the charge nurse should intervene when what behavior is observed
Logo

Nursing Elites

ATI LPN

ATI Adult Medical Surgical

1. When should the charge nurse intervene based on the observed behavior?

Correct answer: B

Rationale: The hospital transporter reading a client's history and physical without a legitimate need violates patient confidentiality. This behavior requires immediate intervention to protect the client's privacy and confidentiality rights.

2. What is the most appropriate nursing intervention to help alleviate severe abdominal pain in a patient with acute pancreatitis?

Correct answer: C

Rationale: Administering prescribed opioid analgesics is the most appropriate nursing intervention to alleviate severe abdominal pain in a patient with acute pancreatitis. Opioid analgesics help manage severe pain effectively in such cases. Encouraging oral intake of clear fluids with electrolytes is contraindicated due to the need for pancreatic rest and potential exacerbation of symptoms. Placing the patient in a semi-Fowler's position helps reduce pressure on the abdomen, unlike a supine position that can worsen the pain. Applying a cold pack is not recommended as it can potentially increase discomfort and vasoconstriction in acute pancreatitis.

3. A primipara at 38-weeks gestation is admitted to labor and delivery for a biophysical profile (BPP). The nurse should prepare the client for what procedures?

Correct answer: C

Rationale: A biophysical profile (BPP) is a prenatal test that assesses the well-being of the fetus. It typically includes ultrasonography to evaluate fetal movements, muscle tone, breathing movements, and amniotic fluid volume. Additionally, a nonstress test is performed to monitor the fetal heart rate in response to its movements. These tests help in determining the overall health and viability of the fetus, making them essential components of prenatal care for assessing fetal well-being.

4. What instruction should the nurse give regarding the administration of alendronate to a patient with osteoporosis?

Correct answer: C

Rationale: The correct instruction for administering alendronate to a patient with osteoporosis is to take the medication with a full glass of water first thing in the morning. It is important for the patient to remain upright for at least 30 minutes after taking the medication to prevent esophageal irritation. Taking alendronate with milk, lying down after intake, or taking it before bedtime can reduce the medication's effectiveness or increase the risk of side effects.

5. A client with heart failure is prescribed digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse teach the client to report?

Correct answer: B

Rationale: Yellow or blurred vision is a hallmark sign of digoxin toxicity. Digoxin toxicity can affect various body systems, but visual disturbances, such as yellow or blurred vision, are important signs that the client should report immediately. Other signs like increased appetite, weight gain, or nasal congestion are not typically associated with digoxin toxicity. Prompt reporting of visual disturbances can help prevent further complications associated with digoxin toxicity.

Similar Questions

A patient with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). What is the priority nursing action?
A patient is admitted with a diagnosis of myasthenia gravis. What symptom should the nurse expect to find during the assessment?
A client with severe anemia is being treated with a blood transfusion. Which assessment finding indicates a transfusion reaction?
What health promotion teaching should prioritize to prevent drug-induced hepatitis?
A 50-year-old man presents with fatigue, arthralgia, and darkening of the skin. Laboratory tests reveal elevated liver enzymes and high serum ferritin levels. What is the most likely diagnosis?

Access More Features

ATI LPN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

ATI LPN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

Other Courses