateral lung crackles is crucial in managing left-sided heart failure.
Question 5 of 5
While bathing a patient with cancer, the nurse assessed several large new bruises on the patient's upper arms and thighs. An understanding of the possible causes and the correct nurse's actions for these findings are that
Correct Answer: B
Rationale: The correct answer is B because new large bruises in a cancer patient could indicate disseminated intravascular coagulation (DIC), a serious condition where blood clots form throughout the body. Reporting and recording the bruises fully is crucial for monitoring changes. Choice A is incorrect as assuming the bruises are from a fall without proper assessment can lead to overlooking a serious medical condition like DIC. Choice C is incorrect as intravascular fluid overload does not typically cause large bruises and placing the patient on strict I/O status may not address the underlying issue. Choice D is incorrect as attributing the bruises to a drug-induced seizure without proper assessment and reporting of DIC symptoms can delay necessary treatment.