Complete Test Bank: ATI Fundamentals for Nursing
Edition 12.0
Content Mastery Series Review
SECTION 1: SAFETY AND INFECTION CONTROL
Question 1.1
A nurse is preparing to administer medications to a client. Which of the following actions
demonstrates proper identification of the client?
A) Ask the client, "Are you Mr. Smith?"
B) Check the room number against the medication administration record
C) Ask the client to state their full name and date of birth
D) Verify the client's name on the wristband without speaking to the client
Answer: C) Ask the client to state their full name and date of birth
Rationale: The Joint Commission requires two client identifiers before administering
medications or performing procedures. The safest method is to use two distinct identifiers,
such as asking the client to state their full name and date of birth, then verifying this against
the wristband and medical record. Asking a leading question like "Are you Mr. Smith?" (A)
may elicit an inaccurate confirmation. Room numbers (B) are not reliable identifiers as
clients can be moved. Verifying only the wristband without verbal confirmation (D) does not
engage the client and may miss errors.
Question 1.2
A nurse is caring for a client who requires droplet precautions. Which personal protective
equipment (PPE) should the nurse wear when entering the room? (Select all that apply)
A) Gown
B) Gloves
C) Surgical mask
D) N95 respirator
E) Eye protection
Answer: A, B, C, E
Rationale: Droplet precautions require a surgical mask, gown, gloves, and eye protection
when within 3 feet of the client. An N95 respirator (D) is required for airborne precautions,
not droplet precautions. Diseases requiring droplet precautions include influenza,
meningitis, and pertussis. The mask should be donned before entering the room, and all PPE
should be removed before exiting, with hand hygiene performed immediately after removal.
,Question 1.3
A nurse is caring for a client who is on fall precautions. Which of the following environmental
modifications is most effective for preventing falls?
A) Keep the floor free of clutter
B) Place the bed in the highest position
C) Remove the call light from the client's reach
D) Dim the lighting to promote sleep
Answer: A) Keep the floor free of clutter
Rationale: A clutter-free environment reduces fall risk by removing tripping hazards.
Additional fall prevention interventions include keeping the bed in the lowest position (not
highest, B), ensuring the call light is within reach (not removed, C), and providing adequate
lighting (not dim, D). The nurse should also ensure nonslip footwear, bed alarms if indicated,
and frequent rounding for high-risk clients.
Question 1.4
A nurse is preparing a sterile field. Which of the following actions maintains sterility?
A) Touch the sterile field with bare hands
B) Keep sterile items above the waist level
C) Place wet items on the sterile field
D) Open sterile packages toward the field
Answer: B) Keep sterile items above the waist level
Rationale: Keeping sterile items above waist level maintains sterility, as areas below the
waist are considered contaminated. The outer 1-inch margin of a sterile field is also
considered contaminated. Touching the field with bare hands (A) contaminates it; sterile
gloves must be worn. Wet items (C) can cause strike-through contamination by allowing
microorganisms to travel through capillary action to the sterile field. Opening sterile
packages away from the field (D) prevents contaminating the sterile area.
Question 1.5
A nurse is caring for a client with a urinary tract infection who requires a urine specimen for
culture and sensitivity. Which action is most appropriate?
A) Collect the first voided morning urine
B) Collect urine from the indwelling catheter drainage bag
C) Collect a clean-catch midstream specimen
D) Collect urine after the client has been off antibiotics for 24 hours
,Answer: C) Collect a clean-catch midstream specimen
Rationale: A clean-catch midstream specimen is the preferred method for urine culture as it
minimizes contamination from the perineum. First voided morning urine (A) is suitable for
routine urinalysis but may not be ideal for culture. Urine from the drainage bag (B) is not
appropriate as it has been sitting and bacteria may have multiplied. While antibiotics can
affect culture results, the provider determines if antibiotics should be discontinued before
collection (D).
Question 1.6
A nurse is caring for a client who has a stage IV pressure injury. Which intervention should
the nurse implement first?
A) Apply a moisture-barrier ointment
B) Cleanse the wound with normal saline
C) Obtain a wound culture
D) Consult the wound care nurse
Answer: B) Cleanse the wound with normal saline
Rationale: The first step in wound care is cleansing the wound to remove debris and
exudate. Normal saline is the preferred cleansing solution as it is isotonic and noncytotoxic.
Moisture-barrier ointment (A) may be applied after cleansing. Obtaining a wound culture (C)
may be ordered but is not the first intervention. Consulting the wound care nurse (D) is
appropriate but should not delay immediate cleansing.
Question 1.7
A nurse is preparing to insert an indwelling urinary catheter for a female client. Which action
is appropriate for maintaining sterility?
