ATI RN
test bank for health assessment Questions
Question 1 of 5
What should the nurse do first when a client is experiencing an allergic reaction?
Correct Answer: A
Rationale: The correct answer is A: Administer epinephrine. Epinephrine is the first-line treatment for an allergic reaction as it helps to reverse severe symptoms like swelling, difficulty breathing, and low blood pressure. Administering epinephrine promptly can prevent the allergic reaction from escalating into a life-threatening situation. Antihistamines (choice B) may be given after epinephrine for symptom relief but are not as immediate in action. Monitoring vital signs (choice C) is important, but administering epinephrine takes precedence in managing the allergic reaction. Providing a cold compress (choice D) may help with local swelling but does not address the systemic effects of the allergic reaction.
Question 2 of 5
What is the proper hand position when performing chest percussion?
Correct Answer: A
Rationale: The proper hand position for chest percussion is to cup the hands, creating a hollow space to allow for effective transmission of percussion vibrations. Cupping the hands helps to produce the desired percussion sound and ensures proper force distribution. Using the side of the hands (B) may not provide enough surface area for effective percussion. Flattening the hands (C) may not generate the desired percussive effect, and spreading the fingers of both hands (D) can result in uneven force application. Therefore, cupping the hands is the most appropriate hand position for chest percussion.
Question 3 of 5
What is the priority nursing action for a client who is receiving blood transfusion and develops a fever?
Correct Answer: A
Rationale: Step 1: Stop the transfusion - Febrile reaction can indicate a transfusion reaction, so stopping the transfusion is crucial. Step 2: Administer antipyretics - To reduce fever and prevent further complications. Step 3: Assess for other signs of transfusion reaction - Such as chills, rash, or hypotension. Summary: Option A is correct as it addresses the immediate need to stop the transfusion and manage the fever. Options B, C, and D do not prioritize stopping the transfusion, which is crucial in this scenario.
Question 4 of 5
Which condition is mammography used to detect?
Correct Answer: B
Rationale: Mammography is used to detect tumors in the breast tissue. It is a screening tool for breast cancer. Tumors can be either benign or malignant. Mammograms help in early detection of abnormalities in breast tissue. Pain, edema, and epilepsy are unrelated to the purpose of mammography. Pain is a symptom, edema is swelling, and epilepsy is a neurological disorder. Therefore, the correct answer is B because mammography is specifically designed to detect tumors in the breast.
Question 5 of 5
What is the first intervention for a client who is at risk for dehydration?
Correct Answer: C
Rationale: Rationale: Choice C, apply ice, is the correct answer as the first intervention for a client at risk for dehydration. Applying ice helps to lower the body temperature, which can reduce sweating and fluid loss. This intervention is crucial in preventing further dehydration. Administering IV fluids (Choice A) may be necessary in severe dehydration cases, but it is not the first intervention. Administering oxygen (Choice B) is not directly related to dehydration. Elevating the leg (Choice D) is not effective in addressing dehydration. In summary, applying ice is the most appropriate initial intervention to prevent dehydration by reducing body temperature and fluid loss.
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