a 54 year old patient is admitted with diabetic ketoacidosis which admission order should the nurse implement first

ATI RN

ATI Leadership Proctored Exam 2023

1. A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?

A. Infuse 1 liter of normal saline per hour.
B. Give sodium bicarbonate 50 mEq IV push.
C. Administer regular insulin 10 U by IV push.
D. Start a regular insulin infusion at 0.1 units/kg/hr.

Correct answer: A

Rationale: In a patient admitted with diabetic ketoacidosis, the initial priority is to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps correct hypovolemia and restore electrolyte balance, making it the first essential step in managing diabetic ketoacidosis. Sodium bicarbonate is not routinely recommended in treating diabetic ketoacidosis and should not be given routinely as it may worsen the acidosis. Administering regular insulin and starting an insulin infusion are important but should come after fluid resuscitation to stabilize the patient's condition.

2. A nurse is caring for a client who is postoperative. When the nurse prepares to change the client's dressing, they say, 'Every time you change my bandage, it hurts so much.' Which of the following interventions is the nurse's priority action?

A. Encourage the client to relax and take deep breaths during the dressing change
B. Educate the client about the importance of the dressing change to prevent infection
C. Administer pain medication 45 minutes before changing the client's dressing
D. Assist the client to a comfortable position for the dressing change

Correct answer: C

Rationale: The correct answer is to administer pain medication 45 minutes before changing the client's dressing. This intervention is the priority action because the client is experiencing pain during the dressing change. Providing pain relief beforehand can help minimize the discomfort and improve the overall experience for the client. Encouraging relaxation techniques (choice A) or educating about dressing change importance (choice B) are valuable but addressing pain is the priority. Assisting the client to a comfortable position (choice D) is essential for the procedure but does not directly address the client's pain.

3. Which of the following is an example of a macro-level health policy?

A. Local health ordinances
B. State licensing regulations
C. National healthcare legislation
D. Institutional policies

Correct answer: C

Rationale: The correct answer is national healthcare legislation. This type of policy operates at a broad level, influencing healthcare delivery and financing across an entire nation. It sets overarching frameworks and regulations that impact various aspects of the healthcare system on a large scale, affecting a wide population rather than specific localities or institutions. Choices A, B, and D are not examples of macro-level health policy. Local health ordinances pertain to specific areas or communities, state licensing regulations focus on a state level, and institutional policies are internal regulations of a particular healthcare facility.

4. Which action by a patient indicates that the home health nurse’s teaching about glargine and regular insulin has been successful?

A. The patient administers the glargine 30 minutes before each meal
B. The patient’s family prefills the syringes with the mix of insulins weekly.
C. The patient draws up the regular insulin and then the glargine in the same syringe.
D. The patient disposes of the open vials of glargine and regular insulin after 4 weeks

Correct answer: D

Rationale:

5. What is the primary goal of a root cause analysis (RCA) in healthcare?

A. To assign blame for errors
B. To prevent future errors by identifying underlying causes
C. To improve patient satisfaction
D. To analyze the financial impact of errors

Correct answer: B

Rationale: The correct answer is B: 'To prevent future errors by identifying underlying causes.' Root cause analysis (RCA) in healthcare aims to delve deep into the factors contributing to an error to prevent its recurrence. Choice A is incorrect as RCA focuses on identifying system issues, not blaming individuals. Choice C is incorrect as while improving patient satisfaction may result from the process, it is not the primary goal. Choice D is incorrect as the main focus of RCA is not financial analysis but rather improving patient safety.