a nurse is providing oral hygiene for an unconscious client what is the priority nursing intervention

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. A nurse is providing oral hygiene for an unconscious client. What is the priority nursing intervention?

A. Position the client on one side with the head turned towards you
B. Handle dentures with care
C. Use gentle brushing and flossing techniques for clients with fragile mucosa
D. Have a suction apparatus ready at the bedside

Correct answer: A

Rationale:

2. The nurse is providing medication for a client with osteomyelitis. What teaching should the nurse indicate in the education?

A. The most common adverse e effect for nonsteroidal anti-inflammatory drugs (NSAIDS)are liver failure and tinnitus
B. The main side effect of acetaminophen is gastrointestinal GI bleeding
C. You should not take more than 4000 mg of acetaminophen a day
D. Nonsteroidal anti-inflammatory drugs (NSAIDS) are very safe and are known to have no side effects

Correct answer: A

Rationale:

3. Why is traction used?

A. It allows the bones to realign
B. It decreases the risk of misalignment
C. It promotes wound healing
D. It allows the client to rest longer

Correct answer: A

Rationale: Traction is used to help align the bones properly during the healing process. Choice A is correct because traction assists in allowing the bones to realign correctly, promoting proper healing. Choice B is incorrect as traction does not decrease the risk of misalignment; instead, it helps reduce misalignment by aiding in bone alignment. Choice C is incorrect because while traction indirectly supports wound healing by ensuring proper bone alignment, its primary purpose is not wound healing. Choice D is incorrect as the primary purpose of traction is not to allow the client to rest longer, but rather to aid in bone alignment for optimal healing.

4. A client has a fractured right arm. What should the nurse do first?

A. Apply ice to the fracture site
B. Administer pain medications
C. Remove the client’s bracelet and rings from the right arm
D. Send the client to radiology for an x-ray

Correct answer: C

Rationale: The nurse should first remove the client's bracelet and rings from the right arm. This action is crucial to prevent complications such as swelling and restricted blood flow, which could worsen the condition. Applying ice, administering pain medications, and sending the client for an x-ray are important steps but should come after ensuring the client's jewelry is removed to avoid any further issues.