ATI Fundamentals Proctored Exam Study GuideATI Fundamentals Proctored Exam Study Guide
A nurse is caring for a client who requires a 24-hr urine
... [Show More] collection. Which of the following statements by the client indicates an understanding of the teaching? Correct Answer: "I flushed what I urinated at 7:00 a.m. and have saved all urine since."
A nurse is assessing a client who has been on bed rest for the past month. Which of the following findings should the nurse identify as an indication that the client has developed thrombophlebitis? Correct Answer: Calf swelling
A nurse manager is overseeing the care on a unit. Which of the following situations should the nurse manager identify as a violation of HIPAA guidelines? Correct Answer: A nurse asks a nurse from another unit to assist with her documentation.
A nurse is caring for a client who requires bed rest and has a prescription for antiembolic stockings. Which of the following actions should the nurse take? Correct Answer: Remove the stockings at least once per shift.
A nurse is administering IV fluid to an older adult client. The nurse should perform which priority assessment to monitor for adverse effects? Correct Answer: Auscultate lung sounds
A nurse is assessing a client's readiness to learn about insulin administration. Which of the following statements should the nurse identify as an indication that the client is ready to learn? Correct Answer: "I can concentrate best in the morning."
A nurse is performing a Romberg's test during the physical assessment of a client. Which of the following techniques should the nurse use? Correct Answer: Have the client stand with her arms at her side and her feet together.
A nurse is planning an deduction session for an older adult client who has just learned that she has type 2 diabetes mellitus. Which of the following strategies should the nurse plan to use with this client? Correct Answer: Allow extra time for the client to respond to questions
A nurse is teaching an older client who is at risk for osteoporosis about beginning a program of regular physical activity. Which of the following types of activity should the nurse recommend? Correct Answer: Walking briskly
A nurse is assessing an adult client who has been immobile for the past 3 weeks. The nurse should identify that which of the following findings requires further intervention? Correct Answer: Erythema on pressure points
A nurse is preparing to administer 0.5 mL of oral single-dose liquid medication to a client. Which of the following actions should the nurse take? Correct Answer: Gently shake the container of medication prior to administration.
A nurse is responding to a call light and finds a client lying on the bathroom floor. Which of the following actions should the nurse take first? Correct Answer: Check the client for injuries
A nurse is caring for a client who is expressing anger over his diagnosis of colorectal cancer. Which of the following actions should the nurse take? Correct Answer: Reassure the client that this is an expected response to grief.
A nurse in a clinic is caring for a middle adult client who states, "The doctor says that, since I am at an average risk for colon cancer, I should have routine screening. What does that involve?" Which of the following responses should the nurse make? Correct Answer: "You should have a fecal occult blood test every year."
A nurse manager is preparing to review medication documentation with a group of newly licensed nurses. Which of the following statements should the nurse manager plan to include in the teaching? Correct Answer: "Use the complete name of the medication magnesium sulfate."
A nurse is caring for a client who has tuberculosis. Which of the following actions should the nurse take? Correct Answer: Place the client in a room with negative-pressure airflow.
Wear gloves when assisting the client with oral care.
Use antimicrobial sanitizer for hand hygiene.
A charge nurse is discussing the responsibility of nurses caring for clients who have Clostridium difficile infection. Which of the following information should the nurse include in the teaching? Correct Answer: Have family members wear a gown and gloves when visiting.
A nurse in a surgical suite notes documentation on a client's medical record he has a latex allergy. In preparation for the client's procedure, which of the following precautions should the nurse take? Correct Answer: Wrap monitoring cords with stockinette and tape them in place.
A nurse is caring for a client who is reporting difficulty falling asleep. Which of the following measures would the nurse recommend? Correct Answer: Use progressive relaxation techniques at bedtime.
A nurse is caring for a client who has a prescription for 5 units of regular insulin and 10 units of NPH insulin to mix together and administer subcutaneously. Determine the correct order of steps for this procedure. Correct Answer: Air into NPH
Air into Regular
Draw up Regular
Draw up NPH
A nurse is reviewing practice guidelines with a group of newly licensed nurses. Which of the following interventions should the nurse include that is within the RN scope of practice? Correct Answer: Initiate an enteral feeding through a gastrostomy tube.
A nurse is caring for a client who requires an NG tube for stomach decompression. Which of the following actions should the nurse take when inserting the NG tube? Correct Answer: Have the client take sips of water to promote insertion of the NG tube into the esophagus.
A nurse is assessing an older client's risk for falls. Which of the following assessments should the nurse use to identify the client's safety needs? Correct Answer: Pupil clarity
Visual fields
Visual acuity
A nurse is evaluating a client's use of a cane. Which of the following actions should the nurse identify as an indication of correct use? Correct Answer: The client holds the cane on the stronger side of her body.
A nurse is performing a peripheral vascular assessment for a client. When placing the bell of the stethoscope on the client's neck, she hears the following sound. This sound indicates which of the following? Correct Answer: Narrowed arterial lumen
A nurse is admitting a client who has varicella. Which of the following types of transmission precautions should the nurse initiate? Correct Answer: Airborne
A nurse is preparing to administer multiple medications to a client who has an enteral feeding tube. Which of the following actions should the nurse plan to take? Correct Answer: Flush the tube with 15 mL of sterile water.
A nurse is caring for a client who has a prescription for wound irrigation. Which of the following actions should the nurse take? Correct Answer: Cleanse the wound from the center outward.
A nurse is providing care to four clients. Which of the following situations requires the nurse the complete an incident report? Correct Answer: A client who has an IV infusion pump receives an additional 250 mL of IV fluid.
A nurse is caring for a client receiving fluid through a peripheral IV catheter. Which of the following findings at the IV site should the nurse identify as infiltration? Correct Answer: Skin blanching
A nurse is preparing a change-of-shift report. Which of the following tools or documents should the nurse use to communicate continuity of care? Correct Answer: Situation, background, assessment, and recommendation (SBAR)
A nurse is admitting a client who has an abdominal wound with a large amount of purulent drainage. Which of the following types of transmission precautions should the nurse initiate? Correct Answer: Contact precautions
A nurse is caring for a client who is having difficulty breathing. The client is lying in bed with a nasal cannula delivering oxygen. Which of the following interventions should the nurse take first? Correct Answer: Assist the client to an upright position.
A nurse is reviewing a client's fluid and electrolyte status. Which of the following findings should the nurse report to the provider? Correct Answer: Potassium 5.4 meq/L
A nurse is lifting a bedside cabinet to move it closer to a client who is si [Show Less]