the unlicensed nursing assistant is applying elastic compression stockings to the client which action by the assistant warrants immediate interventio
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Nursing Elites

ATI RN

ATI RN Custom Exams Set 5

1. The unlicensed nursing assistant is applying elastic compression stockings to the client. Which action by the assistant warrants immediate intervention by the nurse?

Correct answer: A

Rationale: The correct answer is A because compression stockings should be applied while the client is lying down to prevent pooling of blood in the legs, which can occur when the client is sitting or standing. Choice B is not a cause for immediate intervention as inserting two fingers under the proximal end of the stocking helps ensure proper fit. Choice C demonstrates the correct technique of elevating the feet while lying down to put on the stockings. Choice D also shows good care by making sure the toes were warm after putting the stockings on.

2. The Army Medical Department has four major functions. Three are prevention, treatment, and evacuation. What is the fourth?

Correct answer: C

Rationale: The correct answer is C, 'Mobilization.' In the context of the Army Medical Department, mobilization refers to the process of preparing and organizing medical personnel and resources for deployment during military operations. While preparation, training, and selection are important functions within the military medical field, mobilization specifically relates to the readiness and deployment of medical assets in response to operational requirements, making it the fourth major function of the Army Medical Department.

3. A client who _____ diet requires _____ amounts of vitamin C.

Correct answer: B

Rationale: Clients who smoke require more vitamin C due to increased oxidative stress and depletion of vitamin C. Smoking leads to higher levels of oxidative stress in the body, which in turn increases the utilization of vitamin C to counteract the damage caused by free radicals. Choices A, C, and D do not directly impact the body's need for vitamin C as smoking does.

4. The client is diagnosed with pericarditis. When assessing the client, the nurse is unable to auscultate a friction rub. Which action should the nurse implement?

Correct answer: C

Rationale: The correct action for the nurse to implement when unable to auscultate a pericardial friction rub in a client diagnosed with pericarditis is to ask the client to lean forward and listen again. Leaning forward can help bring the heart closer to the chest wall, making it easier to detect the rub. Option A (Notifying the healthcare provider) is incorrect because further assessment is needed before escalating the situation. Option B (Documenting that the pericarditis has resolved) is incorrect as the absence of a friction rub does not necessarily mean resolution. Option D (Preparing to insert a unilateral chest tube) is incorrect as this intervention is not indicated for the absence of a friction rub.

5. The nurse is caring for the client recovering from a percutaneous renal biopsy. Which data indicate that the client is complying with client teaching?

Correct answer: A

Rationale: The correct answer is A. Lying flat in the supine position for 12 hours after a renal biopsy is essential to prevent bleeding and promote recovery. This position helps apply pressure to the biopsy site, reducing the risk of bleeding. Choices B, C, and D are incorrect because continuing oral fluids restriction, changing the dressing, and activating the patient-controlled analgesia pump do not directly indicate compliance with the crucial post-biopsy teaching of maintaining the supine position.

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