what is the nurses priority when caring for a patient with a chest tube
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Nursing Elites

ATI LPN

ATI PN Comprehensive Predictor 2023 Quizlet

1. What is the priority for the nurse when caring for a patient with a chest tube?

Correct answer: A

Rationale: The priority for the nurse when caring for a patient with a chest tube is to ensure tube patency and observe for air leaks. This is essential to prevent complications such as pneumothorax and ensure the patient's lung function. While maintaining sterile technique during dressing changes, monitoring drainage, recording output, and observing for signs of infection and subcutaneous emphysema are also important, ensuring tube patency takes precedence as it directly impacts the patient's respiratory status and overall safety.

2. How should a healthcare provider respond to a patient experiencing a seizure?

Correct answer: D

Rationale: When a patient is experiencing a seizure, the immediate priority is to ensure their safety by placing them in a side-lying position. This helps prevent aspiration in case of vomiting and maintains an open airway. Administering anticonvulsant medications is not within the scope of a healthcare provider's immediate response during a seizure. Applying restraints can potentially harm the patient by restricting movement and causing injury. Monitoring for post-ictal confusion is important after the seizure has ended, but the primary concern during the seizure is ensuring the patient's safety.

3. Which intervention is most important for a client with chronic heart failure?

Correct answer: B

Rationale: The correct answer is to monitor the client's weight daily to assess fluid balance in clients with chronic heart failure. Monitoring weight helps in detecting fluid retention or fluid loss, which is crucial in managing heart failure. Encouraging fluid intake to prevent dehydration (choice A) may worsen fluid overload in heart failure patients. Limiting sodium intake (choice C) is essential but not the most important intervention compared to monitoring weight. Restricting daily activity (choice D) is not recommended as it is important for clients with heart failure to engage in appropriate levels of physical activity to maintain their overall health.

4. What term refers to the agreement to keep promises?

Correct answer: A

Rationale: The term 'fidelity' specifically refers to the agreement to keep promises. Fidelity in healthcare ethics emphasizes the importance of healthcare professionals keeping their commitments to patients. Choice B, 'Non-maleficence,' relates to the ethical principle of doing no harm. Choice C, 'Autonomy,' refers to respecting a patient's right to make decisions about their own healthcare. Choice D, 'Justice,' pertains to fairness and equality in the distribution of healthcare resources.

5. Which of the following is the best strategy for managing dehydration in a client?

Correct answer: B

Rationale: The best strategy for managing dehydration in a client is to monitor fluid and electrolyte levels frequently. This allows healthcare providers to assess the client's hydration status accurately and make informed decisions regarding treatment. Encouraging the client to drink more water (Choice A) may not be sufficient if the dehydration is severe and requires specific interventions. Administering oral rehydration solutions (Choice C) can be beneficial but should be guided by monitoring the client's condition. Increasing the IV fluid rate (Choice D) may be necessary in certain cases, but it is not always the initial or best approach, as monitoring is crucial to avoid fluid and electrolyte imbalances.

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