NSG 261 ATI Comprehensive Test A: Correct Answers & Rationales (80+ Qs)

NSG 261 ATI Comprehensive Test A: Correct Answers & Rationales (80+ Qs) Detailed Document Description This document is a high-yield study guide for nursing students preparing for the NSG 261 ATI Comprehensive Test A. It features over 80 practice questions with a strong emphasis on correct answers, detailed rationales, and test-taking strategies. The content covers critical nursing topics including medical-surgical care, pediatrics, mental health (anorexia, bulimia, alcohol withdrawal), emergency procedures (compartment syndrome, autonomic dysreflexia), delegation, pharmacology (digoxin toxicity, mannitol), and prioritization frameworks (nursing process, urgent vs. non-urgent). Ideal for ATI remediation and NCLEX prep. NSG 261 ATI COMP TEST EXAM| UPDATED & REVIEWED 2026/2027| REAL QUESTIONS WITH ELABORATIVE ANSWERS WITH RATIONALE | GUARANTEED 100% PASS 1. High blood pressure having difficulty following treatment plan. What is the greatest barrier: Absence of symptoms A client without symptoms might not understand the need for treatment, which would indicate the greatest barrier for adherence. --A detailed plan of care A plan of care that is too detailed can be confusing for the client, but this does not indicate the greatest barrier for adherence. --Dietary salt restriction The need for dietary salt restriction does not indicate the greatest barrier for adherence. --Addition of a new medication Adding a new medication does not indicate the greatest barrier for adherence. 2. Client with immunosuppression and continuous iv. What actions should you take: Monitor the client's mouth every 8 hr. The nurse should monitor the client's mouth at least every 8 hr for manifestations of an infection, such as sores or lesions. --Assess the client's IV site every 8 hr. The nurse should monitor the client's IV site for manifestations of an infection every 4 hr. --Check the client's WBC count every 48 hr. The nurse should monitor the client's WBC count every 24 hr. --Monitor the client's mouth every 8 hr. The nurse should monitor the client's mouth at least every 8hr for manifestations of an infection, such as sores or lesions. --Change the client's IV tubing every 48 hr. The nurse should change the IV tubing every 24 hr for a client who has immunosuppression. 3. A nurse manager in a long-term care facility is having difficulty with staffing for weekend shifts and is planning to implement some changes to the scheduling procedure. Which of the following actions should the nurse manager take first?: Form a committee of staff members to investigate current staffing issues. MY RATIONALE The first action the nurse should take when using the nursing process is to assess the current staffing issue. The first stage of change is the "unfreezing stage," in which information is gathered about the problem. Therefore, the first action the nurse manager should take is to form a committee to investigate the problem. --Provide support to staff members who are resistant to staffing changes. It is important to provide support to the staff who are resistant to staffing changes to help them adjust. However, there is another action the nurse should take first. --Schedule a staff meeting to present the different options to staff members. It is important to schedule a staff meeting To present different staffing options. However, there is another action the nurse should take first. --Give the staff members advance written notice of staffing changes. It is important to give the staff advance written notice of the changes, so they can prepare themselves. However, there is another action the nurse should take first. 4. A nurse manager is preparing to teach a group of newly licensed nurses about effective time management. What is the priority: Making a list of activities to complete MY RATIONALE According to evidence-based practice, planning is the most important step in managing time effectively. Therefore, the nurse manager should include making a list of activities to complete as the priority. Other planning activities include setting goals, establishing priorities, and scheduling activities. -Organizing the work environment Organizing the work environment is an important component in the time management process because a neat working environment helps to eliminate distractions and accomplish goals more efficiently. However, evidence-based practice indicates another action is the priority. --Delegating assigned tasks appropriately Delegating lower priority assigned tasks is an important component in the time management process to free time for the newly licensed nurses to complete higher priority tasks. However, evidence-based practice indicates another action is the priority. --Rewarding oneself for accomplishing goals Rewarding oneself for accomplishing goals is an important component in the time management process because this serves as a source of motivation. However, evidence-based practice indicates another action is the priority. 5. Active suicidal thoughts: Serve meals with plastic utensils. The nurse should recommend serving meals with plastic utensils because harmful objects, such as metal utensils, should not be accessible to the client. --Monitor the client for 30 min following meals. A client who is experiencing active suicidal ideations should be observed continuously, rather than for 30 min following meals. The nurse should recommend this intervention for clients who are diagnosed with anorexia nervosa or bulimia nervosa. --Observe the client every 15 min. A client who is experiencing active suicidal ideations should be observed continuously, rather than every 15 min. --Provide the client with a brightly lit environment. A brightly lit environment does not impact the safety of a client who is experiencing active suicidal ideations. Therefore, the nurse should not recommend this intervention for the client. 6. What to delegate to assistive personnel.: Arrange the lunch tray for a client who has a hip fracture. MY RATIONALE Assisting a client with meals is within the range of function of the AP. --Measure the vital signs of a client who just returned from the PACU. Although an AP can measure vital signs, this client is postoperative and requires close assessment, which is not within the range of function of the AP. Postoperative clients are not considered medically stable and are often fragile, so the nurse should not delegate this task to the AP. --Evaluate dietary intake for a client who has anorexia .Evaluation requires professional nursing knowledge. Evaluation is the last step of the nursing process and is not within the range of function of the AP. --Assess I &O for a client who is receiving dialysis. Assessment requires professional nursing knowledge. It is the first step in the nursing process and is not within the range of function of the AP. 7. Assessing a newborn after birth. Which of the following should you report to provider: Nasal flaring MY RATIONALE The nurse should report any indications of respiratory distress such as nasal flaring, retractions, and grunting. --Heart rate 136/min A heart rate of 136/min is within the expected reference range of 110/min to 160/min for a newborn. --Transient strabismus Transient strabismus or nystagmus is an expected finding for a newborn until the age of 3 to 4 months. --Overlapping of sutures Overlapping of sutures occurs with molding following a vaginal delivery and is an expected finding for a newborn.