ATI RN
Nutrition ATI Test
1. In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is your nursing priority care in such a case?
- A. Instruct the client to observe strict bed rest
- B. Check for epidural catheter drainage
- C. Administer analgesia through the epidural catheter as prescribed
- D. Assess respiratory rate carefully
Correct answer: D
Rationale: The nursing priority care in a case where an epidural catheter for Fentanyl epidural analgesia is given during hip surgeries is to assess the respiratory rate carefully. Respiratory depression is a potential side effect of Fentanyl, especially when administered epidurally. Monitoring the respiratory rate is crucial to detect any signs of respiratory distress promptly. Instructing the client to observe strict bed rest (Choice A) may be necessary but is not the priority over ensuring respiratory function. Checking for epidural catheter drainage (Choice B) and administering analgesia through the epidural catheter as prescribed (Choice C) are important aspects of care, but ensuring adequate ventilation takes precedence to prevent complications.
2. Which of the following is not true about Pure Experimental research?
- A. There is a control group
- B. There is an experimental group
- C. Selection of subjects in the control group is randomized
- D. There is a careful selection of subjects in the experimental group
Correct answer: D
Rationale: In Pure Experimental research, subjects in the experimental group are typically selected randomly to minimize bias and ensure that the results are attributable to the intervention being studied. Therefore, the statement 'There is a careful selection of subjects in the experimental group' is not true. This careful selection would introduce bias and compromise the validity of the experimental results. Choices A, B, and C are true for Pure Experimental research as it involves both a control group, an experimental group, and randomization of subject selection in the control group to ensure comparability.
3. Hypertrophic burn scars are caused by:
- A. exaggerated contraction
- B. random layering of collagen
- C. wound ischemia
- D. delayed epithelialization
Correct answer: C
Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.
4. A client receiving total parenteral nutrition (TPN is awaiting the next container. What fluid should the nurse infuse in the interim?
- A. Dextrose 5% in water
- B. 0.9% sodium chloride
- C. Dextrose 10% in water
- D. Lactated Ringer's solution
Correct answer: B
Rationale: The correct answer is 0.9% sodium chloride. When a client receiving TPN is awaiting the next container, infusing 0.9% sodium chloride is the appropriate choice to maintain fluid and electrolyte balance. Dextrose solutions are not recommended as they do not provide sufficient nutrition. Lactated Ringer's solution contains electrolytes but lacks essential nutrients found in TPN, making it an inadequate choice during the delay in TPN delivery.
5. Which of the following statements about Z-Track technique is false?
- A. Z-Track injections prevent irritation of the subcutaneous tissues
- B. The technique involves creating a Zig-Zag like pattern of medication
- C. It forces the medication to be contained in the subcutaneous tissues
- D. It is used when administering Parenteral Iron
Correct answer: B
Rationale: The Z-Track technique is aimed at preventing medication leakage into the surrounding tissues by sealing the medication in the muscle, not by creating a Zig-Zag pattern. Choice A is correct as Z-Track injections help prevent irritation. Choice C is correct as it accurately describes how the technique works. Choice D is also correct as the Z-Track technique is commonly used when administering Parenteral Iron to prevent staining and irritation of the surrounding tissues.
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