ATI RN
Essentials Of Nursing Client Safety Questions
Question 1 of 5
You are precepting a nursing student who is assisting you care for a patient on mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10 mmHg. Your response is:
Correct Answer: D
Rationale: Correct Answer: D Rationale: 1. Positive End-Expiratory Pressure (PEEP) helps open collapsed alveoli by maintaining pressure in the lungs during exhalation. 2. In ARDS, alveoli collapse, leading to ventilation-perfusion mismatch and hypoxemia. 3. By applying PEEP, alveoli are kept open, improving oxygenation and lung compliance. 4. Option A is incorrect as PEEP doesn't directly assist with breathing in and out or improve airflow. 5. Option B is incorrect as PEEP can affect cardiac output but the primary goal is to recruit collapsed alveoli. 6. Option C is incorrect as PEEP doesn't specifically prevent fluid from filling alveoli but rather helps with lung recruitment.
Question 2 of 5
A nurse is caring for a client who is preoperative. The nurse signs as a witness on the client's consent form. The nurse's signature on the consent form indicates which of the following?
Correct Answer: B
Rationale: Rationale for Correct Answer B: The nurse's signature on the consent form confirms the client appears competent to provide consent. This is important as it ensures the client has the capacity to make informed decisions about their care. The nurse assesses the client's ability to understand the information provided regarding the procedure and its risks and benefits. By signing as a witness, the nurse acknowledges that the client is mentally competent to provide consent. Summary of Incorrect Choices: A: Incorrect. The nurse's signature does not determine if the client has a mental illness. This falls under the purview of the healthcare provider, not the nurse. C: Incorrect. While the nurse may have explained the risks and benefits, this is not the sole purpose of the nurse's signature on the consent form. D: Incorrect. The nurse's signature does not indicate the client's spouse agrees with the procedure; this is not the nurse's role in the consent process.
Question 3 of 5
A nurse is preparing an in-service for an annual skills fair at a community medical facility about fire safety. Place the steps in the order in which they should be performed in the case of a fire emergency.
Correct Answer: D
Rationale: Correct Answer: D (Rescue the clients) Rationale: In a fire emergency, the top priority is to ensure the safety of individuals by rescuing them. Once the clients are safe, the nurse can proceed to other steps like pulling the fire alarm, confining the fire, and extinguishing it. By rescuing the clients first, the nurse minimizes the risk of harm and ensures everyone's safety. Summary of Incorrect Choices: A (Pull the fire alarm): While important, pulling the fire alarm should come after rescuing the clients to alert others and initiate the fire safety protocol. B (Confine the fire): Confining the fire is crucial but should be done after ensuring everyone's safety through rescue. C (Extinguish the fire): Extinguishing the fire is essential, but it should not be the first step as the priority is to rescue individuals from harm.
Question 4 of 5
A nurse is delegating morning vital signs to an assistive personnel (AP). What action should the nurse take?
Correct Answer: B
Rationale: The correct answer is B because determining the time frame for reporting results is crucial in ensuring timely and effective communication of vital signs data. This step allows the nurse to promptly address any abnormal findings or changes in the patient's condition. A: Verifying the AP's educational preparation is important but not directly related to delegating morning vital signs. C: Observing the AP obtaining vital signs can be helpful for initial training but may not be necessary for every instance of delegation. D: Asking the AP to take vital signs of a post-surgery client first is not the most appropriate action as prioritization should be based on patient acuity, not the type of surgery.
Question 5 of 5
An assistive personnel (AP) tells the nurse manager that she observed a nurse on the unit removing a small amount of morphine from syringes prior to administering the medication to clients. Which of the following actions should the nurse manager take first?
Correct Answer: A
Rationale: The correct answer is A: Gather data about the nurse's work performance and attendance history. This is the first step because it allows the nurse manager to assess the situation comprehensively before taking any action. By gathering data, the nurse manager can determine the extent of the issue, whether it is an isolated incident or a pattern of behavior. This information will help in making an informed decision on how to proceed. Approaching the nurse (B) directly may not be appropriate without first understanding the full context of the situation. Notifying the risk manager (C) is premature without knowing the full extent of the issue. Referring the nurse to the board of nursing diversion program (D) should only be considered after gathering all relevant information about the nurse's actions.