a nurse is caring for a client who is receiving an opioid analgesic for pain management which of the following assessments is the nurses priority

ATI RN

ATI RN Exit Exam Test Bank

1. While caring for a client receiving an opioid analgesic for pain management, which assessment should the nurse prioritize?

A. Monitor the client's urinary output.
B. Check the client's blood pressure.
C. Assess the client for constipation.
D. Monitor the client's respiratory rate.

Correct answer: D

Rationale: The correct answer is to monitor the client's respiratory rate. When a client is receiving opioids, the priority assessment is the respiratory rate since opioids can lead to respiratory depression. Monitoring urinary output, blood pressure, and constipation are also important but not the priority in this scenario.

2. A nurse is caring for a client who is receiving enteral feedings through an NG tube. Which of the following actions should the nurse take to prevent aspiration?

A. Flush the NG tube with 0.9% sodium chloride before feedings.
B. Place the client in a high Fowler's position during feedings.
C. Administer the feedings over 30 minutes.
D. Warm the formula before administering it.

Correct answer: B

Rationale: The correct answer is to place the client in a high Fowler's position during enteral feedings. This position helps prevent aspiration by promoting the downward flow of the feeding and reducing the risk of regurgitation into the lungs. Choice A is incorrect because flushing the NG tube with 0.9% sodium chloride before feedings is not directly related to preventing aspiration. Choice C is incorrect because the rate of administration does not directly impact the risk of aspiration. Choice D is incorrect because warming the formula does not specifically address the prevention of aspiration during enteral feedings.

3. Which diagnostic test is used to confirm tuberculosis (TB) infection?

A. Chest X-ray
B. Sputum culture
C. Skin test (Mantoux)
D. MRI

Correct answer: C

Rationale: The Mantoux skin test, also known as the Tuberculin Skin Test (TST), is used to confirm tuberculosis (TB) infection. This test involves injecting a small amount of tuberculin protein derivative under the top layer of the skin and then evaluating the immune system's response to the protein. A positive reaction indicates exposure to the TB bacteria. Chest X-rays are used to detect abnormalities in the lungs caused by TB but are not confirmatory. Sputum culture is used to identify the presence of TB bacteria in the sputum. MRIs are not typically used as a primary diagnostic tool for TB.

4. A nurse is caring for a client who has osteoarthritis. Which of the following actions should the nurse take?

A. Apply heat to inflamed joints
B. Provide passive range-of-motion exercises
C. Encourage prolonged use of NSAIDs
D. Apply cold packs to the joints

Correct answer: A

Rationale: Corrected Rationale: Applying heat to inflamed joints can help relieve pain in clients with osteoarthritis. Heat therapy can help improve blood circulation, relax muscles, and reduce stiffness. Choice B, providing passive range-of-motion exercises, may be beneficial for joint mobility but is not the first-line intervention for pain relief in osteoarthritis. Choice C, encouraging prolonged use of NSAIDs, should be done cautiously due to potential side effects and should be guided by a healthcare provider. Choice D, applying cold packs to the joints, is not recommended for osteoarthritis as cold therapy can worsen stiffness and discomfort in this condition.

5. What is the primary purpose of administering an antiemetic?

A. To reduce nausea and vomiting
B. To increase appetite
C. To treat nausea caused by chemotherapy
D. To treat allergic reactions

Correct answer: A

Rationale: The correct answer is A: 'To reduce nausea and vomiting.' Antiemetics are medications used to prevent or alleviate nausea and vomiting. While they may indirectly help with appetite by reducing the unpleasant symptoms that can lead to decreased food intake, their primary purpose is not to increase appetite (Choice B). Choice C, 'To treat nausea caused by chemotherapy,' is partly correct as antiemetics are commonly used to manage chemotherapy-induced nausea, but this is not their exclusive purpose. Choice D, 'To treat allergic reactions,' is incorrect as antiemetics are not primarily used for treating allergic reactions.