A) Clean the perineum from front to back
B) Lubricate the catheter with sterile water-soluble jelly
C) Use sterile gloves only, not sterile drapes
D) Open the catheter kit with ungloved hands
Answer: B) Lubricate the catheter with sterile water-soluble jelly
Rationale: Lubricating the catheter with sterile water-soluble jelly reduces friction and
prevents tissue trauma. The perineum should be cleaned from front to back (A) for infection
prevention, but this is to prevent introduction of rectal flora, not specifically for sterility.
Sterile drapes (C) should be used to maintain a sterile field. The catheter kit should be
opened with sterile technique after applying sterile gloves (D).
Question 1.8
, A nurse is caring for a client with a suspected Clostridium difficile infection. Which infection
control precaution should be implemented?
A) Contact precautions
B) Droplet precautions
C) Airborne precautions
D) Protective environment
Answer: A) Contact precautions
Rationale: C. difficile requires contact precautions because it is transmitted via direct or
indirect contact with contaminated surfaces and hands. Gloves and gown are required, and
alcohol-based hand sanitizers are not effective; handwashing with soap and water is
required. Droplet precautions (B) are for diseases like influenza and meningitis. Airborne
precautions (C) are for tuberculosis and measles. Protective environment (D) is for
immunocompromised clients.
Question 1.9
A nurse is administering a subcutaneous injection. Which action reduces the risk of
needlestick injury?
A) Recap the needle after use
B) Activate the safety shield after use
C) Place the uncapped needle on the bedside table
D) Dispose of the needle in the regular trash
Answer: B) Activate the safety shield after use
Rationale: Needlestick prevention devices should be activated immediately after use.
Recapping needles (A) is never recommended as it increases the risk of injury. Placing
uncapped needles on surfaces (C) creates a hazard. All sharps must be disposed of in
designated puncture-proof containers, not regular trash (D).
Question 1.10
A nurse is applying restraints to a client. Which action is appropriate?
A) Apply restraints to prevent the client from pulling out the feeding tube
B) Tie the restraints to the side rails of the bed
C) Document the client's behavior and alternatives attempted
D) Remove restraints every 4 hours to check circulation
Answer: C) Document the client's behavior and alternatives attempted
Rationale: The use of restraints requires careful documentation including the client's
behavior, alternatives attempted, and ongoing assessment. Restraints should only be used as
Edition 12.0
Content Mastery Series Review
SECTION 1: SAFETY AND INFECTION CONTROL
Question 1.1
A nurse is preparing to administer medications to a client. Which of the following actions
demonstrates proper identification of the client?
A) Ask the client, "Are you Mr. Smith?"
B) Check the room number against the medication administration record
C) Ask the client to state their full name and date of birth
D) Verify the client's name on the wristband without speaking to the client
Answer: C) Ask the client to state their full name and date of birth
Rationale: The Joint Commission requires two client identifiers before administering
medications or performing procedures. The safest method is to use two distinct identifiers,
such as asking the client to state their full name and date of birth, then verifying this against
the wristband and medical record. Asking a leading question like "Are you Mr. Smith?" (A)
may elicit an inaccurate confirmation. Room numbers (B) are not reliable identifiers as
clients can be moved. Verifying only the wristband without verbal confirmation (D) does not
engage the client and may miss errors.
Question 1.2
A nurse is caring for a client who requires droplet precautions. Which personal protective
equipment (PPE) should the nurse wear when entering the room? (Select all that apply)
A) Gown
B) Gloves
C) Surgical mask
D) N95 respirator
E) Eye protection
Answer: A, B, C, E
Rationale: Droplet precautions require a surgical mask, gown, gloves, and eye protection
when within 3 feet of the client. An N95 respirator (D) is required for airborne precautions,
not droplet precautions. Diseases requiring droplet precautions include influenza,
meningitis, and pertussis. The mask should be donned before entering the room, and all PPE
should be removed before exiting, with hand hygiene performed immediately after removal.
,Question 1.3
A nurse is caring for a client who is on fall precautions. Which of the following environmental
modifications is most effective for preventing falls?
A) Keep the floor free of clutter
B) Place the bed in the highest position
C) Remove the call light from the client's reach
D) Dim the lighting to promote sleep
Answer: A) Keep the floor free of clutter
Rationale: A clutter-free environment reduces fall risk by removing tripping hazards.
Additional fall prevention interventions include keeping the bed in the lowest position (not
highest, B), ensuring the call light is within reach (not removed, C), and providing adequate
lighting (not dim, D). The nurse should also ensure nonslip footwear, bed alarms if indicated,
and frequent rounding for high-risk clients.
