NGN ATI PROCTORED FUNDAMENTALS EXAM 3 VERSIONS 2024 EXAM / NGN ATI FUNDAMENTALS PROCTORED 300 EXAM QUESTIONS WITH 100% CORRECT ANSWERS AND RATIONALE /A+
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ATI FUNDAMENTALS VERSION 1
A nurse is caring for a client who will perform fecal occult blood testing at home. Which of the following info should the nurse include when explaining the procedure to the client?
A. Eating more protein is optimal prior to testing B. One stool specimen is sufficient for testing C. A red color change indicates a positive test D. The specimen cannot be contaminated with water or urine - ...ANSWER...D. The stool specimens cannot be contaminated with water or urine
A nurse is talking w/a client who reports constipation. When the nurse discusses dietary changes that can help prevent
constipation, which of the following foods should the nurse recommend?
A. Macaroni & cheese B. Fresh fruit & whole wheat toast C. Rice pudding & ripe bananas D. Roast chicken & white rice - ...ANSWER...B. A high-fiber diet promotes normal bowel elimination
A nurse is caring for a client who has had diarrhea for the past 4 days. When assessing the client, the nurse should expect which of the following findings? Select all.
A. Bradycardia B. Hypotension C. Fever D. Poor skin turgor E. Peripheral edema - ...ANSWER...B, C, D
RATIONALE: fever=caused by dehydration tachycardia not brady hypotension because of decreased BP from dehydration fluid overload=peripheral edema
A nurse is preparing to administer a cleansing enema to an adult client in preparation for a diagnostic procedure. Which of the following are appropriate steps for the nurse to take? Select all.
A. Warm the enema prior to instillation B. Position the client on the left side w/the right leg flexed forward C. Lubricate the rectal tube or nozzle D. Slowly insert the rectal tube about 2 inches E. Hang the enema container 24 inches above the client's anus - ...ANSWER...A, B, C
RATIONALE: -D is the appropriate length of insertion for a child, 3-4 for an adult. -24 inches is too high & will cause it to run to fast & possible painful distention of the colon, 18 inches is the recommended height
While a nurse is administering a cleansing enema, the client reports abdominal cramping. Which of the following is the appropriate intervention?
A. Have the client hold his breath briefly B. Discontinue the fluid instillation
C. Remind the client that cramping is common at this time D. Lower the enema fluid container - ...ANSWER...D. This will slow the rate of instillation & relieve some discomfort
A nurse is caring for a client who has been sitting in a chair for 3 hrs. Which of the following problems is the client at risk for developing?
A. Stasis of secretions B. Muscle atrophy C. Pressure ulcer D. Fecal impaction - ...ANSWER...Answer: C
RATIONALE: Unrelieved pressure over a bony prominence for too long increases the risk of a pressure ulcer
A-sitting will help prevent stasis of secretions B and D-these are from prolonged bed rest
A nurse is caring for a client who is on bed rest. Which of the following interventions should the nurse implement to maintain the patency of the client's airway?
A. Encourage isometric exercises B. Suction Q8 hr
C. Give low-dose heparin D. Promote incentive spirometer use - ...ANSWER...Answer: D. it helps keep airways open and prevent atelectasis
A-this strengthens skeletal muscles B-this is not indicated C-helps prevent thrombus formation
A nurse is caring for a client who is postop. Which of the following nursing interventions reduce the risk of thrombus development? Select all.
A. Instruct the client not to use the Valsalva maneuver B. Apply elastic stockings C. Review lab values for total protein level D. Place pillows under the client's knees & lower extremities E. Assist the client to change position often - ...ANSWER...B, E
A nurse is instructing a postop client about the sequential compression device the provider has prescribed. Which of the following statements should indicate to the nurse that the client understands the teaching?
A. "This device will keep me from getting sores on my skin." B. "This thing will keep the blood pumping through my leg."
C. "With this thing on, my leg muscles won't get weak." D. "This device is going to keep my joints in good shape." - ...ANSWER...B. sequential pressure devices promote venous return in the deep veins of the legs & thus help prevent thrombus formation
To promote the safe use of a cane for a client who is recovering from a minor musculoskeletal injury of the left lower extremity, which of the following instructions should the nurse provide? Select all.
A. Hold the cane on the right side B. Keep 2 points of support on the floor C. Place the cane 15in in front of the feet before advancing D. After advancing the cane, move the weaker leg forward E. Advance the stronger leg so that it aligns evenly w/the cane - ...ANSWER...A, B, D
RATIONALE: C-the client should place the cane 6-10 inches in front before advancing not 15 E-the client should advance the stronger leg past the cane not aligned w/it
A nurse is assessing the pain level of a client who has come to the ER reporting severe abd. pain. The nurse asks the client
whether he has nausea & has been vomiting. The nurse is assessing which of the following?
