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ATI PN Comprehensive Predictor
1. A healthcare provider is caring for a client who has a leg fracture and reports severe pain. Which of the following actions should the healthcare provider take first?
- A. Administer pain medication
- B. Reposition the client's leg
- C. Elevate the client's leg
- D. Check the client's neurovascular status
Correct answer: D
Rationale: Checking the client's neurovascular status is the priority when caring for a client with severe pain after a leg fracture. This assessment is crucial to identify any signs of vascular compromise or nerve damage, such as compartment syndrome. Administering pain medication can help alleviate the pain but should only be done after ensuring the client's neurovascular status is stable. Repositioning or elevating the leg may worsen the condition if there are underlying vascular issues, making these options lower in priority than assessing neurovascular status.
2. How should a healthcare provider manage a patient with sepsis?
- A. Administer IV antibiotics
- B. Monitor vital signs
- C. Administer fluids
- D. All of the above
Correct answer: D
Rationale: Managing a patient with sepsis requires a multi-faceted approach. Administering IV antibiotics is crucial to combat the underlying infection. Monitoring vital signs such as heart rate, blood pressure, respiratory rate, and temperature helps assess the patient's response to treatment and identify any deterioration. Administering fluids is essential to maintain adequate blood pressure and organ perfusion. Therefore, all the options are integral components of sepsis management, making 'All of the above' the correct answer. Choices A, B, and C are all essential in the comprehensive care of a patient with sepsis. Omitting any of these aspects can lead to suboptimal outcomes, as each plays a critical role in addressing different aspects of sepsis management.
3. What should be done to minimize the risk of injury for a client with dementia?
- A. Ensure the client has consistent caregivers
- B. Dim the lights in the client's room
- C. Allow the client to sleep with the bedrails raised
- D. Encourage family members to stay with the client
Correct answer: A
Rationale: The correct answer is to ensure the client has consistent caregivers. This helps reduce confusion and stress for clients with dementia by providing familiarity and routine. Dimming the lights in the client's room (Choice B) may not directly address the risk of injury. Allowing the client to sleep with the bedrails raised (Choice C) can pose a risk if not properly monitored. Encouraging family members to stay with the client (Choice D) may not always be feasible and may not provide the necessary professional support and consistency that consistent caregivers can offer.
4. During a presentation on basic first aid, a nurse educator evaluates a newly licensed home health nurse's understanding of heat stroke. Which symptom indicates the client has heat stroke?
- A. Hypotension
- B. Bradycardia
- C. Clammy skin
- D. Bradypnea
Correct answer: A
Rationale: The correct answer is A: Hypotension. Heat stroke can lead to hypotension, which is low blood pressure. This is a common symptom of heat stroke and requires immediate intervention. Bradycardia (slow heart rate), clammy skin, and bradypnea (slow breathing) are not typically associated with heat stroke. In heat stroke, the body's temperature regulation system fails, leading to a rapid rise in body temperature, which can cause various symptoms including hypotension.
5. A nurse in a pediatric clinic is collecting data from a school-age child whose injuries are inconsistent with the parent's stated cause. Which of the following actions should the nurse take?
- A. Provide teaching to the parents
- B. Report suspected abuse to the appropriate agency
- C. Document the injuries and monitor the child
- D. Counsel the parents privately
Correct answer: B
Rationale: In cases where a child's injuries are inconsistent with the parent's stated cause, it raises concerns about possible abuse. The correct action for the nurse in this situation is to report suspected abuse to the appropriate agency. This is a legal and ethical obligation for healthcare professionals when they suspect child abuse. Providing teaching to the parents (Choice A) may not address the immediate safety concerns of the child. Documenting the injuries and monitoring the child (Choice C) is important but reporting suspected abuse takes precedence to ensure the child's safety. Counseling the parents privately (Choice D) may not be effective if abuse is suspected, as the primary focus should be on protecting the child.
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