ATI PN Adult Medical Surgical 2020 with NGN

ATI PN Adult Medical Surgical 2020 with NGN ( 79 Questions)

A nurse is collecting admission history data from a client who is in a semi-private room. Which of the following data is the priority for the nurse to address?



Correct Answer: B

Choice A reason: This data is not the priority for the nurse to address because it does not pose an immediate threat to the client's health or safety. However, the nurse should assess the client's anxiety level and provide coping strategies and emotional support as needed.

Choice B reason: This data is the priority for the nurse to address because it indicates a potential infection that can be contagious and harmful to the client and others in the room. The nurse should isolate the client in a private room with negative pressure ventilation and wear personal protective equipment when entering the room. The nurse should also notify the infection control team and obtain sputum samples for testing.

Choice C reason: This data is not the priority for the nurse to address because it does not pose an immediate threat to the client's health or safety. However, the nurse should ask about the frequency, severity, duration, triggers, and treatment of the migraine headaches and provide pain relief and comfort measures as needed.

Choice D reason: This data is not the priority for the nurse to address because it does not pose an immediate threat to the client's health or safety. However, the nurse should inquire about the possible causes, such as urinary tract infection, diabetes mellitus, prostate enlargement, or medication side effects, and monitor the client's fluid intake and output and urine characteristics.




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