ATI RN Fundamentals Online
Practice 2024 EDITION GRADE A+
A nurse is administering 1 L of 0.9% sodium chloride to a client who
is postoperative and has fluid volume deficit. Which of the following
changes should the nurse identify as an indication that the treatment
was successful?
Increase in hematocrit
increase in respiratory rate
Decrease in heart rate
Decrease in capillary refill time
Correct Answer:
Decrease in heart rate
Fluid volume deficit causes tachycardia. With correction of the
imbalance, the heart rate should return to the expected range.
Incorrect Answers:
Increase in hematocrit:
Fluid volume deficit causes an increase in hematocrit level due to
depletion of extracellular fluid. With correction of the imbalance,
the hematocrit level should decrease.
increase in respiratory rate
Fluid volume deficit causes an increase in respiratory rate. With
correction of the imbalance, the respiratory rate should return to
the expected range.
Decrease in capillary refill time
Fluid volume deficit slows capillary refill. With correction of the
imbalance, capillary refill time should return to the expected range.
A nurse is caring for a client who is scheduled to be transferred to
a long-term care facility. The client's family questions the nurse
about the reasons for the transfer. Which of the following responses
made by the nurse is appropriate?
"The transfer of your family member is being done because the
provider knows what's best."
"Would you like it if we discussed the transfer with your family
,member?"
"Why are you so concerned about this transfer?"
"I know how you feel. My parent had to be transferred to a long-term
care facility."
Correct Answer:
"Would you like it if we discussed the transfer with your family
member?"
This response facilitates therapeutic communication and provides
general leads while maintaining client confidentiality.
Incorrect Answers:
"The transfer of your family member is being done because the
provider knows what's best."
This is a defensive response which can hinder further communication.
"Why are you so concerned about this transfer?"
Asking a why question can make the recipient defensive which can
hinder further communication.
"I know how you feel. My parent had to be transferred to a long-term
care facility."
This is a sympathetic response, which can interfere with a
therapeutic relationship.
A nurse is reviewing the laboratory results of a female client who
has hypovolemia. Which of the following laboratory result would be a
priority for the nurse report to the provider?
BUN 21 mg/dL (10 to 20 mg/dL)
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
Sodium 132 mEq/L (136 to 145 mEq/L)
Potassium 5.8 mEq/L (3.5 to 5 mEq/L)
Correct Answer:
Potassium 5.8 mEq/L (3.5 to 5 mEq/L)
When using the urgent versus nonurgent approach to client care, the
nurse should determine that this potassium level is above the
expected reference range and should be reported to the provider.
Potassium affects the contractility of the heart and this client
would be at risk for developing dysrhythmias.
Incorrect answers:
BUN 21 mg/dL (10 to 20 mg/dL)
This BUN level is slightly above the expected reference range and is
an expected non-urgent finding for a client who has hypovolemia;
therefore, there is another laboratory result that is a priority for
,the nurse to report to the provider.
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
This creatinine level is slightly above the expected reference range
and is an expected non-urgent finding for a client who has
hypovolemia; therefore, there is another laboratory result that is a
a priority for the nurse to report to the provider.
Sodium 132 mEq/L (136 to 145 mEq/L)
This sodium level is slightly below the expected reference range and
is an expected non-urgent finding for a client who has hypovolemia;
therefore, there is another laboratory result that is a priority for
the nurse to report to the provider.
A nurse is caring for a client who reports difficulty falling asleep.
Which of the following recommendations should the nurse make?
"Drink a cup of hot cocoa before bedtime."
"Maintain a consistent time to wake up each day."
"Exercise 1 hour before going to bed."
"Watch a television program in bed before going to sleep."
Correct Answer:
"Maintain a consistent time to wake up each day."
The client should maintain a consistent time for waking up and going
to sleep. This helps to establish an internal sense of sleep and
waking on a daily basis and helps to maintain it over time. This will
help promote sleep for the client.
