ATI RN
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Question 1 of 5
What is the best method for a nurse to assess a client's pain level?
Correct Answer: A
Rationale: The correct answer is A: Use a numeric pain scale. This method allows for quantitative assessment of pain intensity, aiding in accurate pain management. It is widely used in healthcare settings, providing a standardized way to communicate and monitor pain levels. Visual analog scale (B) is subjective and less precise than numeric scales. Facial expression scale (C) may be influenced by cultural factors and is subjective. Observing for signs of depression (D) is important but not specific to assessing pain intensity.
Question 2 of 5
Which of the following interventions is most appropriate for a client with a deep wound infection?
Correct Answer: B
Rationale: Step 1: Administering IV antibiotics is important for treating infections, but in this case, the focus is on addressing the pain associated with the deep wound infection. Step 2: Administering pain relief helps improve the client's comfort and quality of life while the infection is being treated. Step 3: Changing the dressing is essential for wound care but does not directly address the client's pain from the infection. Step 4: Performing a CT scan may be necessary to assess the extent of the infection, but it does not directly provide immediate relief for the client's pain. Summary: Administering pain relief is the most appropriate intervention as it directly addresses the client's symptoms and improves their comfort level during the treatment of the deep wound infection.
Question 3 of 5
Which type of assessment promotes critical thinking and clustering of similar data?
Correct Answer: A
Rationale: The correct answer is A: Body systems. This type of assessment promotes critical thinking by organizing data systematically based on different body systems, allowing for clustering of similar data and identification of patterns. Comprehensive assessments (B) may include body systems but lack the focused approach of promoting critical thinking. Head to toe assessments (C) are systematic but may not encourage clustering of data. Emergency assessments (D) prioritize immediate interventions rather than promoting critical thinking or clustering of data.
Question 4 of 5
What precaution should the nurse take when administering intravenous electrolyte solution?
Correct Answer: C
Rationale: The correct answer is C. The nurse should prevent infiltration of calcium to avoid tissue necrosis and sloughing. Infiltration of calcium can lead to severe tissue damage due to its caustic nature. Therefore, the nurse should be vigilant in monitoring the IV site and ensuring proper placement to prevent this complication. Choice A is incorrect because infusing hypertonic solutions rapidly can lead to fluid overload and electrolyte imbalances. Choice B is incorrect because exceeding the recommended amount of potassium per liter of fluid can result in hyperkalemia, which can be dangerous. Choice D is incorrect because calcium does not diminish digitalis's action; in fact, calcium can potentiate the effects of digitalis.
Question 5 of 5
What is the priority nursing action for a client who has sustained an electrical burn?
Correct Answer: A
Rationale: The correct answer is A: Administer pain relief. This is the priority nursing action for a client with an electrical burn because pain management is crucial in providing comfort and reducing distress. Pain relief helps the client to relax, promotes healing, and aids in overall recovery. Administering pain relief should be the first step to ensure the client's well-being. Summary: - B: Administering oxygen may be necessary for respiratory support in some cases but is not the priority over pain relief. - C: Applying sterile dressings is important for wound care but should come after addressing pain. - D: Administering beta blockers is not indicated as the priority action for an electrical burn.
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