Questions 9

ATI RN

ATI RN Test Bank

test bank for health assessment Questions

Question 1 of 5

What should the nurse do first when a client is experiencing an allergic reaction?

Correct Answer: A

Rationale: The correct answer is A: Administer epinephrine. Epinephrine is the first-line treatment for an allergic reaction as it helps to reverse severe symptoms like swelling, difficulty breathing, and low blood pressure. Administering epinephrine promptly can prevent the allergic reaction from escalating into a life-threatening situation. Antihistamines (choice B) may be given after epinephrine for symptom relief but are not as immediate in action. Monitoring vital signs (choice C) is important, but administering epinephrine takes precedence in managing the allergic reaction. Providing a cold compress (choice D) may help with local swelling but does not address the systemic effects of the allergic reaction.

Question 2 of 5

What is the priority nursing intervention for a client with a deep wound infection?

Correct Answer: B

Rationale: The correct answer is B: Apply sterile dressings. This is the priority nursing intervention for a client with a deep wound infection because it helps prevent further contamination and promotes wound healing. Sterile dressings create a barrier against external pathogens and keep the wound environment clean, which is crucial in managing infections. Administering IV antibiotics (choice A) may be necessary but treating the wound first is essential. Applying heat to the wound (choice C) can worsen the infection by promoting bacterial growth. Administering IV fluids (choice D) may be needed for hydration but is not the priority in managing a deep wound infection.

Question 3 of 5

What is the priority nursing action for a client who is receiving blood transfusion and develops a fever?

Correct Answer: A

Rationale: Step 1: Stop the transfusion - Febrile reaction can indicate a transfusion reaction, so stopping the transfusion is crucial. Step 2: Administer antipyretics - To reduce fever and prevent further complications. Step 3: Assess for other signs of transfusion reaction - Such as chills, rash, or hypotension. Summary: Option A is correct as it addresses the immediate need to stop the transfusion and manage the fever. Options B, C, and D do not prioritize stopping the transfusion, which is crucial in this scenario.

Question 4 of 5

What is the most important nursing action for a client who has a history of seizures?

Correct Answer: A

Rationale: The correct answer is A: Administer antiepileptic drugs. This is the most important nursing action for a client with a history of seizures because antiepileptic drugs help prevent or reduce the frequency and severity of seizures. By ensuring the client receives their prescribed medication, the nurse can help manage the condition effectively. Placing the client on their side (B) is important to prevent aspiration if a seizure occurs, but administering antiepileptic drugs is more crucial for long-term management. Checking the airway (C) is important during and after a seizure but does not address the underlying cause. Monitoring for hypoglycemia (D) is important as a potential trigger for seizures, but administering antiepileptic drugs takes precedence in managing the condition.

Question 5 of 5

What is the first intervention for a client who is at risk for dehydration?

Correct Answer: C

Rationale: Rationale: Choice C, apply ice, is the correct answer as the first intervention for a client at risk for dehydration. Applying ice helps to lower the body temperature, which can reduce sweating and fluid loss. This intervention is crucial in preventing further dehydration. Administering IV fluids (Choice A) may be necessary in severe dehydration cases, but it is not the first intervention. Administering oxygen (Choice B) is not directly related to dehydration. Elevating the leg (Choice D) is not effective in addressing dehydration. In summary, applying ice is the most appropriate initial intervention to prevent dehydration by reducing body temperature and fluid loss.

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