a nurse is caring for a client who has a chest tube and drainage system in place the nurse observes that the chest tube was accidentally removed which a nurse is caring for a client who has a chest tube and drainage system in place the nurse observes that the chest tube was accidentally removed which
Logo

Nursing Elites

ATI RN

ATI Fundamentals

1. When a chest tube is accidentally removed from a client, which of the following actions should the nurse NOT take first?

Correct answer: B: Apply sterile gauze to the insertion site

Rationale: When a chest tube is accidentally removed, the priority action for the nurse is to immediately seal the insertion site with a gloved hand, a sterile occlusive dressing, or petroleum gauze to prevent air from entering the pleural space and causing a pneumothorax. Applying sterile gauze to the insertion site is not the correct initial action. The first step is to prevent respiratory compromise by ensuring the site is sealed. Therefore, the nurse should not apply sterile gauze to the insertion site first.

2. A nurse is preparing to perform a bladder scan for a client who has overflow incontinence. Which of the following actions should the nurse take?

Correct answer: D

Rationale: The correct answer is to prepare the client for urinary catheterization. Overflow incontinence may indicate bladder distention, where a bladder scan helps assess the need for catheterization. Placing the client in a supine position (Choice A) is not directly related to the procedure. Obtaining a prescription for an indwelling catheter (Choice B) is not necessary before performing a bladder scan. Cleansing the client's abdomen with an antiseptic solution (Choice C) is not specific to preparing for a bladder scan in this situation.

3. A client with breast cancer is receiving doxorubicin (Adriamycin). The nurse monitors the client closely for:

Correct answer: B

Rationale: Doxorubicin (Adriamycin) is an anthracycline chemotherapy agent commonly used to treat various cancers, including breast cancer. One of the significant side effects associated with doxorubicin is cardiotoxicity, which can lead to serious complications such as heart failure and arrhythmias. The risk of cardiotoxicity is dose-dependent, meaning that higher cumulative doses increase the likelihood of cardiac damage. Therefore, it is essential for nurses to monitor cardiac function closely through assessments such as echocardiograms or monitoring for signs and symptoms of heart failure, such as shortness of breath, fatigue, and edema.

4. The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?

Correct answer: C

Rationale: Urinary stasis is the most important factor in the development of UTIs because it provides an environment for bacterial growth. While poor hygiene and congenital anomalies are contributing factors, preventing urinary stasis is key in UTI prevention.

5. Which of the following is one important factor in sustaining employee satisfaction?

Correct answer: D

Rationale: Job satisfaction is a crucial factor in sustaining employee satisfaction. Studies have shown that higher levels of job satisfaction lead to lower turnover rates and higher productivity. Choice A, organization culture, is important but focuses more on the overall environment rather than individual satisfaction. Choice B, individual performance, is relevant but doesn't directly address employee satisfaction. Choice C, performance evaluation, is a process rather than a factor in sustaining satisfaction.

Similar Questions

Low levels of physical activity are more commonly associated with which type of cancer?
A healthcare professional is preparing to administer a transfusion of a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction?
While assessing clients on a medical-surgical unit, which client is at risk for hypokalemia?
A healthcare professional is assessing a client with left-sided heart failure. Which finding is most commonly associated with this condition?
What is an example of proper body mechanics when lifting?

Access More Features

ATI Basic

  • 50,000 Questions with answers
  • All ATI courses Coverage
    • 30 days access @ $69.99

ATI Basic

  • 50,000 Questions with answers
  • All ATI courses Coverage
    • 90 days access @ $149.99