what is the most important nursing action when administering iv potassium
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Nursing Elites

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ATI Comprehensive Predictor PN

1. What is the most important nursing action when administering IV potassium?

Correct answer: C

Rationale: The most important nursing action when administering IV potassium is to administer it slowly and dilute it in IV fluids. This approach helps prevent irritation and hyperkalemia. Monitoring for decreased urine output (Choice A) is important but not as critical as ensuring the safe administration of IV potassium. Administering potassium via IV push (Choice B) is unsafe and can lead to adverse effects. Ensuring the client drinks water before administration (Choice D) is not directly related to the safe administration of IV potassium.

2. What are the risk factors for developing Type 2 diabetes?

Correct answer: A

Rationale: The correct answer is A: Obesity, sedentary lifestyle, and poor diet are established risk factors for developing Type 2 diabetes. Obesity puts extra pressure on the body's ability to properly control blood sugar levels. A sedentary lifestyle contributes to weight gain and insulin resistance. Poor diet, especially one high in processed foods and sugary beverages, can also increase the risk of developing Type 2 diabetes. Choices B, C, and D are incorrect because age, gender, family history, smoking, alcohol consumption, and hypertension can impact overall health but are not the primary risk factors for Type 2 diabetes.

3. A client with a tracheostomy is exhibiting signs of respiratory distress. What is the nurse's immediate priority?

Correct answer: B

Rationale: When a client with a tracheostomy is experiencing respiratory distress, the immediate priority for the nurse is to suction the tracheostomy. This action helps clear the airway of secretions and ensures that the client can breathe effectively. Increasing the oxygen flow rate may be necessary but addressing the airway obstruction is more critical. Notifying the physician immediately is important but may cause a delay in addressing the immediate need for airway clearance. Administering a bronchodilator may help with bronchospasm but should not take precedence over ensuring a clear airway in a client with respiratory distress.

4. Which of the following is an early sign that suctioning is required for a client with a tracheostomy?

Correct answer: B

Rationale: Irritability is an early sign that suctioning is necessary to clear the airway in a client with a tracheostomy. When secretions build up in the tracheostomy tube, the client may become irritable due to the discomfort and the compromised airway. Bradycardia, confusion, and hypotension are not typically early signs that suctioning is required. Bradycardia may occur if the airway becomes severely compromised, confusion may be a late sign of hypoxia, and hypotension is not directly related to the need for suctioning in a client with a tracheostomy.

5. What are the key signs of infection after surgery?

Correct answer: D

Rationale: After surgery, key signs of infection include redness, swelling, and fever. Redness and swelling can indicate inflammation at the surgical site, while fever is a systemic response to infection. Choosing 'All of the above' (Option D) is the correct answer because all three signs are commonly associated with post-surgical infections. Options A, B, and C are incorrect as each of them individually can be a sign of infection, but considering all three together provides a more comprehensive assessment for post-operative infection.

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