Incorrect Answers:
"Drink a cup of hot cocoa before bedtime."
Cocoa contains caffeine, which is a stimulant that can interfere with
sleep.
"Exercise 1 hour before going to bed."
Exercising within 2 hr of bedtime can interfere with sleep.
"Watch a television program in bed before going to sleep."
The client should avoid watching television in bed before going to
sleep to reduce stimulation in order to promote rest.
A nurse on a medical-surgical unit is caring for a client who has a
new prescription for wrist restraints. Which of following actions
should the nurse take?
Pad the client's wrist before applying the restraints.
Evaluate the client's circulation every 8 hr after application.
, Remove the restraints every 4 hr to evaluate the client's status.
Secure the restraint ties to the bed's side rails.
Correct Answer:
Pad the client's wrist before applying the restraints.
The use of restraints without padding can abrade the client's skin,
resulting in client injury.
Incorrect Answers:
Evaluate the client's circulation every 8 hr after application.
The nurse should evaluate the client's circulation, range of motion,
vital signs, and overall status every 15 min after initial
application of restraints.
Remove the restraints every 4 hr to evaluate the client's status.
The nurse should remove the restraints at least every 2 hr to
reposition the client and assess needs for hygiene and toileting.
Secure the restraint ties to the bed's side rails.
The nurse should secure the restraint ties to a part of the bed frame
that moves with the client to reduce the risk of injury.
A client who is nonambulatory notifies the nurse that their 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.
Correct Answer:
Evacuate the client.
According to the RACE mnemonic, the first action in response to a
fire is to rescue the clients, moving them to a safe area.
Incorrect Answers:
Activate the emergency fire alarm.
According to the RACE mnemonic, the second action in response to a
fire is to activate the alarm.
Extinguish the fire.
According to the RACE mnemonic, the fourth action in response to a
fire is to attempt to extinguish the fire.
Confine the fire.
According to the RACE mnemonic, the third action in response to a
Practice 2024 EDITION GRADE A+
A nurse is administering 1 L of 0.9% sodium chloride to a client who
is postoperative and has fluid volume deficit. Which of the following
changes should the nurse identify as an indication that the treatment
was successful?
Increase in hematocrit
increase in respiratory rate
Decrease in heart rate
Decrease in capillary refill time
Correct Answer:
Decrease in heart rate
Fluid volume deficit causes tachycardia. With correction of the
imbalance, the heart rate should return to the expected range.
Incorrect Answers:
Increase in hematocrit:
Fluid volume deficit causes an increase in hematocrit level due to
depletion of extracellular fluid. With correction of the imbalance,
the hematocrit level should decrease.
increase in respiratory rate
Fluid volume deficit causes an increase in respiratory rate. With
correction of the imbalance, the respiratory rate should return to
the expected range.
Decrease in capillary refill time
Fluid volume deficit slows capillary refill. With correction of the
imbalance, capillary refill time should return to the expected range.
A nurse is caring for a client who is scheduled to be transferred to
a long-term care facility. The client's family questions the nurse
about the reasons for the transfer. Which of the following responses
made by the nurse is appropriate?
"The transfer of your family member is being done because the
provider knows what's best."
"Would you like it if we discussed the transfer with your family
,member?"
"Why are you so concerned about this transfer?"
"I know how you feel. My parent had to be transferred to a long-term
care facility."
Correct Answer:
"Would you like it if we discussed the transfer with your family
member?"
This response facilitates therapeutic communication and provides
general leads while maintaining client confidentiality.
Incorrect Answers:
"The transfer of your family member is being done because the
provider knows what's best."
This is a defensive response which can hinder further communication.
"Why are you so concerned about this transfer?"
Asking a why question can make the recipient defensive which can
hinder further communication.
"I know how you feel. My parent had to be transferred to a long-term
care facility."
This is a sympathetic response, which can interfere with a
therapeutic relationship.
