ATI FUNDAMENTALS CMS EXAM
QUESTIONS AND VERIFIED ANSWERS
|GRADE A+| JUST RELEASED
1. A nurse is caring for a client who is at risk for falls. Which of the following actions should
the nurse take?
A. Keep the bed in the highest position
B. Ensure that the client wears socks without treads
C. Place the bedside table close to the client
D. Apply physical restraints immediately
Answer: C
Conceptual Explanation: Placing the bedside table and other personal items within reach
reduces the client’s need to get out of bed, thereby decreasing fall risk.
2. A nurse is preparing to apply a wrist restraint to a client who is pulling at their IV line.
Which of the following actions should the nurse plan to take?
A. Use a quick-release knot to secure the restraint
B. Tie the restraint to the side rails
C. Ensure the restraint is tight enough that no fingers fit
D. Renew the restraint order every 48 hours
,Answer: A
Conceptual Explanation: Restraints should be secured with a quick-release knot to the
bed frame (not the rails) for safety in case of emergency. Two fingers should fit under the
restraint, and orders must be renewed every 24 hours.
3. A nurse is caring for a client who has Clostridium difficile (C. diff). Which of the following
infection control precautions should the nurse implement?
A. Wear an N95 respirator mask
B. Wash hands with soap and water after care
C. Use alcohol-based hand rub for hand hygiene
D. Place the client in a room with negative pressure
Answer: B
Conceptual Explanation: Soap and water must be used for hand hygiene when caring for a
client with C. diff because alcohol-based rubs are ineffective against the spores.
4. A nurse is teaching a client about a new prescription for a cane. Which of the following
instructions should the nurse include?
A. Hold the cane on the weaker side of the body
B. Move the stronger leg forward first when walking
C. Maintain two points of support on the ground at all times
D. Adjust the cane height so the elbow is flexed at 45 degrees
, Answer: C
Conceptual Explanation: The client should maintain two points of support (e.g., cane and
one foot) on the ground at all times for stability. The cane should be held on the stronger
side.
5. A nurse is reviewing the laboratory results of a client who has a fluid volume deficit. Which
of the following findings should the nurse expect?
A. Hematocrit 55%
B. Urine specific gravity 1.010
C. Serum sodium 130 mEq/L
D. BUN 10 mg/dL
Answer: A
Conceptual Explanation: A hematocrit of 55% is elevated (hemoconcentration), which is a
common finding in fluid volume deficit. Normal range is typically 37-52%.
6. A nurse is assessing a client’s peripheral IV site and notes redness, warmth, and a palpable
cord along the vein. The nurse should identify these as manifestations of which of the
following?
A. Infiltration
B. Extravasation
C. Phlebitis
QUESTIONS AND VERIFIED ANSWERS
|GRADE A+| JUST RELEASED
1. A nurse is caring for a client who is at risk for falls. Which of the following actions should
the nurse take?
A. Keep the bed in the highest position
B. Ensure that the client wears socks without treads
C. Place the bedside table close to the client
D. Apply physical restraints immediately
Answer: C
Conceptual Explanation: Placing the bedside table and other personal items within reach
reduces the client’s need to get out of bed, thereby decreasing fall risk.
2. A nurse is preparing to apply a wrist restraint to a client who is pulling at their IV line.
Which of the following actions should the nurse plan to take?
A. Use a quick-release knot to secure the restraint
B. Tie the restraint to the side rails
C. Ensure the restraint is tight enough that no fingers fit
D. Renew the restraint order every 48 hours
,Answer: A
Conceptual Explanation: Restraints should be secured with a quick-release knot to the
bed frame (not the rails) for safety in case of emergency. Two fingers should fit under the
restraint, and orders must be renewed every 24 hours.
3. A nurse is caring for a client who has Clostridium difficile (C. diff). Which of the following
infection control precautions should the nurse implement?
A. Wear an N95 respirator mask
B. Wash hands with soap and water after care
C. Use alcohol-based hand rub for hand hygiene
D. Place the client in a room with negative pressure
Answer: B
Conceptual Explanation: Soap and water must be used for hand hygiene when caring for a
client with C. diff because alcohol-based rubs are ineffective against the spores.
4. A nurse is teaching a client about a new prescription for a cane. Which of the following
instructions should the nurse include?
A. Hold the cane on the weaker side of the body
B. Move the stronger leg forward first when walking
C. Maintain two points of support on the ground at all times
D. Adjust the cane height so the elbow is flexed at 45 degrees
, Answer: C
Conceptual Explanation: The client should maintain two points of support (e.g., cane and
one foot) on the ground at all times for stability. The cane should be held on the stronger
side.
5. A nurse is reviewing the laboratory results of a client who has a fluid volume deficit. Which
of the following findings should the nurse expect?
A. Hematocrit 55%
B. Urine specific gravity 1.010
C. Serum sodium 130 mEq/L
D. BUN 10 mg/dL
Answer: A
Conceptual Explanation: A hematocrit of 55% is elevated (hemoconcentration), which is a
common finding in fluid volume deficit. Normal range is typically 37-52%.
6. A nurse is assessing a client’s peripheral IV site and notes redness, warmth, and a palpable
cord along the vein. The nurse should identify these as manifestations of which of the
following?
A. Infiltration
B. Extravasation
C. Phlebitis
