ATI RN Fundamentals Proctored EXAM LATEST 200
QUESTIONS AND 100- Verified ANSWERS JUST
RELEASED
SECTION 1: SAFETY & INFECTION CONTROL
1. A nurse is applying restraints to a confused client. Which action is required?
A. Secure the restraint to the bed rail
B. Check circulation every 2 hours
C. Obtain a provider's order within 1 hour
D. Use a square knot for quick release
Answer: C. Obtain a provider's order within 1 hour
Rationale: A provider's order is required within 1 hour for restraints to ensure legal
and ethical use. Restraints should not be tied to bed rails, circulation checks are
more frequent, and quick-release knots are standard.
2. A patient is on contact precautions for MRSA. Which action is most
appropriate?
A. Wear gloves only for procedures
B. Wear gloves and gown for all patient contact
C. Use alcohol-based hand sanitizer only
D. Allow visitors without PPE
Answer: B. Wear gloves and gown for all patient contact
Rationale: Contact precautions require gloves and gown for all interactions to
prevent MRSA spread. Gloves alone or sanitizer alone are insufficient. Visitors need
PPE.
,3. A nurse is caring for a client diagnosed with severe acute respiratory
syndrome (SARS). The nurse is aware that health care professionals are required
to report communicable and infectious diseases. Which of the following
illustrate the rationale for reporting? (Select all that apply)
A. Planning and evaluating control and prevention strategies
B. Determining public health priorities
C. Ensuring proper medical treatment
D. Identifying endemic disease
E. Monitoring for common-source outbreaks
Answer: A, B, C, E
Rationale: Reporting is necessary for planning/evaluating strategies, determining
public health priorities, ensuring proper treatment, and monitoring outbreaks.
Endemic disease is already prevalent, so reporting is not necessary for
identification.
4. A nursing instructor is reviewing documentation with a group of nursing
students. Which of the following legal guidelines should they follow when
documenting in a client's record? (Select all that apply)
A. Cover errors with correction fluid and write in the correct information
B. Put the date and time on all entries
C. Document objective data, leaving out opinions
D. Use as many abbreviations as possible
E. Wait until the end of the shift to document
Answer: B, C
Rationale: Documentation must include date and time on all entries and should be
objective, leaving out opinions. Errors should be corrected with a single line and
"mistaken entry," not correction fluid. Abbreviations should be limited.
Documentation should occur in real-time.
,5. A nurse is discussing occurrences that require completion of an incident
report with a newly licensed nurse. Which of the following should the nurse
include in the teaching? (Select all that apply)
A. Medication error
B. Needlestick
C. Conflict with a provider and nursing staff
D. Omission of prescription
E. Missed specimen collection of a prescribed laboratory test
Answer: A, B, D
Rationale: Incident reports are required for medication errors, needlesticks, and
omissions of prescriptions. Staff conflicts and missed lab specimen collections are
not typically considered reportable incidents.
6. A nurse is caring for a client who has a low platelet count as a result of
chemotherapy. Which of the following is the nurse's priority instruction for
measuring vital signs for this client?
A. "Don't measure the client's temperature rectally."
B. "Count the client's radial pulse for 30 seconds and multiply by 2."
C. "Don't let the client know you are counting her respirations."
D. "Let the client rest for 5 minutes before you measure her BP."
Answer: A. "Don't measure the client's temperature rectally."
Rationale: The greatest risk to a client with a low platelet count is injury that
results in bleeding. Obtaining a temperature rectally increases the risk for
bleeding.
7. A nurse is evaluating an assistive personnel (AP) who is changing the linens
for a client on contact precautions. Which of the following actions by the AP
requires intervention by the nurse?
, A. Shaking the clean linens to fully extend them over the bed
B. Placing dirty linens directly into a designated biohazard bag
C. Disinfecting the mattress after removing the soiled sheets
D. Removing gloves and performing hand hygiene before leaving the room
Answer: A. Shaking the clean linens to fully extend them over the bed
Rationale: Shaking linens creates air currents that can lift and disperse
microorganisms and pathogens throughout the room environment. Linens should
be carefully rolled inwards without shaking.
8. A nurse is preparing to administer an enteral feeding to a client via a
nasogastric (NG) tube. Which action should the nurse take first?
A. Flush the tube with 30 mL of warm water
B. Verify the placement of the tube by checking the gastric pH
C. Warm the formula to room temperature
D. Elevate the head of the bed to 30 degrees
Answer: B. Verify the placement of the tube by checking the gastric pH
Rationale: The nurse's first action must always be safety-focused. Verifying proper
tube placement prevents accidental administration of formula into the lungs,
which can cause severe aspiration pneumonia.
9. A nurse is performing hand hygiene. How long should they scrub with soap
and water?