A nurse is reviewing the laboratory results of a female client who
has hypovolemia. Which of the following laboratory result would be a
priority for the nurse report to the provider?
BUN 21 mg/dL (10 to 20 mg/dL)
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
Sodium 132 mEq/L (136 to 145 mEq/L)
Potassium 5.8 mEq/L (3.5 to 5 mEq/L)
Correct Answer:
Potassium 5.8 mEq/L (3.5 to 5 mEq/L)
When using the urgent versus nonurgent approach to client care, the
nurse should determine that this potassium level is above the
expected reference range and should be reported to the provider.
Potassium affects the contractility of the heart and this client
would be at risk for developing dysrhythmias.
Incorrect answers:
BUN 21 mg/dL (10 to 20 mg/dL)
This BUN level is slightly above the expected reference range and is
an expected non-urgent finding for a client who has hypovolemia;
therefore, there is another laboratory result that is a priority for
,the nurse to report to the provider.
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
This creatinine level is slightly above the expected reference range
and is an expected non-urgent finding for a client who has
hypovolemia; therefore, there is another laboratory result that is a
a priority for the nurse to report to the provider.
Sodium 132 mEq/L (136 to 145 mEq/L)
This sodium level is slightly below the expected reference range and
is an expected non-urgent finding for a client who has hypovolemia;
therefore, there is another laboratory result that is a priority for
the nurse to report to the provider.
A nurse is caring for a client who reports difficulty falling asleep.
Which of the following recommendations should the nurse make?
"Drink a cup of hot cocoa before bedtime."
"Maintain a consistent time to wake up each day."
"Exercise 1 hour before going to bed."
"Watch a television program in bed before going to sleep."
Correct Answer:
"Maintain a consistent time to wake up each day."
The client should maintain a consistent time for waking up and going
to sleep. This helps to establish an internal sense of sleep and
waking on a daily basis and helps to maintain it over time. This will
help promote sleep for the client.
Incorrect Answers:
"Drink a cup of hot cocoa before bedtime."
Cocoa contains caffeine, which is a stimulant that can interfere with
sleep.
"Exercise 1 hour before going to bed."
Exercising within 2 hr of bedtime can interfere with sleep.
"Watch a television program in bed before going to sleep."
The client should avoid watching television in bed before going to
sleep to reduce stimulation in order to promote rest.
A nurse on a medical-surgical unit is caring for a client who has a
new prescription for wrist restraints. Which of following actions
should the nurse take?
Pad the client's wrist before applying the restraints.
Evaluate the client's circulation every 8 hr after application.
, Remove the restraints every 4 hr to evaluate the client's status.
Secure the restraint ties to the bed's side rails.
Correct Answer:
Pad the client's wrist before applying the restraints.
The use of restraints without padding can abrade the client's skin,
resulting in client injury.
Incorrect Answers:
Evaluate the client's circulation every 8 hr after application.
The nurse should evaluate the client's circulation, range of motion,
vital signs, and overall status every 15 min after initial
application of restraints.
Remove the restraints every 4 hr to evaluate the client's status.
The nurse should remove the restraints at least every 2 hr to
reposition the client and assess needs for hygiene and toileting.
Secure the restraint ties to the bed's side rails.
The nurse should secure the restraint ties to a part of the bed frame
that moves with the client to reduce the risk of injury.
A client who is nonambulatory notifies the nurse that their 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.
Correct Answer:
Evacuate the client.
According to the RACE mnemonic, the first action in response to a
fire is to rescue the clients, moving them to a safe area.
Incorrect Answers:
Activate the emergency fire alarm.
According to the RACE mnemonic, the second action in response to a
fire is to activate the alarm.
Extinguish the fire.
According to the RACE mnemonic, the fourth action in response to a
fire is to attempt to extinguish the fire.
Confine the fire.
According to the RACE mnemonic, the third action in response to a
