what is the role of the nurse in the care of a patient with a pressure ulcer what is the role of the nurse in the care of a patient with a pressure ulcer
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Nursing Elites

ATI LPN

ATI PN Comprehensive Predictor 2020

1. What is the role of the nurse in the care of a patient with a pressure ulcer?

Correct answer: B

Rationale: The correct answer is B: Assess the wound and reposition the patient frequently. When caring for a patient with a pressure ulcer, it is crucial for the nurse to assess the wound regularly to monitor its progress and prevent complications. Additionally, repositioning the patient frequently helps to relieve pressure on the affected area, prevent further damage, and promote healing. Choice A is incorrect because while cleaning the wound is important, applying a protective dressing is not the primary role of the nurse in managing a pressure ulcer. Choice C is incorrect as applying pressure to the ulcer is harmful, and monitoring for signs of healing should not involve applying pressure. Choice D is incorrect as providing pain relief and administering antibiotics may be necessary but are not the primary interventions for managing a pressure ulcer.

2. Which of the following is an indication of lower respiratory infection?

Correct answer: C

Rationale: Inability to lie supine is a significant indication of lower respiratory infection. This symptom often occurs due to breathing difficulties and discomfort experienced by individuals with lower respiratory infections, such as pneumonia or bronchitis. It can be caused by lung inflammation, consolidation, or fluid buildup in the lungs, making lying flat uncomfortable or difficult. Monitoring a patient's ability to lie flat can provide valuable information about the severity and progression of a lower respiratory infection.

3. The client is starting therapy with digoxin (Lanoxin). What instruction should the nurse reinforce about the medication?

Correct answer: C

Rationale: The correct answer is C: 'Monitor for yellow or blurred vision.' When a client is taking digoxin, it is crucial to monitor for signs of toxicity, such as yellow or blurred vision, as these can indicate an adverse reaction. Reporting these visual disturbances promptly to the healthcare provider is important for further evaluation and management to prevent potential complications. Choices A, B, and D are incorrect because taking digoxin with meals, avoiding dairy products, or increasing potassium-rich foods are not specific instructions related to monitoring for adverse effects of digoxin therapy.

4. In the absence of an occupational nurse at a garment factory, who should provide the occupational health needs of the factory workers?

Correct answer: C

Rationale: In the scenario where a garment factory lacks an occupational nurse, the responsibility of addressing the occupational health needs of the factory workers falls under the jurisdiction of the Public Health nurse of the Rural Health Unit (RHU) in their municipality. Public Health nurses are trained to provide essential health services to the community, including monitoring and promoting health in workplaces. They can assess workplace hazards, provide health education, and facilitate access to medical care when necessary, making them the most suitable option among the given choices to cater to the occupational health needs of the factory workers.

5. A client undergoing surgery is being taught about the use of a patient-controlled analgesia (PCA) pump by a nurse. Which statement by the client indicates an understanding of the teaching?

Correct answer: D

Rationale: The correct answer is D because clients should press the button on the PCA pump when they feel pain to receive controlled doses of medication. Option A is incorrect as the client should be the one to self-administer the medication through the PCA pump. Option B is incorrect as the primary purpose of the PCA pump is to manage pain, not to keep the client comfortable. Option C is incorrect because the client should not adjust the dosage themselves; instead, they should communicate any pain concerns to the healthcare provider.

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