ATI Custom T1 PM Summer 2023 Exam 5 | Nurselytic

Correct Answer: D

Rationale:
Correct Answer: D. Describing to the client the location of the food on the tray promotes client independence by empowering them to locate and feed themselves. By providing specific instructions, the client can use their remaining senses to identify and consume the food. This intervention encourages self-reliance and fosters a sense of control over their own care.

Incorrect

Choices:
A: Placing the client's hands on the tray does not promote independence as it involves physical assistance rather than empowering the client to do it themselves.
B: Assigning assistive personnel to feed the client removes the client's autonomy and does not encourage self-care.
C: Asking if the client prefers a liquid diet addresses dietary preferences but does not directly promote independence in feeding.

Correct Answer: B

Rationale: The correct answer is B. Storing narcotic medications in the original package helps ensure proper identification, dosage, and expiration dates. It also prevents confusion with other medications.
Choice A is incorrect because unused narcotic medications should be disposed of properly, not in a trash container.
Choice C is incorrect as obtaining medications from different pharmacies can lead to drug interactions and duplicate therapy.
Choice D is incorrect as over-the-counter medications should be stored in a secure, locked cabinet to prevent accidental ingestion, especially by children.

Correct Answer: D

Rationale:
Correct Answer: D. Describing to the client the location of the food on the tray promotes client independence by empowering them to locate and feed themselves. By providing specific instructions, the client can use their remaining senses to identify and consume the food. This intervention encourages self-reliance and fosters a sense of control over their own care.

Incorrect

Choices:
A: Placing the client's hands on the tray does not promote independence as it involves physical assistance rather than empowering the client to do it themselves.
B: Assigning assistive personnel to feed the client removes the client's autonomy and does not encourage self-care.
C: Asking if the client prefers a liquid diet addresses dietary preferences but does not directly promote independence in feeding.

Correct Answer: C

Rationale: The correct answer is C: Encourage the client to take deep breaths. This action will help improve oxygenation by increasing lung ventilation and oxygen exchange. Deep breathing helps to expand the lungs fully, allowing more oxygen to enter the bloodstream. Decreasing the head of the bed (
A) is typically done for clients with respiratory distress to improve oxygenation. Asking the client to cough (
B) every 4 hours may help with airway clearance but does not directly address oxygen saturation. Requesting an opioid analgesic (
D) is not indicated for improving oxygen saturation and may potentially depress the respiratory drive, worsening the situation.

Correct Answer: A

Rationale: The correct answer is A: Severity. By asking the client to rate the pain on a scale of 0 to 10, the nurse is assessing the severity of the pain. This helps the nurse understand the intensity of the pain the client is experiencing, which is crucial for determining appropriate interventions. Assessing the severity of pain is a fundamental aspect of pain assessment. Other choices are incorrect because: B (Quality) focuses on the characteristics of the pain, C (Region) identifies the location of the pain, and D (Precipitating cause) seeks to determine what triggers the pain. These options are important aspects of pain assessment but do not directly address the intensity or severity of the pain, making them less relevant in this context.