a nurse is planning care for an adolescent client with chronic renal failure which action should the nurse include a nurse is planning care for an adolescent client with chronic renal failure which action should the nurse include
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Nursing Elites

ATI LPN

PN ATI Capstone Proctored Comprehensive Assessment Form A

1. A nurse is planning care for an adolescent client with chronic renal failure. Which action should the nurse include?

Correct answer: D

Rationale: In chronic renal failure, it is essential to restrict protein intake to the Recommended Dietary Allowance (RDA) to reduce the accumulation of waste products that the kidneys can no longer effectively eliminate. Choices A, B, and C are incorrect because in chronic renal failure, high calcium, high potassium, and increased fluid intake can further strain the kidneys and worsen the condition.

2. A nurse is caring for a client with a pressure ulcer. Which of the following interventions is most appropriate?

Correct answer: D

Rationale: The correct answer is to cleanse the wound from the center outwards. This technique helps prevent infection and promotes healing by ensuring that any contaminants are moved away from the center of the wound. Administering a protein supplement (choice A) or increasing protein intake in the client's diet (choice B) may be beneficial for overall healing but are not the most appropriate interventions specifically for wound care. Increasing IV fluid intake (choice C) is important for hydration but is not the most appropriate intervention for managing a pressure ulcer.

3. What is an important consideration when administering a blood transfusion?

Correct answer: A

Rationale: The correct answer is to ensure the blood is compatible with the recipient's blood type. This is crucial to prevent transfusion reactions, which can be life-threatening. Choice B is incorrect because warming blood to body temperature is not a standard practice and may lead to hemolysis. Choice C is incorrect as blood products are carefully screened for clots before distribution. Choice D is incorrect because it is not necessary for the recipient to eat before a blood transfusion.

4. Which of the following best describes the role of a community health nurse?

Correct answer: C

Rationale: The primary role of a community health nurse is to focus on promoting health and preventing disease within the community. They work to improve the overall health and well-being of individuals and populations by providing education, preventive care, and support to enhance community health outcomes. Community health nurses collaborate with community members, organizations, and public health agencies to address health disparities, implement health promotion strategies, and advocate for equitable access to healthcare services.

5. A nurse is preparing to administer a dose of insulin. Which of the following should the nurse do first?

Correct answer: B

Rationale: The correct answer is to verify the client's blood glucose level first before administering insulin. This step is crucial to determine the appropriate dose of insulin based on the client's current blood glucose level. Checking the expiration date (Choice A) is important but not the first step in this scenario. Obtaining the client's weight (Choice C) is not directly related to the immediate administration of insulin. Assessing for signs of hypoglycemia (Choice D) should be done after administering insulin to monitor for potential side effects or adverse reactions.

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