ATI RN
ATI Community Health Nursing Ch 7
1. For a complete spinal injury, which statement is true?
- A. Some of the motor and sensory functions are lost
- B. Only the motor functions are lost
- C. Only the sensory functions are lost
- D. Both the motor and sensory functions are lost
Correct answer: D
Rationale: In a complete spinal injury, there is total loss of motor and sensory functions below the level of the injury. This means that both motor (ability to move) and sensory (ability to feel) functions are affected. It is important to distinguish between complete and incomplete spinal injuries, as complete injuries result in the loss of all functions below the level of injury, while incomplete injuries allow for some preservation of motor or sensory functions.
2. The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?
- A. Verify the patient identification (ID) according to hospital policy
- B. Obtain the temperature, blood pressure, and pulse before the transfusion
- C. Double-check the product numbers on the PRBCs with the patient ID band
- D. Monitor the patient for shortness of breath or chest pain during the transfusion
Correct answer: B
Rationale: The correct answer is B. Unlicensed assistive personnel (UAP) can obtain the temperature, blood pressure, and pulse before a transfusion as their education includes measurement of vital signs. UAP would then report the vital signs to the registered nurse (RN). Option A is typically a nursing responsibility to ensure patient safety and avoid errors in patient identification. Option C involves cross-checking important details and ensuring accuracy, which is usually performed by nursing staff to prevent errors. Option D requires monitoring for potential adverse reactions during the transfusion, which is a nursing responsibility due to the need for assessment and intervention in case of complications.
3. A healthcare professional is providing care for a client with a diagnosis of bipolar disorder. Which client behavior would the healthcare professional identify as characteristic of a manic episode?
- A. Sleeping excessively
- B. Excessive energy
- C. Decreased appetite
- D. Lack of interest in activities
Correct answer: B
Rationale: During a manic episode in bipolar disorder, individuals often experience heightened energy levels, increased goal-directed activity, and may engage in risky behaviors. This excessive energy is a key characteristic of manic episodes. Choice A, sleeping excessively, is more characteristic of a depressive episode. Choice C, decreased appetite, can be seen in various mood disorders but is not specific to manic episodes. Choice D, lack of interest in activities, is more indicative of a depressive episode rather than a manic episode. It is important for healthcare professionals to recognize these signs to provide appropriate care and support to individuals with bipolar disorder.
4. Which of the following has the greatest effect on an increase in body weight?
- A. Carbohydrate intake
- B. Protein intake
- C. Fat intake
- D. Total kilocalories
Correct answer: D
Rationale: Total kilocalories have the greatest effect on body weight as they represent the overall energy intake from all macronutrients combined. While the consumption of specific macronutrients like carbohydrates, proteins, and fats can affect weight management, the total calories consumed play the most significant role in determining body weight. Therefore, choices A, B, and C are incorrect as they focus on individual macronutrients rather than the overall energy balance provided by total kilocalories.
5. A healthcare provider is planning to administer Ciprofloxacin IV to a client who has cystitis. Which of the following actions should the healthcare provider take?
- A. Administer a concentrated solution.
- B. Infuse the medication over 60 min.
- C. Infuse the solution through the primary IV fluid tubing.
- D. Choose a small peripheral vein for administration.
Correct answer: B
Rationale: Ciprofloxacin should be infused over 60 minutes to minimize vein irritation and reduce the risk of adverse effects. Administering a concentrated solution can lead to vein irritation and potential complications. Infusing the solution through the primary IV fluid tubing can cause incompatibility issues. Choosing a small peripheral vein may not be suitable for administering Ciprofloxacin, which should be infused through a larger vein to prevent vein irritation and ensure a proper dilution of the medication.
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