a nurse is caring for an intubated and sedated geriatric client what intervention is most appropriate for reducing the risk for a friction and shear i
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Nursing Elites

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. A nurse is caring for an intubated and sedated geriatric client. What intervention is most appropriate for reducing the risk for a friction and shear injury?

Correct answer: A

Rationale:

2. What is accurate health promotion teaching to prevent ear infection or trauma? (Select all that apply)

Correct answer: D

Rationale: The correct health promotion teachings to prevent ear infection or trauma include blowing the nose gently without blocking nostrils, wearing hearing protection when exposed to loud noise, and avoiding the use of cotton-tipped applicators to clean the external ear. Blocking one nostril when blowing the nose is incorrect, as it can cause problems. Therefore, choice A is inaccurate. Additionally, using cotton-tipped applicators to clean the external ear can lead to trauma or infection, making choice C a correct preventive measure.

3. A nurse is providing teaching to an older client who has osteoarthritis that is affecting the knees. What statement by the client indicates a correct understanding of the teaching?

Correct answer: A

Rationale:

4. What occurs during stage three of bone healing?

Correct answer: B

Rationale: During stage three of bone healing, callus formation occurs. This process involves the formation of a soft callus made of collagen and cartilage, which bridges the gap between bone fragments. Choice A, consolidation, typically happens in later stages and involves the hardening of the callus into mature bone. Choices C and D are incorrect as granulation formation and hematoma formation occur in earlier stages of bone healing, specifically stages one and two, respectively.

5. On inspection, which client does the nurse suspect of having a visual impairment?

Correct answer: C

Rationale: Tilting the head may indicate a visual impairment as the client attempts to compensate for vision loss.

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