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ATI RN Fundamentals Practice Tests A & B
- A nurse is caring for a client who reports pain. When documenting the quality of the client's pain on an initial pain assessment, the nurse should record which of the following client statements? "I am having mild pain" "The pain is like a dull ache in my stomach" "I notice that the pain gets worse after I eat" "The pain makes me feel nauseous" "The pain is like a dull ache in my stomach"
- A client in non ambulatory notifies the nurse that his trash can is on fire. After the nurse confirms the presence of the fire, which of the following actions should the nurse take next? Activate the emergency fire alarm Extinguish the fire Evacuate the client Confine the fire Evacuate the client
- A nurse is completing an admission assessment for a client who reports vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect? Neck vein distention Urine specific gravity 1.010 Rapid Heart rate Blood pressure 144/82 mmHg Rapid heart rate
- A nurse has accepted a verbal prescription for "thee tenths of a milligram of
levothyroxine IV stat" for a client who has myxedema coma. How should the nurse transcribe the dosage of this medication in the client's medical record? .3 mg 0.3 mg 0.30 mg 3/10 mg 0.3 mg
- A nurse is preparing a heparin infusion for a client who was admitted to the facility with deep vein thrombosis. The prescription reads 25,000 units of heparin in 0.9% sodium chloride 250 ml to infuse at 800 units/hour. At what rate should the nurse set the infusion pump? 8 ml/hour
- A nurse is caring for a client who has a prescription for wound irrigation. Which of the following actions should the nurse take? Wear sterile gloves when removing the old dressing Warm the irrigation solution to 40.5 C (105 F) Cleanse the wound from the center outward Use a 20 ml syringe to irrigate the wound Cleanse the wound from the center outward
should the nurse verify with the provider? Medication name Route of administration Medication dose Frequency of administration Medication dose
- A nurse is caring for a client who has recently started using a behind the ear hearing aid. Which of the following statements should the nurse identify as an indication that the client understands the use of this assistive device? "This type of hearing aid does not allow for fine tuning of volume" "I shouldn't have trouble keeping the hearing aid in place during exercise" "I expect to hear a whistling sound when I first insert the hearing aid" "I will be sure to remove my hearing aid before taking a shower" "I will be sure to remove my hearing aid before taking a shower"
- A nurse enters a client's room and finds her on the floor. The client's roommate reports that the client was trying to get out of bed and fell over the side rail onto the floor. Which of the following statements should the nurse document about this incident? "Incident report completed" "Client climbed over the side rails" "Client found lying on the floor" "Client was trying to get out of bed" "Client found lying on the floor"
- A nurse on a medical unit is preparing to discharge a client to home. Which of the following actions should the nurse take as part of the medication reconciliation process? Seal unused medications from the facility in a plastic bag Evaluate the client's ability to self administer medications Report an identified discrepancy to The Joint Commission Compare prescriptions with medications the client received while at the facil- ity Compare prescriptions with medications the client received while at the facility
- A nurse is caring for a client who requires an informed consent for a sur- gical procedure. Which of the following actions is the nurse's responsibility? Describe the procedure to the client Witness the client's signature on the consent form Inform the client of alternatives to the procedure Tell the client which team members will assist with the procedure Witness the client's signature on the consent form
- A nurse is admitting a client who has rubella. Which of the following types of transmission based precautions should the nurse initiate? droplet airborne contact protective environment droplet
- A nurse is administering IV fluids to a client. When monitoring for adverse effects, which of the following assessments should the nurse identify as the priority? Auscultate lung sounds Measure urine output Monitor blood pressure readings Monitor electrolyte levels Measure urine output
- A middle adult client tells the nurse, "I feel so useless now that my children do not need me anymore." Which of the following responses should the nurse make? "Most people are happy when their children grow up and leave home" "You should be proud that your children are becoming independent" "Maybe you should consider why you are feeling useless" "People in middle adulthood often find satisfaction in nurturing and guiding young people" "People in middle adulthood often find satisfaction in nurturing and guiding young people"
- A nurse is providing discharge teaching for a client who has a new pre- scription for a home oxygen concentrator. Which of the following instructions should the nurse provide to the client and his family? (select all that apply) Check
the cord routinely for frays or tearing Keep the unit at least 1-2 m (4 feet) away from a gas stove Consider purchasing a generator for power backup Observe for signs of hypoxia Select synthetic clothing and bedding Check the cord routinely for frays or tearing Keep the unit at least 1-2 m (4 feet) away from a gas stove Observe for signs of hypoxia
- A nurse is reviewing protocol in preparation for suctioning secretions from a client who has a new tracheostomy. Which of the following actions should the nurse plan to take? Use a resuscitation bag with 80% oxygen prior to the procedure Select a suction catheter that is half the size of the lumen Place the end of the suction catheter in water soluble lubricant
HIPPAA guidelines? A nurse who is caring for a client reviews the client's medical chart with a nursing student who is working with the nurse A nurse asks a nurse from another unit to assist with documentation for a client A nurse who is caring for a client returns a call to the person appointed in the health care proxy to discuss the client's care A nurse discusses a client's status with the physical therapist who is caring for the client A nurse asks a nurse from another unit to assist with documentation for a client
- A charge nurse is discussing the responsibility of nurses caring for clients who have a Clostridium difficle infection. Which of the following information should the nurse include in the teaching? Assign the client to a room with a negative airflow system Use alcohol based hand sanitizer when leaving the client's room
Clean contaminated surfaces in the client's room with a phenol solution Have family members wear a gown and gloves when visiting Have family members wear a gown and gloves when visiting
- A nurse is preparing to administer 0.5 ml of oral single dose liquid med- ication to a client. Which of the following actions should the nurse take? Gently shake the container of medication prior to administration Transfer the medication to a medicine cup Place the client in a semi fowler's position prior to medication administration Verify the dosage by measuring the liquid before administering it Gently shake the container of medication prior to administration
- A nurse is caring for a client who has limited mobility in his lower extrem- ities. Which of the following actions should the nurse take to prevent skin breakdown? Place the client in high fowler's position Increase the client's intake of carbohydrates Massage reddened areas with unscented lotion Have the client use a trapeze bar when changing position Have the client use a trapeze bar when changing position
- A nurse is preparing to delegate client care tasks to an assistive personnel. Which of the following tasks should the nurse delegate? Ambulating a client who is postoperative Inserting an indwelling urinary catheter for a client Demonstrating the use of an incentive spirometer to a client Confirming that a client's pain has decreased after receiving an analgesic -
"Will I ever begin to fell in charge of my life again?" "What could I have done to deserve this illness?"
