ATI RN
RN-ATI-Fundamentals-of-Nursing-2023-2024 Questions
Extract:
Question 1 of 5
A nurse is providing discharge teaching to the partner of a client who has a tracheostomy. Which of the following information should the nurse include in the teaching?
Correct Answer: D
Rationale: The correct answer is D: How to change the tracheostomy dressing using clean technique. This is important as it helps prevent infection and promotes healing. First, wash hands thoroughly.
Then, remove the old dressing, clean around the stoma with sterile saline, and apply a new sterile dressing. The other choices are incorrect because:
A) Operating the suction machine should only be done by healthcare professionals.
B) Securing the tracheostomy tube is essential but not the priority in this scenario.
C) Changing the tracheostomy tube daily is not recommended unless there is a specific reason to do so, as it can cause trauma to the stoma.
Question 2 of 5
A nurse is caring for a client whose partner recently died. The nurse sits with the client to provide comfort. Which of the following ethical principles is the nurse demonstrating?
Correct Answer: D
Rationale: The correct answer is D: Beneficence. Beneficence is the ethical principle of doing good and acting in the best interest of the client. In this scenario, the nurse is demonstrating beneficence by providing comfort and support to the client who is grieving the loss of their partner. The nurse's actions are aimed at benefiting the client's emotional well-being.
Rationale for why the other choices are incorrect:
A: Fidelity refers to being faithful or loyal to commitments and promises. Sitting with the client in this scenario is not about loyalty but rather about providing emotional support.
B: Veracity relates to truth-telling and honesty. While important, it is not the primary ethical principle being demonstrated in this scenario.
C: Autonomy is the principle that respects the client's right to make their own decisions. While important, in this case, the nurse is providing support rather than focusing on the client's decision-making.
E, F, G: These choices are not provided, but based
Question 3 of 5
A nurse is responding to a call light and finds a client lying on the bathroom floor. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct action is to check the client for injuries first. This is crucial to assess the immediate physical condition of the client and determine the severity of any potential harm. This step ensures timely intervention and appropriate care. Moving hazardous objects (
B) is important, but not the first priority. Notifying the provider (
C) can be done after ensuring the client's safety. Asking the client about how she felt (
D) can wait until the immediate safety concerns are addressed.
Question 4 of 5
A nurse is providing discharge teaching to the partner of a client who has a tracheostomy. Which of the following information should the nurse include in the teaching?
Correct Answer: A
Rationale: The correct answer is A: How to operate the portable suction machine. This is important because maintaining a patent airway is crucial for a client with a tracheostomy. Suctioning helps to remove secretions and prevent blockages. Teaching the partner how to operate the suction machine ensures that they can assist in emergencies and daily care.
Choice B (How to secure the tracheostomy tube with ties at the back of the neck) is incorrect because securing the tube is important, but it is typically done by healthcare professionals initially and may not need to be done daily by the partner.
Choice C (How to change the nondisposable tracheostomy tube daily) is incorrect because changing the tracheostomy tube is a sterile procedure that should be done by healthcare professionals, not the partner.
Choice D (How to change the tracheostomy dressing using clean technique) is incorrect because changing the dressing is also typically done by healthcare professionals and requires sterile technique, not just
Question 5 of 5
A nurse is reinforcing teaching with a client who has hypertension and a prescription to measure her blood pressure daily. Which of the following client statements indicates an understanding of the teaching?
Correct Answer: C
Rationale:
Correct Answer: C. "I should remove constrictive clothing prior to measuring my blood pressure."
Rationale: Removing constrictive clothing ensures accurate blood pressure readings by preventing interference with blood flow. Tight clothing can artificially elevate blood pressure readings. By removing constrictive clothing, the client allows for an accurate assessment of their blood pressure.
Choice A: Waiting 15 minutes after drinking coffee is not directly related to obtaining an accurate blood pressure reading. Caffeine intake can temporarily raise blood pressure, but waiting 15 minutes may not be sufficient to eliminate its effects.
Choice B: Measuring blood pressure with the arm elevated above the heart is not a recommended method for accurate readings. The arm should be supported at heart level for accurate measurements.
Choice D: Measuring blood pressure immediately after eating breakfast can lead to inaccurate readings. It is recommended to wait at least 30 minutes after consuming a meal before measuring blood pressure for accurate results.