a nurse is caring for a client who is receiving pain medication through a pca pump which of the following actions should the nurse take
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Nursing Elites

ATI RN

ATI Leadership Proctored Exam 2019

1. When a client is receiving pain medication through a PCA pump, which of the following actions should the nurse take?

Correct answer: D

Rationale: When a client is receiving pain medication through a PCA pump, it is essential to adjust the settings if their pain level is not adequately controlled. Increasing the basal rate and shortening the lock-out interval time can help manage the client's pain more effectively. This adjustment should be made by the healthcare provider based on the client's pain assessment and response to the current settings. It is crucial to individualize the PCA pump settings to optimize pain management for each client. Choices A, B, and C are incorrect because educating the family not to push the button, explaining vital sign monitoring, and setting a specific pain level for button pushing are not direct actions the nurse should take to adjust the PCA pump settings for effective pain management.

2. Attending a continuing education class on advanced technology in health care is interpreted as which of the following by the nurse manager?

Correct answer: D

Rationale: The correct answer is D: 'Essential to nursing care.' Advancements in technology play a crucial role in modern healthcare delivery. By attending a class on advanced technology, the staff nurse can enhance their skills and knowledge, ultimately benefiting nursing care. Choices A, B, and C are incorrect because advanced technology is not exclusive to nurse managers, is important for improving patient care, and is not a waste of time as it helps nurses stay updated with the latest advancements.

3. One of the steps in coaching is often overlooked and taken for granted. What is this step?

Correct answer: D

Rationale: In coaching, tying the problem to clients' care is crucial but often overlooked. This step ensures that the coach and the client focus on issues directly impacting the client's well-being. Stating the target (choice A) is important but not as critical as tying the problem to clients' care. Jumping to conclusions (choice B) is counterproductive in coaching as it may lead to incorrect assumptions. Asking for suggestions (choice C) is valuable, but it does not address the core aspect of linking the issue to the client's care, which is essential for effective coaching.

4. A client is having difficulty breathing while receiving supplemental oxygen via a nasal cannula in a supine position. Which of the following interventions should the nurse take first?

Correct answer: C

Rationale: When a client is experiencing difficulty breathing, the priority intervention is to assist the client to an upright position. This position helps improve ventilation by maximizing lung expansion and promoting better oxygenation. Suctioning the airway may be necessary if there is an obstruction, but repositioning the client is the initial step. Instructing the client to perform incentive spirometry and humidifying oxygen are important interventions but not the first priority in this scenario.

5. When a nurse observes a fellow nurse preparing an incorrect dose of medication, what is the best action to take?

Correct answer: D

Rationale: The best action to take when a nurse observes a fellow nurse preparing an incorrect dose of medication is to report the error to the supervisor immediately. Reporting the error is crucial to ensure patient safety and prevent any potential harm. Ignoring the error (Choice A) is not appropriate as it puts the patient at risk. Administering the medication anyway (Choice B) could harm the patient. Correcting the error without informing the nurse (Choice C) does not address the root cause of the issue, which should be brought to the attention of the supervisor for proper investigation and resolution.

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