CCC 1 ATI Fundamentals PN Funds Practice Set 2 of 4
comprehensive Questions and Answers with 100%
Correct Answers | Latest Version
Question 1.
A nurse is auscultation the breath sounds of a client who has asthma. When the client
exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should
document this as which of the following? * Crackles * Rhonchi * Wheezes * Stridor
Correct Answer: Wheezes - Wheezes are continous, high-pitched squeaking sounds,
first evident on expiration, but possibly evident on inspiration as the sirway
obstruction of asthma worsens. Wheezes are often audible without a stethoscope.
Question 2.
A nurse is receiving a provider's prescription for a client via telephone. Which of the following
actions should the nurse take to ensure the accuracy of the telephone prescription? (SATA)
* Repeat the order back to the prescriber * Question any part of the prescription that is
unclear or inappropriate * Transcribe the prescription into the client's medical record * Obtain
the prescriber's signature within 8 hr * Implement a voice mail prescription if the nurse can
hear and understand it well
Correct Answer: Repeat the order back to the prescriber - The nurse should read it
back and have the prescriber confirm verbally that it is correct. Question any part of
the prescription that is unclear or inappropriate is correct. - This is essential for any
prescription, verbal or written. Transcribe the prescription into the client's medical
record is correct. - This is the usual procedure after accepting a telephone
prescription. *********************************** Obtain the prescriber's signature within 8
hr is INCORRECT. Although the policy may vary with the facility, the usual rule is to
obtain the prescriber's signature within 24 hr Implement a voice mail prescription if
you can hear and understand it well is INCORRECT. If a provider leaves a voice mail
prescription, the nurse should call back the provider and take the prescription
verbally over the telephone.
Question 3.
A nurse is planning to collect data on a client's abdomen who reports "stomach pain". Which
of the following actions should the nurse do first? * Auscultate * Percuss * Inspect * Palpate
Correct Answer: Inspect - The nurse should inspect the abdomen for external
abnormal conditions first
, Question 4.
A nurse is caring for an older client who has a fractured hip and will require rehabilitative
care. Which of the following statements is appropriate? * Rehabilitation began with the
client's admission to the hospital * The focus of rehabilitative care is the client's physical
injuries * The client will require long-term rehabilitation services * The client will require
inpatient rehabilitation services
Correct Answer: Rehabilitation - Rehabilitation is a process that assists an ill person
or a person with a disability or impairment to achieve the best possible level of
functioning. The process of rehabilitation begins with the client's acute care hospital
admission.
Question 5.
A nurse is preparing to administer a cleansing enema for a client who has constipation.
Which of the following is an appropriate action by the nurse? * Keep the container of solution
at a level to maintain client comfort. * Hold the container of solution 12 inches above the
anus * Hold the container of solution level with the upper hip * Slowly lower the container 24
inches below the anus
Correct Answer: Hold the container of solution 12 inches above the anus - The nurse
holding the container of solution 12 to 18 inches above the anus is correct to allow a
greater force of fluid flowing to properly cleanse the colon.
Question 6.
A nurse is reinforcing teaching to a group of assistive personal (AP) about caring for clients
with restraints. Which of the following state- ments by one of the APs indicates an
understanding of the teaching? * I will tie restraints in double knots * I will tie a restraints to
the moving parts of the bed frame * I will ensure that restraints fit tightly against the client * I
will put four side rails up if a client is confused
Correct Answer: I will tie a restraint to the moving part of the bed frame - This
statement by one of the AP's indicates an understanding of the teaching. Restraints
should be tied to the moving part of the bed frame
Question 7.
A nurse is caring for a client and is in the nurse-client helping relationship. Which of the
following communication techniques should the nurse use in this phase? * Elicit information
from the client * Encourage the client to use self-exploration * Review the client's progress
toward personal objectives * Talk with others who have information about the client
Correct Answer: Elicit information from the client - Obtaining information from the
client is an appropriate communication technique in the orientation phase
comprehensive Questions and Answers with 100%
Correct Answers | Latest Version
Question 1.
