ATI RN
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Question 1 of 5
What is the priority nursing action for a client experiencing anaphylaxis?
Correct Answer: A
Rationale: The correct answer is A: Administer epinephrine. Epinephrine is the first-line treatment for anaphylaxis as it quickly reverses severe allergic reactions. It works by constricting blood vessels, relaxing airway muscles, and increasing heart rate. These actions help to counteract the potentially life-threatening symptoms of anaphylaxis, such as difficulty breathing and a drop in blood pressure. Applying antihistamines (B) may help with mild allergic reactions but are not sufficient for anaphylaxis. Administering morphine (C) or pain relief (D) is not appropriate initially as they do not address the immediate life-threatening nature of anaphylaxis.
Question 2 of 5
Which action should not be performed when fetal distress is indicated?
Correct Answer: C
Rationale: The correct answer is C: decrease maternal fluids. When fetal distress is indicated, decreasing maternal fluids helps prevent further stress on the fetus by reducing the volume of amniotic fluid. This can help improve blood flow to the placenta and oxygen delivery to the baby. Increasing maternal fluids (choice A) can worsen the situation by potentially increasing amniotic fluid volume and further compromising fetal oxygenation. Administering oxygen (choice B) is important to improve oxygen supply to the fetus. Turning the mother (choice D) can help relieve pressure on the baby but is not the primary action when fetal distress is indicated.
Question 3 of 5
The Indian Act of 1876 classifies First Nations people into registered status Indians or nonstatus Indians. Knowing a First Nations person's status is important for health care providers, as it:
Correct Answer: C
Rationale: The correct answer is C because knowing a First Nations person's status guides health care providers in planning care. First Nations individuals with status are entitled to specific benefits not covered under provincial health plans. This knowledge helps tailor treatment plans and access appropriate resources. Choice A is incorrect because status does not directly relate to provincial health insurance coverage. Choice B is incorrect as it inaccurately states that only those with status can have unlimited benefits across Canada. Choice D is incorrect because status does not necessarily influence how a person interacts with their community.
Question 4 of 5
A nurse is caring for a patient who is post-operative following a total knee replacement. The nurse should prioritize which of the following interventions?
Correct Answer: A
Rationale: The correct answer is A: Encouraging early ambulation. This is a priority intervention because early ambulation helps prevent complications such as blood clots and respiratory issues. It also promotes circulation and aids in the recovery process. Administering pain medication (B) is important but not the top priority. Providing wound care and dressing changes (C) is necessary but can be done after ensuring the patient's mobility. Monitoring for signs of infection (D) is also crucial, but promoting early ambulation takes precedence in this scenario to prevent complications.
Question 5 of 5
The nurse is performing a functional assessment on an 82-year-old patient who recently had a stroke. Which of the following questions would be the most important to ask?
Correct Answer: B
Rationale: The correct answer is B: "Are you able to dress yourself?" This question is the most important because it directly assesses the patient's functional abilities post-stroke, providing crucial information about their independence and self-care abilities. It helps determine the patient's level of disability and need for assistance with activities of daily living. Choice A: "Do you wear glasses?" is not as important in this context as it does not directly address the patient's functional status post-stroke. Choice C: "Do you have any thyroid problems?" is irrelevant to the functional assessment of a patient post-stroke. Choice D: "How many times a day do you have a bowel movement?" is not as critical as assessing the patient's ability to perform basic activities of daily living.
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