how should a nurse care for a patient with a central line

ATI RN

ATI RN Exit Exam Test Bank

1. How should a healthcare professional care for a patient with a central line?

A. Flush the line daily
B. Monitor for infection
C. Change the dressing weekly
D. Replace the central line every week

Correct answer: B

Rationale: When caring for a patient with a central line, monitoring for infection is crucial. This is because central lines can introduce bacteria into the bloodstream, leading to serious infections. While flushing the line daily and changing the dressing weekly are important aspects of central line care, monitoring for infection takes precedence. Infections can occur rapidly and have severe consequences, so early detection through vigilant monitoring is key. Replacing the central line every week is not a standard practice and should only be done when clinically indicated, such as in cases of infection or malfunction.

2. A client with a new diagnosis of diabetes mellitus is being taught about foot care by a nurse. Which of the following instructions should the nurse include?

A. Soak your feet in warm water every day to prevent dryness.
B. Trim your toenails straight across to prevent injury.
C. Apply lotion between your toes after bathing.
D. Wear cotton socks to keep your feet dry.

Correct answer: B

Rationale: The correct answer is B: 'Trim your toenails straight across to prevent injury.' In clients with diabetes, trimming toenails straight across is essential to prevent ingrown toenails and injury. Choice A is incorrect because soaking feet in warm water can lead to dryness, which is not recommended for diabetic foot care. Choice C is incorrect as applying lotion between the toes can create excess moisture, increasing the risk of fungal infections. Choice D is incorrect because although cotton socks are recommended, the primary purpose is to prevent moisture buildup, not specifically to keep the feet dry.

3. What is the best intervention for a patient with dehydration?

A. Administer IV fluids
B. Provide oral fluids
C. Encourage fluid intake
D. Administer electrolytes

Correct answer: A

Rationale: Administering IV fluids is the best intervention for a patient with dehydration because it is the fastest and most effective way to rehydrate the body. IV fluids can quickly restore fluid volume and electrolyte balance in severe cases of dehydration. Providing oral fluids or encouraging fluid intake may not be sufficient for patients with moderate to severe dehydration, as they may have impaired gastrointestinal absorption. While electrolytes are essential for rehydration, administering them alone without fluid replacement may not address the primary issue of fluid loss in dehydration.

4. How should a healthcare professional manage a patient with fluid overload in heart failure?

A. Monitor daily weight
B. Check for edema
C. Monitor intake and output
D. Administer diuretics

Correct answer: A

Rationale: Monitoring daily weight is crucial in managing a patient with fluid overload in heart failure. Weight fluctuations can indicate fluid retention or loss, guiding healthcare professionals in adjusting treatment. While checking for edema (Choice B) and monitoring intake and output (Choice C) are important aspects of patient care, they are not as direct in assessing fluid overload as daily weight monitoring. Administering diuretics (Choice D) is a treatment option based on the assessment of fluid overload, making it a secondary intervention compared to monitoring weight.

5. A client who is postoperative following a colon resection reports pain. Which of the following actions should the nurse take?

A. Assist the client in changing positions in bed
B. Administer a PRN dose of morphine
C. Encourage the client to use relaxation techniques
D. Offer the client a back massage

Correct answer: B

Rationale: Administering a PRN dose of morphine is the most appropriate action to manage postoperative pain in a client following a colon resection. Morphine is a potent analgesic commonly used to relieve moderate to severe pain, especially in postoperative settings. While assisting the client to change positions in bed, encouraging relaxation techniques, and offering a back massage can provide comfort and support, they may not be sufficient in managing the pain following a major surgical procedure like a colon resection. Therefore, the priority intervention for acute postoperative pain control in this scenario is to administer medication like morphine.