A nurse is auscultation the breath sounds of a client who has asthma. When the client
exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should
document this as which of the following? * Crackles * Rhonchi * Wheezes * Stridor
Correct Answer: Wheezes - Wheezes are continous, high-pitched squeaking sounds,
first evident on expiration, but possibly evident on inspiration as the sirway
obstruction of asthma worsens. Wheezes are often audible without a stethoscope.
Question 2.
A nurse is receiving a provider's prescription for a client via telephone. Which of the following
actions should the nurse take to ensure the accuracy of the telephone prescription? (SATA)
* Repeat the order back to the prescriber * Question any part of the prescription that is
unclear or inappropriate * Transcribe the prescription into the client's medical record * Obtain
the prescriber's signature within 8 hr * Implement a voice mail prescription if the nurse can
hear and understand it well
Correct Answer: Repeat the order back to the prescriber - The nurse should read it
back and have the prescriber confirm verbally that it is correct. Question any part of
the prescription that is unclear or inappropriate is correct. - This is essential for any
prescription, verbal or written. Transcribe the prescription into the client's medical
record is correct. - This is the usual procedure after accepting a telephone
prescription. *********************************** Obtain the prescriber's signature within 8
hr is INCORRECT. Although the policy may vary with the facility, the usual rule is to
obtain the prescriber's signature within 24 hr Implement a voice mail prescription if
you can hear and understand it well is INCORRECT. If a provider leaves a voice mail
prescription, the nurse should call back the provider and take the prescription
verbally over the telephone.
Question 3.
A nurse is planning to collect data on a client's abdomen who reports "stomach pain". Which
of the following actions should the nurse do first? * Auscultate * Percuss * Inspect * Palpate
Correct Answer: Inspect - The nurse should inspect the abdomen for external
abnormal conditions first
, Question 4.
A nurse is caring for an older client who has a fractured hip and will require rehabilitative
care. Which of the following statements is appropriate? * Rehabilitation began with the
client's admission to the hospital * The focus of rehabilitative care is the client's physical
injuries * The client will require long-term rehabilitation services * The client will require
inpatient rehabilitation services
Correct Answer: Rehabilitation - Rehabilitation is a process that assists an ill person
or a person with a disability or impairment to achieve the best possible level of
functioning. The process of rehabilitation begins with the client's acute care hospital
admission.
Question 5.
A nurse is preparing to administer a cleansing enema for a client who has constipation.
Which of the following is an appropriate action by the nurse? * Keep the container of solution
at a level to maintain client comfort. * Hold the container of solution 12 inches above the
anus * Hold the container of solution level with the upper hip * Slowly lower the container 24
inches below the anus
Correct Answer: Hold the container of solution 12 inches above the anus - The nurse
holding the container of solution 12 to 18 inches above the anus is correct to allow a
greater force of fluid flowing to properly cleanse the colon.
Question 6.
A nurse is reinforcing teaching to a group of assistive personal (AP) about caring for clients
with restraints. Which of the following state- ments by one of the APs indicates an
understanding of the teaching? * I will tie restraints in double knots * I will tie a restraints to
the moving parts of the bed frame * I will ensure that restraints fit tightly against the client * I
will put four side rails up if a client is confused
Correct Answer: I will tie a restraint to the moving part of the bed frame - This
statement by one of the AP's indicates an understanding of the teaching. Restraints
should be tied to the moving part of the bed frame
Question 7.
A nurse is caring for a client and is in the nurse-client helping relationship. Which of the
following communication techniques should the nurse use in this phase? * Elicit information
from the client * Encourage the client to use self-exploration * Review the client's progress
toward personal objectives * Talk with others who have information about the client
Correct Answer: Elicit information from the client - Obtaining information from the
client is an appropriate communication technique in the orientation phase
