what is the first nursing action when caring for a client with a wound infection
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Nursing Elites

ATI LPN

ATI PN Comprehensive Predictor 2023 with NGN

1. What is the first nursing action when caring for a client with a wound infection?

Correct answer: B

Rationale: The first nursing action when caring for a client with a wound infection is to perform a wound culture before applying antibiotics. This step is crucial to identify the specific infecting organism and determine the most effective antibiotic therapy. Choices A, C, and D are incorrect because changing the dressing, cleansing the wound, or applying a wet-to-dry dressing should only be done after obtaining the culture results and starting appropriate antibiotic treatment.

2. A nurse is educating a client on how to use a cane due to left-leg weakness. What should the nurse include in the teaching?

Correct answer: A

Rationale: The correct answer is to use the cane on the stronger side. By doing so, the client will have better support and balance. Choice B is incorrect because advancing the cane and the weaker leg at the same time may lead to instability and falls. Choice C is incorrect as using the cane on the weaker side does not provide optimal support. Choice D is incorrect as advancing the cane 30 to 45 cm (12-18 in) with each step is not a standard recommendation for cane use.

3. Which of the following actions should the nurse take to ensure the safety of a client using home oxygen?

Correct answer: B

Rationale: The correct answer is B: 'Keep oxygen tanks upright at all times.' Oxygen tanks should be stored in an upright position to prevent leaks and accidents. Choice A is incorrect as smoking should never be allowed near oxygen due to the risk of fire. Choice C is incorrect as oxygen equipment should be stored in a well-ventilated area, not in a closet. Choice D is incorrect as oxygen tanks must be kept a minimum of 5 to 10 feet away from heat sources to prevent combustion. Therefore, the best practice is to keep oxygen tanks upright to ensure safety.

4. What should a person recommend to a client experiencing constipation?

Correct answer: B

Rationale: Increasing dietary fiber is an effective recommendation for clients experiencing constipation as it helps promote regular bowel movements. Choice A, increasing fluid intake, is also important but the most appropriate initial recommendation for constipation is to increase dietary fiber. Choice C, administering a laxative, should not be the first-line recommendation and is typically considered after dietary and lifestyle interventions. Choice D, encouraging bed rest, does not directly address constipation relief or prevention.

5. Which term specifically refers to positive actions taken to help others?

Correct answer: A

Rationale: The correct answer is A, 'Beneficence.' Beneficence is the ethical principle that involves taking positive actions to help others. Choice B, 'Justice,' pertains to fairness and equity in treatment, not specifically positive actions. Choice C, 'Autonomy,' relates to respecting individuals' rights to make their own decisions, not necessarily taking actions to help others. Choice D, 'Non-maleficence,' focuses on the obligation to avoid causing harm rather than actively helping others.

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