a nurse is caring for a client who has diaper dermatitis which of the following actions should the nurse take

ATI RN

ATI Comprehensive Exit Exam 2023

1. A nurse is caring for a client who has diaper dermatitis. Which of the following actions should the nurse take?

A. Apply zinc oxide ointment to the irritated area
B. Wipe stool from the skin using store-bought baby wipes
C. Apply talcum powder to the irritated area
D. Apply a warm compress to the irritated area

Correct answer: A

Rationale: Correct answer: Applying zinc oxide ointment to the irritated area is the most appropriate action for diaper dermatitis. Zinc oxide is a barrier cream that helps protect the skin and promote healing. Choice B is incorrect because using store-bought baby wipes may contain chemicals or fragrances that can further irritate the skin. Choice C is incorrect as talcum powder can also worsen the condition by drying out the skin. Choice D is incorrect because a warm compress is not typically used for diaper dermatitis; it may provide relief for other conditions but is not the best option for diaper dermatitis.

2. What is the best intervention for a patient with constipation?

A. Administer a stool softener
B. Encourage fluid intake
C. Provide a high-fiber diet
D. Administer a laxative

Correct answer: B

Rationale: Encouraging fluid intake is the best intervention for a patient with constipation. Fluids help soften stools, making them easier to pass. While stool softeners and laxatives can also help with constipation, they are more of a short-term solution and may not address the root cause. A high-fiber diet is beneficial for preventing constipation in the long run, but in the immediate situation of constipation, fluid intake is key.

3. How should signs of infection in a post-surgical patient be assessed?

A. Check the surgical site
B. Check the patient's vital signs
C. Monitor for fever
D. Check for abnormal breath sounds

Correct answer: A

Rationale: Assessing the surgical site is crucial in identifying early signs of infection post-surgery. Changes such as redness, swelling, warmth, or drainage may indicate an infection developing. While monitoring vital signs and fever are important in infection assessment, they are general indicators and may not show localized signs at the surgical site. Checking for abnormal breath sounds is more relevant when assessing respiratory issues rather than infection at the surgical site.

4. A client is prescribed furosemide and needs to consume potassium-rich foods. Which of the following foods should the client be advised to include in the diet?

A. Grapes.
B. Apples.
C. Bananas.
D. Rice.

Correct answer: C

Rationale: The correct answer is C: Bananas. Bananas are rich in potassium and should be included in the diet of clients taking furosemide, a potassium-wasting diuretic. Grapes, apples, and rice are not as high in potassium as bananas and would not be as effective in replenishing potassium levels in clients taking furosemide.

5. What is the priority nursing intervention for a patient experiencing respiratory distress?

A. Administer oxygen
B. Reposition the patient
C. Administer bronchodilators
D. Administer IV fluids

Correct answer: A

Rationale: The correct answer is to administer oxygen. In a patient experiencing respiratory distress, ensuring adequate oxygenation is the priority. Administering oxygen helps improve oxygen levels, which is crucial for the patient's well-being. Repositioning the patient, administering bronchodilators, or giving IV fluids are important interventions in certain situations, but when a patient is in respiratory distress, providing oxygen takes precedence over other actions.