, NU 136: Fundamentals of Nursing – ATI
Questions and Answers with Rationales
2026/2027 update
Question 1
A nurse is caring for a client with severe respiratory depression
caused by opioid overdose. Which specific antidote should the
nurse anticipate administering?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Vitamin K
Correct Answer: B. Naloxone
Expert Rationale: Naloxone is an opioid receptor antagonist
that rapidly reverses central nervous system and respiratory
depression induced by opioid analgesics.
Question 2
A nurse is caring for an adult client with decreased mobility who
has been prescribed bed rest. Which nursing action should the
nurse take to decrease the client's risk of developing plantar
flexion contractures (footdrop)?
A. Place a firm pillow directly under the client's knees.
, B. Position a soft trochanter roll under each of the client's
hips.
C. Advise the client to wear rubber-soled supportive slippers.
D. Apply an ankle-foot orthotic device to the client's feet.
Correct Answer: D. Apply an ankle-foot orthotic device to
the client's feet
Expert Rationale: To prevent footdrop and maintain neutral
dorsiflexion, the nurse should utilize specialized devices such as
an ankle-foot orthotic (AFO) or a rigid footboard placed
perpendicular to the mattress. Placing a pillow under the knees
promotes venous stasis and knee flexion contractures, while
trochanter rolls prevent external hip rotation, not footdrop.
Question 3
A nurse is preparing to suction secretions from an adult client
who has a newly placed tracheostomy tube. Which action should
the nurse plan to take during this procedure?
A. Select a suction catheter that has a diameter of half the size
of the tracheostomy lumen.
B. Adjust the wall suction regulator pressure to 170\ mmHg.
C. Lubricate the tip of the suction catheter liberally with a
water-soluble petroleum jelly.
D. Hyperoxygenate the client with 21\% room air via manual
resuscitation bag.
, Correct Answer: A. Select a suction catheter that has a
diameter of half the size of the tracheostomy lumen
Expert Rationale: Selecting a suction catheter whose diameter
is no more than half the internal diameter of the tracheostomy
tube prevents the rapid depletion of oxygen from the lungs,
minimizing hypoxia and mucosal trauma. Wall suction should
be maintained between 100 and 120\mmHg for adults,
petroleum-based lubricants are contraindicated due to lipid
pneumonia risks, and hyperoxygenation with high
concentrations of oxygen is required prior to suctioning.
Question 4
A charge nurse is reviewing assignment guidelines with a newly
licensed nurse regarding caring for clients with a Clostridioides
difficile (C. diff) infection. Which infection control practice
should the nurse include in the teaching?
A. Assign the client to a negative-pressure airflow isolation
room.
B. Utilize alcohol-based hand rub sanitizer upon exiting the
client's room.
C. Ensure that family members wear a gown and gloves when
visiting.
D. Disinfect contaminated room surfaces with a standard
phenol solution.
Correct Answer: C. Ensure that family members wear a
gown and gloves when visiting
Questions and Answers with Rationales
2026/2027 update
Question 1
A nurse is caring for a client with severe respiratory depression
caused by opioid overdose. Which specific antidote should the
nurse anticipate administering?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Vitamin K
Correct Answer: B. Naloxone
Expert Rationale: Naloxone is an opioid receptor antagonist
that rapidly reverses central nervous system and respiratory
depression induced by opioid analgesics.
Question 2
A nurse is caring for an adult client with decreased mobility who
has been prescribed bed rest. Which nursing action should the
nurse take to decrease the client's risk of developing plantar
flexion contractures (footdrop)?
A. Place a firm pillow directly under the client's knees.
, B. Position a soft trochanter roll under each of the client's
hips.
C. Advise the client to wear rubber-soled supportive slippers.
D. Apply an ankle-foot orthotic device to the client's feet.
Correct Answer: D. Apply an ankle-foot orthotic device to
the client's feet
Expert Rationale: To prevent footdrop and maintain neutral
dorsiflexion, the nurse should utilize specialized devices such as
an ankle-foot orthotic (AFO) or a rigid footboard placed
perpendicular to the mattress. Placing a pillow under the knees
promotes venous stasis and knee flexion contractures, while
trochanter rolls prevent external hip rotation, not footdrop.
Question 3
A nurse is preparing to suction secretions from an adult client
who has a newly placed tracheostomy tube. Which action should
the nurse plan to take during this procedure?
A. Select a suction catheter that has a diameter of half the size
of the tracheostomy lumen.
B. Adjust the wall suction regulator pressure to 170\ mmHg.
C. Lubricate the tip of the suction catheter liberally with a
water-soluble petroleum jelly.
D. Hyperoxygenate the client with 21\% room air via manual
resuscitation bag.
, Correct Answer: A. Select a suction catheter that has a
diameter of half the size of the tracheostomy lumen
Expert Rationale: Selecting a suction catheter whose diameter
is no more than half the internal diameter of the tracheostomy
tube prevents the rapid depletion of oxygen from the lungs,
minimizing hypoxia and mucosal trauma. Wall suction should
be maintained between 100 and 120\mmHg for adults,
petroleum-based lubricants are contraindicated due to lipid
pneumonia risks, and hyperoxygenation with high
concentrations of oxygen is required prior to suctioning.
Question 4
A charge nurse is reviewing assignment guidelines with a newly
licensed nurse regarding caring for clients with a Clostridioides
difficile (C. diff) infection. Which infection control practice
should the nurse include in the teaching?
A. Assign the client to a negative-pressure airflow isolation
room.
B. Utilize alcohol-based hand rub sanitizer upon exiting the
client's room.
C. Ensure that family members wear a gown and gloves when
visiting.
D. Disinfect contaminated room surfaces with a standard
phenol solution.
Correct Answer: C. Ensure that family members wear a
gown and gloves when visiting
