ATI RN
Introduction to Nursing 203 Quizlet Questions
Question 1 of 5
Which client should the on-duty nurse assess first?
Correct Answer: B
Rationale: The correct answer is B: The 89-year-old client with end-stage right-sided heart failure blood pressure of 78/50 mm Hg and a “do not resuscitate” order. This client should be assessed first because of the critically low blood pressure and the "do not resuscitate" order, indicating the client's preference for end-of-life care. This situation requires immediate intervention and communication with the healthcare team to ensure the client's wishes are respected. Choice A is stable with heart failure but has normal vital signs. Choice C is receiving I.V. heparin for thrombophlebitis, which is important but not immediately life-threatening. Choice D has new-onset atrial fibrillation but is stable and receiving appropriate treatment. Prioritizing based on acuity and potential for deterioration is crucial in nursing practice.
Question 2 of 5
When can chest physiotherapy be performed?
Correct Answer: B
Rationale: The correct answer is B: One hour after meals. Performing chest physiotherapy after meals helps prevent potential issues like reflux or vomiting during treatment. Waiting one hour allows for digestion to begin, reducing the risk of regurgitation. Performing chest physiotherapy immediately before meals (A) may cause discomfort or interfere with eating. During meals (C) is not ideal as it can disrupt the eating process. Before bedtime (D) may lead to discomfort while lying down and could affect sleep. Thus, the best timing for chest physiotherapy is one hour after meals to ensure effectiveness and patient comfort.
Question 3 of 5
What action indicates the client needs more practice in combining two insulins?
Correct Answer: C
Rationale: Rationale: Choice C is correct because instilling intermediate-acting insulin into the vial of short-acting insulin is incorrect practice as it can lead to incorrect dosing and timing. The client should not mix different types of insulin in the same vial. Incorrect Choices: A: Rolling the vial to mix intermediate-acting insulin is a correct technique. B: Instilling air into insulin vials is incorrect but not related to combining insulins. D: Inverting vials before withdrawing insulin is a common practice and not indicative of issues in combining insulins.
Question 4 of 5
You have read from the chart that a blood transfusion was prescribed to Gella, a patient with aplastic anemia. Which of the following actions should you do FIRST?
Correct Answer: D
Rationale: The correct answer is D: Look for signed informed consent. This is the first step because before any medical procedure, including blood transfusion, it is essential to ensure that the patient has given informed consent. This protects the patient's autonomy and ensures they are aware of the risks and benefits. Checking patient vital signs (A) can be done after obtaining consent. Ordering blood (B) and obtaining administration tubing (C) are important but should come after confirming consent.
Question 5 of 5
When preparing the epinephrine injection from an ampule, Nurse Andrae initially:
Correct Answer: A
Rationale: The correct answer is A because tapping the ampule at the top helps ensure that all the medication flows to the base, making it easier to withdraw the correct dose. Tapping prevents medication from getting stuck at the top. Checking the expiration date (B) is important but not the initial step. Removing the needle cap and expelling air (C) is done after drawing up the medication. Breaking the ampule neck (D) is the final step after ensuring the medication is properly prepared.