A. 10 seconds
B. 40-60 seconds
C. 20 seconds
D. 5 seconds
Answer: B. 40-60 seconds
QUESTIONS AND 100- Verified ANSWERS JUST
RELEASED
SECTION 1: SAFETY & INFECTION CONTROL
1. A nurse is applying restraints to a confused client. Which action is required?
A. Secure the restraint to the bed rail
B. Check circulation every 2 hours
C. Obtain a provider's order within 1 hour
D. Use a square knot for quick release
Answer: C. Obtain a provider's order within 1 hour
Rationale: A provider's order is required within 1 hour for restraints to ensure legal
and ethical use. Restraints should not be tied to bed rails, circulation checks are
more frequent, and quick-release knots are standard.
2. A patient is on contact precautions for MRSA. Which action is most
appropriate?
A. Wear gloves only for procedures
B. Wear gloves and gown for all patient contact
C. Use alcohol-based hand sanitizer only
D. Allow visitors without PPE
Answer: B. Wear gloves and gown for all patient contact
Rationale: Contact precautions require gloves and gown for all interactions to
prevent MRSA spread. Gloves alone or sanitizer alone are insufficient. Visitors need
PPE.
,3. A nurse is caring for a client diagnosed with severe acute respiratory
syndrome (SARS). The nurse is aware that health care professionals are required
to report communicable and infectious diseases. Which of the following
illustrate the rationale for reporting? (Select all that apply)
A. Planning and evaluating control and prevention strategies
B. Determining public health priorities
C. Ensuring proper medical treatment
D. Identifying endemic disease
E. Monitoring for common-source outbreaks
Answer: A, B, C, E
Rationale: Reporting is necessary for planning/evaluating strategies, determining
public health priorities, ensuring proper treatment, and monitoring outbreaks.
Endemic disease is already prevalent, so reporting is not necessary for
identification.
4. A nursing instructor is reviewing documentation with a group of nursing
students. Which of the following legal guidelines should they follow when
documenting in a client's record? (Select all that apply)
A. Cover errors with correction fluid and write in the correct information
B. Put the date and time on all entries
C. Document objective data, leaving out opinions
D. Use as many abbreviations as possible
E. Wait until the end of the shift to document
Answer: B, C
Rationale: Documentation must include date and time on all entries and should be
objective, leaving out opinions. Errors should be corrected with a single line and
"mistaken entry," not correction fluid. Abbreviations should be limited.
Documentation should occur in real-time.
,5. A nurse is discussing occurrences that require completion of an incident
report with a newly licensed nurse. Which of the following should the nurse
include in the teaching? (Select all that apply)
A. Medication error
B. Needlestick
C. Conflict with a provider and nursing staff
D. Omission of prescription
E. Missed specimen collection of a prescribed laboratory test
Answer: A, B, D
Rationale: Incident reports are required for medication errors, needlesticks, and
omissions of prescriptions. Staff conflicts and missed lab specimen collections are
not typically considered reportable incidents.
6. A nurse is caring for a client who has a low platelet count as a result of
chemotherapy. Which of the following is the nurse's priority instruction for
measuring vital signs for this client?
A. "Don't measure the client's temperature rectally."
B. "Count the client's radial pulse for 30 seconds and multiply by 2."
C. "Don't let the client know you are counting her respirations."
D. "Let the client rest for 5 minutes before you measure her BP."
Answer: A. "Don't measure the client's temperature rectally."
Rationale: The greatest risk to a client with a low platelet count is injury that
results in bleeding. Obtaining a temperature rectally increases the risk for
bleeding.
7. A nurse is evaluating an assistive personnel (AP) who is changing the linens
for a client on contact precautions. Which of the following actions by the AP
requires intervention by the nurse?
, A. Shaking the clean linens to fully extend them over the bed
B. Placing dirty linens directly into a designated biohazard bag
C. Disinfecting the mattress after removing the soiled sheets
D. Removing gloves and performing hand hygiene before leaving the room
Answer: A. Shaking the clean linens to fully extend them over the bed
Rationale: Shaking linens creates air currents that can lift and disperse
microorganisms and pathogens throughout the room environment. Linens should
be carefully rolled inwards without shaking.
8. A nurse is preparing to administer an enteral feeding to a client via a
nasogastric (NG) tube. Which action should the nurse take first?
A. Flush the tube with 30 mL of warm water
B. Verify the placement of the tube by checking the gastric pH
C. Warm the formula to room temperature
D. Elevate the head of the bed to 30 degrees
Answer: B. Verify the placement of the tube by checking the gastric pH
Rationale: The nurse's first action must always be safety-focused. Verifying proper
tube placement prevents accidental administration of formula into the lungs,
which can cause severe aspiration pneumonia.
9. A nurse is performing hand hygiene. How long should they scrub with soap
and water?
A. 10 seconds
B. 40-60 seconds
C. 20 seconds
D. 5 seconds
Answer: B. 40-60 seconds
