ATI RN
Chapter 1 Introduction to Nursing Quizlet Questions
Question 1 of 5
To properly perform the endotracheal insertion, the nurse:
Correct Answer: B
Rationale: Step-by-step rationale for choice B: 1. Inserting the catheter until coughing or resistance is felt ensures proper placement without causing trauma. 2. This technique helps clear secretions effectively without causing damage to the airway. 3. It allows the nurse to gauge the depth of insertion based on the patient's response. 4. Stopping at coughing or resistance prevents going too far and potentially damaging the airway. Summary: A: Turning on wall suction to 180 mmHg is incorrect as it can cause trauma to the airway. C: Withdrawing the catheter while continuously suctioning is incorrect as it can lead to hypoxia. D: Reentering the tracheostomy after suctioning the mouth is incorrect as it can introduce pathogens to the airway.
Question 2 of 5
When giving an I.M. injection, the nurse should insert the needle into the muscle at an angle of:
Correct Answer: D
Rationale: The correct angle for an I.M. injection is 90 degrees (straight in). This angle ensures proper medication absorption and minimizes tissue damage. Inserting the needle at 15, 30, or 45 degrees can lead to suboptimal drug delivery or cause pain and discomfort. It is crucial to follow evidence-based guidelines to administer injections safely and effectively.
Question 3 of 5
Nurse should recommend to their clients the avoidance of the habitual use of laxatives. Which of the following is the rationale for this?
Correct Answer: B
Rationale: The correct answer is B: It will cause chronic constipation. Habitual use of laxatives can lead to the bowel becoming dependent on them to function properly, causing chronic constipation when laxatives are stopped. This occurs due to the bowel becoming less responsive to natural stimuli for movement. Choice A is incorrect because fecal impaction is a risk of abrupt discontinuation of laxatives, not habitual use. Choice C is incorrect because laxatives typically do not significantly alter the pH of the gastrointestinal tract. Choice D is incorrect because laxatives do not inhibit intestinal enzymes but rather stimulate bowel movement.
Question 4 of 5
A client is admitted with frequent, loose stools. Prior to implementing orders to insert a Foley catheter, the nurse would first:
Correct Answer: A
Rationale: Step 1: Assess the client's condition and potential causes of frequent, loose stools. Step 2: Apply a fecal incontinence bag to contain and monitor stool output. Step 3: Monitor the effectiveness of the bag in managing stool output. Step 4: If necessary, implement further interventions based on assessment findings. Summary: - Option B: Performing perineal care is important for hygiene but does not directly address the issue of managing stool output. - Option C: Administering an antidiarrheal agent may mask symptoms without addressing the underlying cause. - Option D: Inserting a rectal tube is invasive and not typically indicated before trying less invasive interventions like a fecal incontinence bag.
Question 5 of 5
In obtaining the cerebrospinal fluid, the needle is inserted:
Correct Answer: B
Rationale: The correct answer is B: Between L3 and L4. The cerebrospinal fluid is obtained via a procedure called lumbar puncture, commonly known as a spinal tap. The needle is inserted between the third and fourth lumbar vertebrae to avoid the spinal cord itself. This location provides access to the subarachnoid space where the cerebrospinal fluid circulates. Choosing A, C, or D would result in potential damage to the spinal cord or improper collection of cerebrospinal fluid.