a nurse is caring for a client who is scheduled for a thoracentesis which of the following supplies should the nurse ensure are not in the clients roo

ATI RN

ATI Fundamentals

1. A client is scheduled for a thoracentesis. Which of the following supplies should NOT be in the client's room?

A. Oxygen equipment
B. Incentive spirometer
C. Pulse oximeter
D. Sterile dressing

Correct answer: B

Rationale: During a thoracentesis procedure, the focus is on draining fluid or air from the pleural space. An incentive spirometer, which helps improve lung function, is not a necessary supply for this specific procedure. Oxygen equipment, pulse oximeter for monitoring oxygen saturation levels, and sterile dressing for wound care may be needed during or after the procedure.

2. After routine patient contact, how long should hand washing last at least?

A. 30 seconds
B. 1 minute
C. 2 minutes
D. 3 minutes

Correct answer: A

Rationale: Proper hand washing for 30 seconds is recommended after routine patient contact as it effectively removes pathogens. This duration ensures thorough cleaning without excessive time consumption, promoting infection control and prevention.

3. Which of the following measures is not recommended to prevent pressure ulcers?

A. Massaging the reddened area with lotion
B. Using a water or air mattress
C. Adhering to a schedule for positioning and turning
D. Providing meticulous skin care

Correct answer: A

Rationale: Massaging a reddened area can cause further tissue damage by increasing pressure on already compromised skin. The other options, such as using specialized mattresses, adhering to repositioning schedules, and maintaining good skin care, are all recommended strategies to prevent pressure ulcers by reducing pressure and friction on vulnerable areas of the skin.

4. A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?

A. Encourage the patient to walk in the hall alone
B. Discourage the patient from walking in the hall for a few more days
C. Accompany the patient for his walk
D. Consult a physical therapist before allowing the patient to ambulate

Correct answer: C

Rationale: Accompanying the patient for his walk is the appropriate nursing intervention in this scenario to ensure his safety during his first ambulation. This allows the nurse to provide immediate assistance if needed and ensures the patient's well-being during this critical postoperative period.

5. What is the appropriate needle gauge for intradermal injection?

A. 20G
B. 22G
C. 25G
D. 26G

Correct answer: D

Rationale: Intradermal injections require a very fine needle to be used to deliver the medication into the dermis layer of the skin. A 26G needle is typically used for intradermal injections as it is thin enough to penetrate the skin's surface and deposit the medication accurately.