Question 1.4
A nurse is preparing a sterile field. Which of the following actions maintains sterility?
A) Touch the sterile field with bare hands
B) Keep sterile items above the waist level
C) Place wet items on the sterile field
D) Open sterile packages toward the field
Answer: B) Keep sterile items above the waist level
Rationale: Keeping sterile items above waist level maintains sterility, as areas below the
waist are considered contaminated. The outer 1-inch margin of a sterile field is also
considered contaminated. Touching the field with bare hands (A) contaminates it; sterile
gloves must be worn. Wet items (C) can cause strike-through contamination by allowing
microorganisms to travel through capillary action to the sterile field. Opening sterile
packages away from the field (D) prevents contaminating the sterile area.
Question 1.5
A nurse is caring for a client with a urinary tract infection who requires a urine specimen for
culture and sensitivity. Which action is most appropriate?
A) Collect the first voided morning urine
B) Collect urine from the indwelling catheter drainage bag
C) Collect a clean-catch midstream specimen
D) Collect urine after the client has been off antibiotics for 24 hours
,Answer: C) Collect a clean-catch midstream specimen
Rationale: A clean-catch midstream specimen is the preferred method for urine culture as it
minimizes contamination from the perineum. First voided morning urine (A) is suitable for
routine urinalysis but may not be ideal for culture. Urine from the drainage bag (B) is not
appropriate as it has been sitting and bacteria may have multiplied. While antibiotics can
affect culture results, the provider determines if antibiotics should be discontinued before
collection (D).
Question 1.6
A nurse is caring for a client who has a stage IV pressure injury. Which intervention should
the nurse implement first?
A) Apply a moisture-barrier ointment
B) Cleanse the wound with normal saline
C) Obtain a wound culture
D) Consult the wound care nurse
Answer: B) Cleanse the wound with normal saline
Rationale: The first step in wound care is cleansing the wound to remove debris and
exudate. Normal saline is the preferred cleansing solution as it is isotonic and noncytotoxic.
Moisture-barrier ointment (A) may be applied after cleansing. Obtaining a wound culture (C)
may be ordered but is not the first intervention. Consulting the wound care nurse (D) is
appropriate but should not delay immediate cleansing.
Question 1.7
A nurse is preparing to insert an indwelling urinary catheter for a female client. Which action
is appropriate for maintaining sterility?
A) Clean the perineum from front to back
B) Lubricate the catheter with sterile water-soluble jelly
C) Use sterile gloves only, not sterile drapes
D) Open the catheter kit with ungloved hands
Answer: B) Lubricate the catheter with sterile water-soluble jelly
Rationale: Lubricating the catheter with sterile water-soluble jelly reduces friction and
prevents tissue trauma. The perineum should be cleaned from front to back (A) for infection
prevention, but this is to prevent introduction of rectal flora, not specifically for sterility.
Sterile drapes (C) should be used to maintain a sterile field. The catheter kit should be
opened with sterile technique after applying sterile gloves (D).
Question 1.8
, A nurse is caring for a client with a suspected Clostridium difficile infection. Which infection
control precaution should be implemented?
A) Contact precautions
B) Droplet precautions
C) Airborne precautions
D) Protective environment
Answer: A) Contact precautions
Rationale: C. difficile requires contact precautions because it is transmitted via direct or
indirect contact with contaminated surfaces and hands. Gloves and gown are required, and
alcohol-based hand sanitizers are not effective; handwashing with soap and water is
required. Droplet precautions (B) are for diseases like influenza and meningitis. Airborne
precautions (C) are for tuberculosis and measles. Protective environment (D) is for
immunocompromised clients.
Question 1.9
A nurse is administering a subcutaneous injection. Which action reduces the risk of
needlestick injury?
A) Recap the needle after use
B) Activate the safety shield after use
C) Place the uncapped needle on the bedside table
D) Dispose of the needle in the regular trash
Answer: B) Activate the safety shield after use
Rationale: Needlestick prevention devices should be activated immediately after use.
Recapping needles (A) is never recommended as it increases the risk of injury. Placing
uncapped needles on surfaces (C) creates a hazard. All sharps must be disposed of in
designated puncture-proof containers, not regular trash (D).
Question 1.10
A nurse is applying restraints to a client. Which action is appropriate?
A) Apply restraints to prevent the client from pulling out the feeding tube
B) Tie the restraints to the side rails of the bed
C) Document the client's behavior and alternatives attempted
D) Remove restraints every 4 hours to check circulation
Answer: C) Document the client's behavior and alternatives attempted
Rationale: The use of restraints requires careful documentation including the client's
behavior, alternatives attempted, and ongoing assessment. Restraints should only be used as
