Nutrition ATI Test

Correct Answer: A

Rationale: After a bronchoscopy procedure, the nurse's priority is to check the patient's gag reflex before allowing them to eat to prevent aspiration. The gag reflex helps protect the airway by triggering a cough or gag response if something touches the back of the throat. This is crucial to ensure that the patient can protect their airway and prevent food or fluids from entering the lungs, especially when the throat may be sensitive or compromised post-bronchoscopy. Checking for the wearing off of anesthesia, swallowing reflex, or peristalsis are important assessments but not the immediate priority before feeding in this context.

Correct Answer: D

Rationale: Blood transfusions need to be administered promptly after receiving the blood from the blood bank to ensure patient safety and effectiveness. Waiting too long can lead to complications such as bacterial growth in the blood product, which can be harmful when infused. Administering the blood within 6 hours is crucial to prevent such risks. Choices A, B, and C are incorrect because waiting for 1, 2, or 4 hours respectively can increase the likelihood of complications associated with delayed transfusion.

Correct Answer: D

Rationale: The client experiencing tremors, dizziness, diaphoresis, weakness, and stating that the TPN bag is empty is likely experiencing hypoglycemia. Hypoglycemia can occur when the TPN infusion suddenly stops, leading to a rapid drop in blood sugar levels. Symptoms of hypoglycemia include tremors, dizziness, diaphoresis, and weakness. Choices A, B, and C are incorrect as the symptoms presented are more consistent with hypoglycemia rather than fluid volume overload, sepsis, or hyperglycemia.

Correct Answer: B

Rationale: Clients addicted to hallucinogens often exhibit constricted pupils due to the effects of the drug on the sympathetic nervous system. This sympathetic stimulation causes the pupils to constrict rather than dilate. Choices A, C, and D are incorrect. Dilated pupils are more commonly associated with stimulant use, while bradycardia (slow heart rate) and bradypnea (slow breathing) are not typical effects of hallucinogens.

Correct Answer: A

Rationale: The correct answer is A: 1 cup of ready-to-eat cereal flakes. For a preschool child, 1 cup of ready-to-eat cereal flakes provides a 1-ounce serving of grains, meeting the requirement. Choice B, 1⁄2 slice of whole wheat bread, is not the correct answer as it does not constitute a 1-ounce serving of grains. Similarly, choice C, 1⁄2 of a 6-inch flour tortilla, does not offer a 1-ounce serving of grains. Choice D, 1 cup of cooked rice, also does not provide a 1-ounce serving of grains for a preschool child, making it an incorrect choice.