ATI EXIT QUESTIONS AND ANSWERS (NCLEX)

ATI EXIT QUESTIONS AND ANSWERS (NCLEX) A nurse is caring for a client with severe peripheral arterial disease of the right lower extremity. Which intervention is appropriate? A.) Apply cold compresses to the affected extremity B.) Apply warm compresses to the affected extremity C.) Keep the affected extremity above the level of the heart D.) Keep the affected extremity below the level of the heart - CORRECT ANSWER -ANSWER--->D.) Keep the affected extremity below the level of the heart RATIONALE: The nurse should NEVER apply direct heat to the limb. Sensitivity is decreased in the affected limb & burns may result A nurse is providing care for a client with a Jackson-Pratt drain. Which of the following nursing interventions has the highest priority? A.) Securing the tube and drainage bulb to the pt B.) Keeping the drainage bulb depressed to manual suction C.) "Milking" the tubing before emptying the drain D.) Cleansing the insertion site of the tube w/betadine - CORRECT ANSWER -ANSWER-->B.) Keeping the drainage bulb depressed to manual suction RATIONALE: Securing the tubing helps to keep tension from being placed on the tubing & bulb. While this is helpful, maintaining the bulb to suction is the highest priority nursing intervention