a nurse enters a clients room and finds them on the floor the clients roommate reports that the client was trying to get out of bed and fell over the a nurse enters a clients room and finds them on the floor the clients roommate reports that the client was trying to get out of bed and fell over the
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Nursing Elites

ATI RN

ATI Leadership Practice B

1. A nurse enters a client's room and finds them on the floor. The client's roommate reports that the client was trying to get out of bed and fell over the side rail onto the floor. Which of the following statements should the nurse document about this incident?

Correct answer: C

Rationale: The correct answer is C: "Client was trying to get out of bed." This statement accurately reflects the sequence of events leading to the client's fall and provides crucial information for assessing the situation. Choice A is incorrect because documenting the completion of an incident report is not relevant to describing the incident itself. Choice B incorrectly states that the client climbed over the side rails, which is not supported by the information provided. Choice D is too vague and does not provide details about the client's actions prior to falling.

2. What is the first-line treatment for a patient experiencing wheezing and coughing due to an allergic reaction?

Correct answer: A

Rationale: The correct answer is A: Albuterol via nebulizer. Albuterol is the first-line treatment for wheezing caused by an allergic reaction as it quickly opens the airways, providing rapid relief. Choice B, Methylprednisolone 100 mg IV, is a systemic corticosteroid that may be used in severe cases to reduce inflammation but is not the initial treatment for acute wheezing. Choice C, Cromolyn 20 mg via nebulizer, is a mast cell stabilizer that is more commonly used for prophylaxis rather than acute relief in allergic conditions. Choice D, Aminophylline 500 mg IV, is a bronchodilator that is less commonly used now due to its narrow therapeutic window and potential for toxicity, making it less preferred than Albuterol for initial treatment of wheezing.

3. What term refers to the situation where the pay of newer employees is similar to or higher than that of more experienced employees?

Correct answer: A

Rationale: Salary compression is the term used to describe the situation where the pay of newer employees is similar to or higher than that of more experienced employees. This can happen when newer employees are paid higher salaries to attract them, leading to a compressed salary structure in the organization. Choice B, 'Salary expectations,' does not specifically refer to the scenario described in the question. Choice C, 'Salary range,' is a broader term referring to the range of salaries offered for a particular job or position, not specifically related to the disparity between new and experienced employees. Choice D, 'Salary inflation,' does not accurately describe the situation of newer employees earning higher salaries than more experienced ones; instead, it refers to a general increase in wages across the board.

4. A client is experiencing a panic attack. Which action should the nurse take first?

Correct answer: A

Rationale: During a panic attack, the immediate priority for the nurse is to provide support and reassurance to the client. Remaining with the client helps establish a sense of safety and trust, which can help calm the client during an episode of panic. Administering medication, encouraging physical activity, and deep breathing techniques are beneficial interventions, but offering reassurance and support should be the initial step to address the immediate emotional distress and anxiety experienced by the client.

5. What is the result when a single zygote separates into two parts, each developing into a separate individual?

Correct answer: B

Rationale: The correct answer is B, Monozygotic twin. A monozygotic twin, also known as an identical twin, is the result when a single zygote splits into two parts, leading to the development of two genetically identical individuals. Choices A, C, and D are incorrect because they do not accurately describe the scenario where a single zygote splits into two parts to form identical twins. Dizygotic twin (Choice A) refers to fraternal twins, which result from two separate eggs fertilized by two different sperm cells. Fraternal twin (Choice C) is another term for dizygotic twins, arising from two separate zygotes. Nonidentical twin (Choice D) is a synonymous term for dizygotic or fraternal twins, indicating that they are not genetically identical.

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