ATI RN
ATI Fundamentals
1. When preparing an in-service on malpractice issues in nursing, which of the following examples should the nurse include in the teaching?
- A. Leaving a nasogastric tube clamped after administering oral medication
- B. Documenting communication with a provider in the progress notes of the client's medical record
- C. Administering potassium via IV bolus
- D. Placing a yellow bracelet on a client who is at risk for falls
Correct answer: C
Rationale: Administering potassium via IV bolus is a high-risk procedure that requires careful attention and adherence to established protocols to prevent serious complications like cardiac arrest. Errors in administering IV medications, especially potent ones like potassium, can lead to severe harm to the patient and potential legal consequences for the healthcare provider. Therefore, including this example in the in-service on malpractice issues helps emphasize the importance of safe medication administration practices and the potential implications of errors.
2. When a chest tube is accidentally removed from a client, which of the following actions should the nurse NOT take first?
- A. Obtain a chest x-ray
- B. Apply sterile gauze to the insertion site
- C. Place tape around the insertion site
- D. Assess respiratory status
Correct answer: B
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.
3. When caring for a client who speaks a language different from their own, what action should the nurse take?
- A. Request an interpreter of a different sex from the client.
- B. Request a family member or friend to interpret information for the client.
- C. Direct attention toward the interpreter when speaking to the client.
- D. Review the facility policy about the use of an interpreter.
Correct answer: D
Rationale: When caring for a client who speaks a different language, it is essential for the nurse to review the facility policy about the use of an interpreter. Using a professional interpreter ensures accurate communication and protects the client's confidentiality. Requesting an interpreter of a specific sex or relying on family members or friends can lead to miscommunication or breaches of confidentiality. Directing attention towards the interpreter helps facilitate communication but does not address the need for a professional interpreter as per facility policy.
4. A client is being instructed on how to perform pursed-lip breathing. Which of the following should be included in the plan of care?
- A. Take quick breaths upon inhalation.
- B. Place your hand over your stomach.
- C. Take a deep breath in through your nose.
- D. Puff your cheeks upon exhalation.
Correct answer: C
Rationale: Pursed-lip breathing is a breathing technique that involves inhaling slowly through the nose and exhaling gently through pursed lips. This technique helps improve breathing efficiency and can be beneficial for individuals with respiratory conditions. Instructing the client to take a deep breath in through the nose is essential for proper execution of pursed-lip breathing, making choice C the correct answer.
5. How many drops are equivalent to 1 tsp?
- A. 15
- B. 60
- C. 10
- D. 30
Correct answer: B
Rationale: 1 teaspoon (tsp) is equivalent to approximately 60 drops. Drops and teaspoons vary in volume and size, affecting the conversion ratio. Choice A (15 drops) is incorrect as it's a common misconception. Choice C (10 drops) and Choice D (30 drops) do not align with the standard conversion of 1 tsp to 60 drops.
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