what is the first action for a nurse when a patient experiences a fall
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Nursing Elites

ATI RN

ATI RN Comprehensive Exit Exam

1. What is the first action for a healthcare provider when a patient experiences a fall?

Correct answer: A

Rationale: The correct answer is to 'Assess the patient for injuries' when a patient experiences a fall. This is crucial to promptly identify any injuries and provide appropriate care. Calling for help may be necessary, but assessing the patient's condition takes precedence to ensure immediate attention to any injuries. Documenting the fall and notifying the healthcare provider would follow after the initial assessment and necessary actions have been taken.

2. A healthcare provider is caring for a client who has a new prescription for enoxaparin. Which of the following actions should the healthcare provider take?

Correct answer: B

Rationale: The correct answer is to inject the medication into the client's abdomen. Enoxaparin is a medication that should be administered subcutaneously into the abdomen to ensure proper absorption. Choice A is incorrect because enoxaparin should not be administered intramuscularly. Choice C is incorrect because massaging the injection site after administration is not recommended for enoxaparin injections. Choice D is incorrect because aspirating for blood return is not necessary before administering a subcutaneous injection like enoxaparin.

3. What is the initial action a healthcare provider should take for a patient with chest pain?

Correct answer: A

Rationale: The correct initial action for a patient with chest pain is to administer oxygen. Chest pain can be caused by insufficient oxygenation, and providing oxygen helps alleviate the pain by increasing oxygen levels in the blood. Administering nitroglycerin or morphine may be appropriate based on the underlying cause of the chest pain, but oxygen should be given first to ensure the patient's oxygen supply is adequate. Surgery is not typically the initial intervention for chest pain.

4. A nurse is providing teaching about gastrostomy tube feedings to the parents of a school-age child. Which of the following instructions should the nurse give?

Correct answer: A

Rationale: The correct answer is to administer the feeding over 30 minutes. This slow administration helps prevent complications like nausea. Placing the child in a supine position after the feeding can increase the risk of aspiration, making choice B incorrect. Changing the feeding bag and tubing every 3 days is important for infection control and hygiene but is not directly related to the administration process, making choice C incorrect. Warming the formula in the microwave is not recommended as it can create hot spots that may burn the child's mouth or esophagus, so choice D is incorrect.

5. A nurse is preparing discharge information for a client who has type 2 diabetes mellitus. Which of the following resources should the nurse provide?

Correct answer: B

Rationale: The correct answer is B. Food exchange lists from the American Diabetes Association are a reliable resource for meal planning in diabetes. They provide structured guidance on appropriate food choices and portion sizes. Choice A, personal blogs, may not always offer accurate and evidence-based information. Choice C, diabetes medication information from the Physicians' Desk Reference, is not directly related to meal planning. Choice D, food label recommendations from the Institute of Medicine, while important for understanding nutritional content, may not provide the structured meal planning guidance needed for a client with type 2 diabetes mellitus.

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