a nurse caring for a client who is vomiting which of the following actions should the nurse take first
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Nursing Elites

ATI RN

Adult Medical Surgical ATI

1. A client is vomiting. Which of the following actions should the nurse take first?

Correct answer: C

Rationale: When a client is vomiting, the priority action for the nurse is to prevent the client from aspirating. Aspiration can lead to serious respiratory complications. Providing the client with an emesis basin can be helpful but preventing aspiration takes precedence. Notifying housekeeping and administering an antiemetic are secondary actions that can be addressed once the client's safety is ensured.

2. A nurse is assessing a client for a suspected anaphylactic reaction following a CT scan with contrast media. For which of the following client findings should the nurse intervene first?

Correct answer: B

Rationale:

3. A client with chronic obstructive pulmonary disease (COPD) is being assessed by a nurse. Which finding does the nurse expect?

Correct answer: A

Rationale: Clients with COPD commonly develop a barrel chest, characterized by an increased anteroposterior diameter of the chest. This change is due to chronic air trapping and hyperinflation of the lungs. A decreased respiratory rate, weight gain, and productive cough with yellow sputum are not typical findings in COPD. Instead, COPD patients often present with an increased respiratory rate, weight loss, and a chronic cough with sputum production.

4. A client with chronic obstructive pulmonary disease (COPD) is being assessed by a nurse. Which finding should the nurse expect?

Correct answer: A

Rationale: In COPD, the client often develops a barrel chest, characterized by an increased anterior-posterior diameter of the chest. This change is due to air trapping and hyperinflation of the lungs. Decreased respiratory rate, weight gain, and productive cough with yellow sputum are not typically associated with COPD. Weight loss is more common due to increased work of breathing and decreased energy expenditure in individuals with COPD.

5. When caring for a client with acute pancreatitis, what intervention is most appropriate?

Correct answer: B

Rationale: Administering pain medication as needed is the most appropriate intervention for a client with acute pancreatitis. Pain management is crucial as pancreatitis can cause severe and debilitating pain. Providing pain relief is essential to improve the client's comfort and well-being.

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