a client sustained a crushing injury to his right arm during a car accident he arrives to the emergency room complaining of numbness in his right hand
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Nursing Elites

ATI RN

Multi Dimensional Care | Final Exam

1. A client sustained a crushing injury to his right arm during a car accident. He arrives to the emergency room complaining of numbness in his right hand. He has no other injuries. What should the nurse do first?

Correct answer: A

Rationale: Assessing the radial pulse checks for adequate circulation and potential complications.

2. What may be a cause of conductive hearing loss?

Correct answer: D

Rationale: Otitis media can cause conductive hearing loss by affecting the middle ear.

3. Unlicensed assistive personnel (UAP) is assisting a client in traction. Which of these actions requires immediate intervention?

Correct answer: A

Rationale: The correct answer is A because traction weights should hang freely to maintain their effectiveness. Choice B is incorrect because providing pillows to cushion unaffected extremities is appropriate. Choice C is also incorrect as emptying the catheter bag is a routine nursing task. Choice D is incorrect as teaching the client to use the call light promotes client safety.

4. What activities should the client avoid after cataract surgery? (Select all that apply)

Correct answer: D

Rationale: After cataract surgery, the client should avoid activities that can increase intraocular pressure. Blowing one’s nose and bearing down during defecation can raise the pressure inside the eye, which can be harmful during the healing process. Lifting items heavier than 10 pounds can also lead to an increase in intraocular pressure. Therefore, all the activities mentioned in the choices (nose blowing, bearing down during defecation, and lifting heavy items) should be avoided after cataract surgery to promote proper healing and reduce the risk of complications.

5. What observation by the nurse indicates the need for further teaching to unlicensed assistive personnel (UAP) on assisting with ambulation?

Correct answer: C

Rationale: Choice C is the correct answer because the UAP should walk slightly behind or to the side of the client, not in front, to provide proper support during ambulation. Choices A, B, and D are not indicative of incorrect technique or the need for further teaching. Putting shoes on the client, removing floor rugs and loose objects, and using a transfer (gait) belt are all appropriate actions when assisting with ambulation.

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