a nurse is assessing a client who is receiving a continuous heparin infusion which of the following findings should the nurse report to the provider a nurse is assessing a client who is receiving a continuous heparin infusion which of the following findings should the nurse report to the provider
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ATI RN Exit Exam Test Bank

1. A nurse is assessing a client who is receiving a continuous heparin infusion. Which of the following findings should the nurse report to the provider?

Correct answer: D

Rationale: The correct answer is D because an INR of 1.0 is below the therapeutic range for clients receiving heparin, indicating a potential need for dosage adjustment. Platelet count (choice A) within normal range, aPTT (choice B) within therapeutic range, and hemoglobin level (choice C) are not directly related to the monitoring of heparin therapy and would not require immediate reporting to the provider.

2. A client is receiving oxygen therapy via a nasal cannula. The nurse should explain that this method of oxygen delivery does which of the following?

Correct answer: Delivers a specific concentration of oxygen constantly

Rationale: A nasal cannula is a device used for delivering supplemental oxygen to patients. It delivers a specific concentration of oxygen constantly, typically ranging from 1-6 liters per minute. This method is effective for patients who require low to moderate levels of oxygen. Choices B and C are incorrect because a nasal cannula does not deliver a high concentration of oxygen and is not considered a low concentration delivery method. Choice D is incorrect because a nasal cannula does not restrict the client's ability to eat, speak, or drink; it allows them to perform these activities while receiving oxygen therapy.

3. Which of the following is a key component of a successful quality improvement (QI) project?

Correct answer: C

Rationale: Ongoing training and education is the correct answer as it is an essential component of a successful quality improvement project. Continuous training and education help ensure that staff are knowledgeable about and up-to-date with the latest practices, technologies, and methodologies in healthcare. This ongoing learning process contributes to improving the quality of care provided.\nChoice A, standardized care protocols, though important, is more about ensuring consistency in care delivery rather than driving quality improvement initiatives. Choice B, employee satisfaction, while significant for staff morale, is not directly related to the core processes of quality improvement projects. Choice D, financial incentives, although motivating, are not the primary driver for successful quality improvement projects; it is the knowledge and skills gained through training and education that play a more critical role in enhancing quality.

4. The nurse is preparing to complete documentation on a patient's chart. Which should be included in documentation of nursing care? (Select all that apply.)

Correct answer: D

Rationale: Proper documentation includes reassessments, initial assessments, care provided, and the patient's response, but incident reports are typically documented separately.

5. What procedure is used to remove fluid from the pleural space to help a patient breathe more easily?

Correct answer: A

Rationale: Thoracentesis is the correct answer. It is a procedure where a needle is inserted into the pleural space to drain fluid, relieving pressure and helping the patient breathe more easily. Bronchoscopy (choice B) is a procedure used to examine the airways, not to drain fluid. An echocardiogram (choice C) is an imaging test to assess the heart's structure and function, not related to draining pleural fluid. A CT scan (choice D) is a cross-sectional imaging test that provides detailed pictures of the inside of the body, not used for draining pleural fluid.

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