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

ATI RN

ATI Fundamentals Proctored Exam 2023

1. A client who wears glasses is under the care of a nurse. Which of the following actions should the nurse take?

Correct answer: Store the glasses in a labeled case.

Rationale: It is essential for the nurse to store the client's glasses in a labeled case to ensure they are kept safe and protected from damage. Storing them in a case helps prevent scratches, breakage, or misplacement. This practice promotes proper eyewear hygiene and ensures the client has their glasses readily available when needed. Cleaning the glasses with hot water or a paper towel can potentially damage the lenses or frames. Storing the glasses on the bedside table increases the risk of misplacement or damage.

2. A 5-year-old has patient-controlled analgesia (PCA) for pain management after abdominal surgery. What information does the nurse include in teaching the parents about the PCA?

Correct answer: C

Rationale: The correct answer is C because the PCA pump can be programmed to deliver a continuous basal rate of pain medication to maintain pain control. While the goal of PCA is effective pain relief, it does not guarantee a pain-free state. In the case of a 5-year-old child, the parents or nurse can administer boluses if necessary since the child may not fully comprehend using the PCA button. Monitoring every 1 to 2 hours for patient response is adequate and there is no need for monitoring every 15 minutes, as stated in choice D, unless specific circumstances dictate more frequent monitoring.

3. A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take?

Correct answer: B

Rationale: Blurred vision and headache in a child with acute glomerulonephritis may indicate severe hypertension, which requires immediate assessment and intervention. Blood pressure should be checked, and the healthcare provider notified.

4. A childbirth leave of __________ predicts favorable maternal physical and mental health, supportive marital interaction, and sensitive caregiving.

Correct answer: D

Rationale: Research indicates that a childbirth leave of 12 weeks or more leads to favorable outcomes for maternal physical and mental health, supportive marital interaction, and sensitive caregiving. This extended period of leave allows mothers to recover physically, adjust psychologically, and establish strong bonds with their newborn, which ultimately benefits the whole family. Choices A, B, and C are incorrect as they do not provide the optimal duration needed for mothers to experience the full range of benefits associated with an extended childbirth leave.

5. For individuals with lactose intolerance, which of the following foods should be avoided?

Correct answer: B

Rationale: Individuals with lactose intolerance lack the enzyme lactase needed to break down lactose. Milk contains lactose, a sugar found in dairy products, and should be avoided by individuals with lactose intolerance. Choices A, C, and D are not sources of lactose and are generally well-tolerated by individuals with lactose intolerance.

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