- A nurse is calculating a client's fluid intake over the past 8 hours. Which of the following items should the nurse plan to document on the client's intake and output record as 120 ml of fluid? 2 cups of soup 1 quart of water 8 oz of ice chips 6 oz of tea 1 quart of water
- A nurse is planning teaching for a group of adolescents who each recently had a surgical placement of an ostomy. Which of the following methods should the nurse use as a psychomotor approach to learning? Role play Group discussions Question-answer meetings Practice sessions Practice sessions
- A nurse is preparing to obtain a lower extremity blood pressure from a client and no longer palpates the popliteal pulse after 92 mmHg. Which of the following is the measurement in mmHg to which the nurse should inflate the cuff when obtaining blood pressure? 92 mmHg 102 mmHg 122 mmHg 140mmHg 122 mmHg
- A nurse is planning care for a client who has vision loss. Which of the following interventions should the nurse include in the plan of care to assist the client with feeding? Assign a staff member to feel the client Provide small handheld utensils for the client Thicken liquids on the client's tray Arrange food in a consistent pattern on the client's plate Arrange food in a consistent pattern on the client's plate
- A nurse is caring for a client who has a terminal diagnosis and whose health is declining. The client requests information about advance directives. Which of the following responses should the nurse make? "We can talk about advance directives, and I can also give you some brochures about them" "You should set up a time to talk with your provider about that" "Let's discuss how you are feeling today, and we'll save the planning for when
Cleanse latex ports on IV tubing with chlorhexidine before injecting medica- tion Wear hypoallergenic latex gloves that contain powder Wrap monitoring cords with stockinette and tape them in place
- A nurse is teaching a group of staff nurses about the use of essential oils for aromatherapy. The nurse should include in the teaching that this therapy might be contraindicated for which of the following clients? A client who has a history of physical abuse A client who has a permanent pacemaker A client who has ulcerative colitis A client who has asthma A client who has asthma
- A nurse is planning care for a client who has tuberculosis. The nurse should use which of the following pieces of personal protective equipment when providing care for the client? Gown
N95 respirator Shoe covers Surgical cap N95 respirator
- A nurse is caring for a client who has a prescription for 5 units of regular insulin and 10 units on NPH insulin to mix together and administer subcuta- neously. Determine the correct order of steps for this procedure. Inject 5 units of air into the bottle of regular insulin Withdraw the correct dose of regular insulin from the bottle Inject 10 units of air into the bottle of NPH insulin Withdraw the correct dose of NPH insulin from the bottle 1. Inject 10 units of air into the bottle of NPH insulin
- Inject 5 units of air into the bottle of regular insulin
- Withdraw the correct dose of regular insulin from the bottle
- Withdraw the correct dose of NPH insulin from the bottle
- A nurse is assessing an adult client who has been immobile for the past 3 weeks. For which of the following findings should the nurse intervene? Erythema on pressure points Lower extremity pulse strength of 2+ Fluid intake of 3,000 ml per day One bowel movement every other day Erythema on pressure points
- A charge nurse is observing a newly licensed nurse prepare a sterile field for a dressing change. Which of the following actions by the newly licensed nurse requires intervention by the charge nurse? The newly licensed nurse places the cap of a bottle of sterile saline solution on
"The recommendation is to have a sigmoidoscopy every 10 years" "You should have a fecal occult blood test every year"
- A nurse is discussing the use of herbal supplements for health promotion with a client. Which of the following client statements indicates an understand- ing of herbal supplement use? "I can take echinacea to improve my immune system" "I can take feverfew to reduce my level of anxiety" "I can take ginger to improve my memory" "I can take ginkgo biloba to relieve nausea" "I can take echinacea to improve my immune system"
- A nurse is caring for a client who has an indwelling urinary catheter.Which of the following findings indicates that the catheter requires irrigation? Urine has an unusual odor Urine specific gravity is 1.035 Bladder scan shows 535 ml of urine Urine is positive for ketones Bladder scan shows 535 ml of urine
- A nurse is giving change of shift report about a client they admitted earlier that day who has pneumonia. Which of the following pieces of information is the priority for the nurse to provide? Admitting diagnosis Breath sounds Body temperature Diagnostic test results Breath sounds
- A home health nurse is completing an admission assessment of an older
adult client who has their caregiver present. Which of the following findings should the nurse identify as a potential indication of elder abuse? The caregiver is the client's financial power of attorney The client is in a wheelchair with the wheels locked The client reports receiving a full bath twice each week The caregiver insists on remaining in the room The caregiver insists on remain- ing in the room
- A nurse is performing a peripheral vascular assessment for a client. When placing the bell of the stethoscope on the client's neck, the nurse hears a "bruit". This sound indicates which of the following? Narrowed arterial lumen Distended jugular veins Impaired ventricular contraction Asynchronous closure of the aortic and pulmonic valves Narrowed arterial lumen
