ATI RN
Fluid and Electrolytes ATI
1. What would be the best initial nursing action prior to inserting an IV?
- A. Instruct the patient to wash their hands.
- B. Prepare the IV insertion site with povidone iodine.
- C. Verify the order for IV therapy.
- D. Identify a suitable vein.
Correct answer: C
Rationale: The best initial nursing action prior to inserting an IV is to verify the order for IV therapy. This step ensures that the IV insertion is appropriate and necessary based on the physician's orders. Instructing the patient to wash their hands (Choice A) is important for infection control but not the immediate priority before IV insertion. While preparing the IV insertion site with povidone iodine (Choice B) and identifying a suitable vein (Choice D) are crucial steps in the process, confirming the order for IV therapy (Choice C) takes precedence to ensure the correct intervention is being performed.
2. What is the narrowing of the arteries due to the buildup of plaque, which can lead to heart attacks and strokes?
- A. Coronary artery disease
- B. Peripheral artery disease
- C. Aortic stenosis
- D. Mitral valve prolapse
Correct answer: A
Rationale: Coronary artery disease is the correct answer. It is the narrowing or blockage of the coronary arteries due to plaque buildup, which can lead to heart attacks and other cardiovascular issues. Choice B, Peripheral artery disease, involves the narrowing of arteries in the limbs, not specifically the coronary arteries. Choice C, Aortic stenosis, refers to the narrowing of the aortic valve opening, not the arteries. Choice D, Mitral valve prolapse, is a condition where the valve between the left atrium and left ventricle doesn't close properly, unrelated to arterial narrowing.
3. When caring for a client experiencing alcohol withdrawal, which intervention should the nurse implement to prevent complications?
- A. Provide a well-lit environment.
- B. Administer antipsychotic medication as prescribed.
- C. Monitor the client's vital signs closely.
- D. Encourage the client to express their feelings.
Correct answer: C
Rationale: Monitoring the client's vital signs closely is crucial during alcohol withdrawal as it helps detect any physiological changes early, such as hypertension, tachycardia, or fever, which can indicate potential complications like delirium tremens. Early identification and prompt intervention can prevent severe outcomes in clients experiencing alcohol withdrawal.
4. Approximately 75% of reputable producers of bottled water use groundwater as their water source. Plain tap water is the most natural source of fluids.
- A. Both statements are true.
- B. Both statements are false.
- C. The first statement is true; the second is false.
- D. The first statement is false; the second is true.
Correct answer: A
Rationale: Both statements are true. Approximately 75% of reputable producers of bottled water use groundwater as their water source, which is the same source as the public water supply. Plain tap water, coming from underground sources or reservoirs, is indeed a natural source of fluids. The first statement is supported by the fact that groundwater is a common source for bottled water due to its purity and taste. The second statement is true as tap water is sourced from natural reservoirs or underground aquifers in most cases, making it a natural fluid source for consumption. Other choices are incorrect because both statements are factually accurate based on common practices in the production and sourcing of bottled water and tap water.
5. To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine which body areas?
- A. Nail beds
- B. Skin on the back of the hand
- C. Hard palate of the mouth
- D. Soles of the feet
Correct answer: C
Rationale: To accurately assess for jaundice in a patient with dark skin pigmentation, the nurse should examine the hard palate of the mouth. Jaundice is best assessed in the sclera; however, in dark-skinned patients, normal yellow pigmentation may be present in the sclera, making it difficult to detect jaundice. Inspection of the hard palate for a yellow color can confirm the presence of jaundice. Cyanosis is best observed in the nail beds, not indicative of jaundice. While skin on the palm of the hand can indicate jaundice, the back of the hand is not a typical area for assessment. Jaundice can be assessed on the soles of the feet in dark-skinned patients, but it is better visualized in the hard palate for accurate evaluation.
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