a nurse is preparing to administer blood to a client which of the following actions should the nurse take first a nurse is preparing to administer blood to a client which of the following actions should the nurse take first
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Nursing Elites

ATI RN

ATI Comprehensive Exit Exam 2023 With NGN

1. A nurse is preparing to administer blood to a client. Which of the following actions should the nurse take first?

Correct answer: D

Rationale: The correct answer is to verify the client's blood type and Rh factor first before administering blood. This is crucial to ensure compatibility and prevent transfusion reactions. Checking the client's identification bracelet (Choice A) is important but should come after verifying blood type. Obtaining vital signs (Choice B) and initiating the transfusion slowly (Choice C) are important steps but verifying blood type is the priority to ensure safe blood administration.

2. Which heart chamber ejects blood into the systemic arterial circulation via the aorta?

Correct answer: D

Rationale: The correct answer is D, Left ventricle. The left ventricle pumps oxygenated blood into the systemic circulation via the aorta. This chamber receives oxygen-rich blood from the left atrium and contracts forcefully to propel blood into the aorta, distributing it to the body. The other options, right atrium, left atrium, and right ventricle, do not directly eject blood into the systemic arterial circulation via the aorta. The right atrium receives deoxygenated blood from the body, the left atrium receives oxygenated blood from the lungs, and the right ventricle pumps blood to the lungs for oxygenation.

3. Why is it discouraged to use terms such as 'schizophrenic', 'autistic', and 'retarded' when referring to people with mental illness?

Correct answer: D

Rationale: It is discouraged to use terms like 'schizophrenic', 'autistic', and 'retarded' when referring to people with mental illness because people with mental illness should not be defined solely by their condition. Using such labels can reduce individuals to just their diagnosis, overlooking their individuality and other aspects of their identity. It is essential to treat individuals with mental illness with respect and dignity, focusing on their humanity rather than reducing them to a label. Choices A, B, and C are incorrect because the main reason for discouraging these terms lies in not defining individuals by their conditions, rather than the terms being in or out of the DSM, the number of diagnosed individuals, or the perception of whether there is anything wrong with using such terms.

4. A nurse is caring for four hospitalized clients. Which of the following clients should the nurse identify as being at risk for fluid volume deficit?

Correct answer: The client who has gastroenteritis and is febrile

Rationale: Gastroenteritis can lead to fluid loss through vomiting and diarrhea, especially when accompanied by fever. Fever can increase insensible water loss through sweating as well. Both vomiting and diarrhea can significantly contribute to fluid volume deficit, making the client with gastroenteritis and fever at higher risk compared to the other clients described in the options.

5. The nurse is doing preoperative teaching with the client who is about to undergo creation of a Kock pouch. The nurse interprets that the client has the best understanding of the nature of the surgery if the client makes which of the following statements?

Correct answer: A

Rationale: A Kock pouch is a continent ileostomy. As the ileostomy begins to function, the client drains it every 3 to 4 hours and then decreases the draining about 3 times a day or as needed when full. The client does not need to wear a drainage bag but should wear an absorbent dressing to absorb mucous drainage from the stoma. Ileostomy drainage is liquid. The client would be able to pass stool only from the rectum if an ileal-anal pouch or anastomosis were created. This type of operation is a two-stage procedure.

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