A. Presence of associated symptoms B. Location of the pain C. Pain quality D. Aggravating & relieving factors - ...ANSWER...A. this is a common symptom people have when experiencing pain
A nurse is assessing a client who is reporting severe pain despite analgesia. The nurse can best assess the intensity of the client's pain by:
A. asking what precipitates the pain B. questioning the client about the location of the pain C. offering the client a pain scale to measure his pain D. using open-ended questions to identify the situation - ...ANSWER...C. pain scale can measure the amount and intensity of the pain
A nurse is obtaining hx from a client who has pain. The nurse's guiding principle throughout this process should be that:
A. some clients exaggerate their level of pain
B. pain must have an identifiable source to justify the use of opioids. C. objective data are essential in assessing pain D. pain is whatever the client says it is - ...ANSWER...D the client is the best source of information in their pain, it is a subjective experience
A nurse is caring for a client who is receiving morphine via a PCA infusion device after abd. surgery. Which of the following statements indicates that the client knows how to use the device?
A. "I'll wait to use the device until it's absolutely necessary." B. "I'll be careful about pushing the button so I don't get an overdose." C. "I should tell the nurse if the pain doesn't stop after I use this device." D. "I will ask my son to push the dose button when I am sleeping." - ...ANSWER...C.
RATIONALE: The client should let the nurse know if not receiving adequate pain control, so they can reevaluate the pain control plan
A nurse is monitoring a client who is receiving opioid analgesia for adv effects of the med. Which of the following effects should the nurse anticipate? Select all.
A. Urinary incontinence B. Diarrhea C. Bradypnea D. Orthostatic hypotension E. Nausea - ...ANSWER...C, D, E
RATIONALE: Urinary retention, not incontinence is an adv effect of these meds as well as constipation, not diarrhea.
A nurse is assessing a client who takes haloperidol (Haldol) for the tx of schizophrenia. Which of the following findings should the nurse document as extrapyramidal symptoms (EPS)? Select all.
A. Orthostatic hypotension B. Fine motor tremors C. Acute dystonias D. Decreased level of consciousness E. Uncontrollable restlessness - ...ANSWER...B, C, E
RATIONALE: A and D are adverse effects, but not EPS
A nurse is providing teaching about managing anticholinergic effects for a client who has a new prescription for oxybutunin (Ditropan XL). Which of the following are appropriate to include in the teaching? Select all.
A. Take frequent sips of water B. Wear sunglasses when exposed to sunlight C. Use a soft toothbrush when brushing teeth D. Take the medication w/an antacid E. Urinate prior to taking the med - ...ANSWER...A, B, E
side effects of this med include: dry mouth, photophobia, and urinary retention
A nurse is reviewing the reported meds of a client who was recently admitted. The meds include cimetidine (Tagamet) & imipramine hydrochloride (Tofranil). Knowing that cimetidine decreases the metabolism of imipramine hydrochloride, the nurse should identify that this combination is likely to result in which of the following effects?
A. Decreased therapeutic effects of cimetidine B. Increased risk of imipramine hydrochloride toxicity C. Decreased risk of adv effects of cimetidine
D. Increased therapeutic effects of imipramine hydrochloride - ...ANSWER...B. A med that decreases the metabolism of a 2nd med increases the serum level of the 2nd med, increasing risk for toxicity
A nurse in an outpatient clinic is caring for a client who states she is trying to get pregnant. The client currently takes a Category D pregnancy risk med for the control of seizures. Which of the following statements by the nurse is appropriate?
A. "This med is prescribed if necessary but it is known to cause adverse effects to the fetus." B. "This med has evidence indicating that it is safe to take during pregnancy & will not harm the fetus." C. "This med cannot be taken during pregnancy because the risk outweighs the potential benefits." D. "This med hasn't been studied in pregnant women but is believed to be safe for the fetus." - ...ANSWER...A. Category D meds are known to cause harm to fetuses, however the use during pregnancy may be warranted based on potential benefits.
A nurse in an outpatient surgical center is admitting a client for a laproscopic procedure. The client has a prescription for
preoperative diazepam (Valium). Prior to administering the med, which of the following actions is the highest priority?
A. Teaching the client about the purpose of the med B. Administering the med to the client at the prescribed time C. Identifying the client's med allergies D. Documenting the client's anxiety level - ...ANSWER...C. The greatest risk to the client is an allergic reaction to the med
A nurse is preparing to administer methylprednisolone acetate (Depo-Medrol) 10 mg by IV bolus. The amount available is 40 mg/mL. How many mL should the nurse administer? (round to nearest tenth) - ...ANSWER...0.3 mL
A nurse is preparing to administer lactated Ringer's (LR) IV 100 mL over 15min. The nurse should set the infusion pump to deliver how many mL/hr? (round to nearest whole number) - ...ANSWER...400 mL/hr
A nurse is preparing to administer 0.9% sodium chloride (0.9% NaCl) 250 mL IV to infuse over 30min. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (round to nearest whole number) - ...ANSWER...83 gtt/min
A nurse is caring for a client who is at high risk for aspiration. Which of the following is an appropriate nursing intervention?
A. Give the client thin liquids. B. Instruct the client to tuck her chin when swallowing. C. Have the client use a straw. D. Encourage the client to lie down & rest after meals. - ...ANSWER...B. Tucking when swallowing allows food to pass down esophagus more easily.
A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following is the body's priority energy reserve?
A. Fat B. Protein C. Glycogen D. Carbohydrates - ...ANSWER...D. carbs provide glucose
A nurse is caring for a client who is on a low-residue diet. The nurse should expect to see which of the following foods on the client's [Show Less]