ATI RN
Introduction to Professional Nursing Quizlet Questions
Question 1 of 5
What is the best nursing action for a client with renal failure having difficulty with defecation?
Correct Answer: A
Rationale: The correct answer is A: Give laxative as ordered. In renal failure, constipation is common due to fluid and electrolyte imbalances. Laxatives can help soften stools and promote bowel movements without increasing fluid intake, which is restricted in renal failure. Increasing fluid intake (B) may worsen fluid overload. Raw fruits and vegetables (C) high in potassium and phosphorus can be harmful. Increasing activity (D) may not directly address the constipation issue.
Question 2 of 5
Helena is a post-surgical patient with a hemoglobin level of 7.6 g/dL and hematocrit of 25%. Today, she was prescribed with pRBC transfusion. You took the client’s temperature and it was at 38.2 C orally. Which of the following is the correct intervention?
Correct Answer: D
Rationale: The correct answer is D: Notify physician. Delay transfusion. Rationale: 1. Fever (temperature of 38.2 C) indicates possible infection or reaction to transfusion. 2. In a post-surgical patient, fever could be a sign of sepsis or transfusion reaction. 3. Delaying transfusion allows for further assessment and investigation by the physician. 4. Proceeding with transfusion without addressing the fever could worsen the patient's condition. Summary: - Choice A is incorrect because fever post-surgery is not normal and requires further evaluation. - Choice B is incorrect as administering anti-histamine does not address the underlying issue of fever. - Choice C is incorrect as giving Acetaminophen without further evaluation of the cause of fever is not appropriate.
Question 3 of 5
Nurse Fely is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. Which of the following assessment findings is the MOST ALARMING?
Correct Answer: A
Rationale: The correct answer is A: Temperature: 38.1 C. A fever is the most alarming finding as it indicates a potential systemic infection, especially in a client with a central line and redness at the insertion site. Fever can be a sign of sepsis which requires immediate intervention. Choice B: Expiration date is next month is not relevant to the current situation and does not indicate an immediate threat to the client's health. Choice C: Dressing change due today, while important for infection prevention, is not the most alarming finding in this scenario as it can be addressed promptly. Choice D: Tight tubing connections can lead to complications but are not as urgent or life-threatening as a fever in a client with a central line and redness at the site.
Question 4 of 5
Nurse Corazon has just received a unit of packed red blood cells from the blood bank to transfuse into a client as ordered. Before preparing the blood for transfusion, Nurse Corazon noticed the presence of bubbles in the bag. She should take which of the following actions?
Correct Answer: C
Rationale: Rationale: 1. Bubbles in blood bag indicate possible contamination or improper handling. 2. Returning the bag to the blood bank ensures safety and quality control. 3. Adding saline or heparin can compromise the integrity of the blood product. 4. Double-checking by another nurse does not address the issue of bubbles. Summary: - Choice A: Does not address the potential issue with the blood bag. - Choice B: Adding saline can affect the blood product's composition. - Choice C: Correct - ensures proper handling and safety. - Choice D: Adding heparin can alter the blood product's function.
Question 5 of 5
A client has an order of small volume enema after an oral laxative fails to produce sufficient stool return. The nurse informs the client of the procedure. The client asks the nurse what small volume enema is all about. The nurse offered an APPROPRIATE answer when she states that small volume enema is:
Correct Answer: C
Rationale: The correct answer is C: Used to clean the sigmoid and rectum. Small volume enema is specifically designed to target the lower part of the colon, which includes the sigmoid colon and rectum. This type of enema is not meant to cleanse the entire colon like a large volume enema would. It is focused on providing relief and stimulation to the lower bowel to help with stool return. Explanation of incorrect choices: A: A laxative solution - Small volume enema is not just a laxative solution, it is a specific type of enema with a targeted purpose. B: Given to cleanse the colon - Small volume enema is not intended to cleanse the entire colon but rather the lower part. D: A commercially prepared enema - While small volume enemas can be commercially prepared, this choice does not address the specific purpose of the enema, which is to clean the sigmoid and rectum.