a nurse is reinforcing teaching about food selection with a client who has a moderate burn injury which of the following foods should the nurse recomm
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Nursing Elites

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ATI PN Comprehensive Predictor

1. A nurse is reinforcing teaching about food selection with a client who has a moderate burn injury. Which of the following foods should the nurse recommend as being high in vitamin C?

Correct answer: A

Rationale: Tomatoes are high in vitamin C, which is crucial for wound healing, making them an excellent recommendation for a client with a burn injury. Carrots, avocados, and apricots are not as rich in vitamin C compared to tomatoes, and therefore, they are not the best choice for promoting healing in this scenario.

2. While caring for a client with an IV infusion who develops redness and warmth at the IV site, what is the most appropriate intervention?

Correct answer: D

Rationale: The correct intervention when a client develops redness and warmth at the IV site, indicating phlebitis, is to discontinue the IV and notify the provider. This is crucial to prevent further complications. Elevating the IV site and applying an ice pack (Choice A) may not address the underlying issue of phlebitis. Administering an anti-inflammatory medication (Choice B) is not the primary intervention for phlebitis. Applying a cold compress (Choice C) may provide temporary relief but does not address the need to discontinue the IV when phlebitis occurs.

3. What is the correct way to assess for pitting edema?

Correct answer: A

Rationale: The correct way to assess for pitting edema is to press over a bony area, typically the tibia, for 5 seconds and then release. This allows for the identification of pitting edema, characterized by an indentation that persists for a few seconds. Choice B is incorrect as pitting edema assessment does not involve checking for discoloration. Choice C is incorrect as the presence of a rash is not indicative of pitting edema. Choice D is incorrect as rebound tenderness is a different assessment used for abdominal conditions, not for pitting edema.

4. A client is prescribed simvastatin. Which instruction should the nurse provide during teaching?

Correct answer: B

Rationale: The correct answer is B: 'Avoid drinking grapefruit juice.' Grapefruit juice can increase the risk of toxicity when taken with simvastatin. Instructing the client to avoid grapefruit juice helps prevent this interaction. Choice A is incorrect because the timing of medication administration for simvastatin is usually in the evening. Choice C is unrelated to simvastatin therapy. Choice D is not necessary for monitoring while taking simvastatin.

5. What intervention is essential for a client with dehydration?

Correct answer: B

Rationale: Administering oral rehydration solutions is essential for a client with dehydration as it helps replenish lost fluids and electrolytes directly through the oral route. Monitoring electrolyte levels regularly (Choice A) is important but not as essential as providing immediate rehydration. Increasing fluid intake to maintain hydration (Choice C) may not be sufficient for a client already dehydrated and needing rapid replenishment. Administering intravenous fluids (Choice D) is a more invasive intervention typically reserved for severe cases of dehydration or when the client cannot tolerate oral fluids.

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