what is the priority nursing action for a patient with shortness of breath
Logo

Nursing Elites

ATI RN

ATI RN Exit Exam 2023

1. What is the priority nursing action for a patient with shortness of breath?

Correct answer: A

Rationale: Administering oxygen is the priority nursing action for a patient experiencing shortness of breath. Oxygen therapy aims to improve oxygenation levels quickly, addressing the underlying cause of the symptom. Repositioning the patient, checking oxygen saturation, and elevating the head of the bed are important interventions but administering oxygen takes precedence in this scenario to ensure adequate oxygen supply to the body.

2. A nurse is caring for a client who has a new prescription for nitroglycerin transdermal patches. Which of the following instructions should the nurse include?

Correct answer: C

Rationale: The correct answer is to apply the nitroglycerin transdermal patch in the morning and remove it at bedtime. This schedule helps prevent tolerance to the medication. Choice A is incorrect because the patch should be rotated to different sites to prevent skin irritation. Choice B is incorrect as daily rotation is recommended, not daily application to the same site. Choice D is incorrect as the patch should be removed during a bath as it may decrease the efficacy of the medication.

3. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following actions should the nurse take to prevent infection?

Correct answer: B

Rationale: The correct answer is to change the TPN tubing every 24 hours. This action helps reduce the risk of infection because the high glucose content of TPN promotes bacterial growth. Choice A is incorrect as changing the tubing every 48 hours would not provide adequate infection prevention. Option C, monitoring urine output, is important for assessing renal function but is not directly related to preventing TPN-related infections. Option D, monitoring weight, is essential for assessing nutritional status but does not directly address infection prevention in TPN administration.

4. What is the initial step when a patient is experiencing chest pain?

Correct answer: A

Rationale: Administering oxygen is the initial step in managing chest pain. Oxygen helps improve oxygenation levels in the blood, which is crucial in cases of chest pain. Repositioning the patient, providing pain relief, or administering nitroglycerin may be necessary steps depending on the underlying cause, but administering oxygen takes precedence as it addresses the primary concern of oxygen supply to the body during chest pain.

5. A client is receiving discharge instructions following a stroke. Which of the following client statements indicates an understanding of the teaching?

Correct answer: A

Rationale: The correct answer is A. Avoiding aspirin is crucial for this client as it can increase the risk of bleeding after a stroke. Choice B about consuming dairy products for calcium intake is not directly related to stroke management. Choice C regarding fluid intake is a good practice for overall health but not specifically related to stroke care. Choice D about limiting fiber intake is not typically a concern after a stroke unless there are specific complications that warrant it.

Similar Questions

What is the best method to monitor fluid balance in a patient receiving diuretics?
A nurse is teaching a client who has a new diagnosis of type 1 diabetes mellitus. Which of the following findings should the nurse identify as a manifestation of hypoglycemia?
A nurse is caring for a client with schizophrenia. Which of the following assessment findings should the nurse expect?
A nurse is caring for a client following the application of a cast. Which of the following actions should the nurse take first?
A nurse is assessing a client who is 30 minutes postoperative following an arterial thrombectomy. What should the nurse report?

Access More Features

ATI RN Basic
$69.99/ 30 days

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

ATI RN Premium
$149.99/ 90 days

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

Other Courses