ATI PROCTORED FUNDAMENTALS EXAM()

ATI PROCTORED FUNDAMENTALS EXAM() A nurse is caring for a client who requires a 24-hr urine collection. Which of the following statements by the client indicates an understanding of the teaching? - CORRECT ANSWER-"I flushed what I urinated at 7:00 a.m. and have saved all urine since." A nurse is assessing a client who has been on bed rest for the past month. Which of the following findings should the nurse identify as an indication that the client has developed thrombophlebitis? - CORRECT ANSWER-Calf Swelling A nurse manager is overseeing the care on a unit. Which of the following situations should the nurse manager identify as a violation of HIPAA guidelines? - CORRECT ANSWER-A nurse asks a nurse from another unit to assist with her documentation. A nurse is caring for a client who requires bed rest and has a prescription for antiembolic stockings. Which of the following actions should the nurse take? - CORRECT ANSWER-Remove the stockings at least once per shift. A nurse is administering IV fluid to an older adult client. The nurse should perform which priority assessment to monitor for adverse effects? - CORRECT ANSWER-Auscultate Lung Sounds A nurse is teaching an older client who is at risk for osteoporosis about beginning a program of regular physical activity. Which of the following types of activity should the nurse recommend? - CORRECT ANSWER-Walking Briskly A nurse is assessing an adult client who has been immobile for the past 3 weeks. The nurse should identify that which of the following findings requires further intervention? - CORRECT ANSWER-Erythema on pressure points A nurse is responding to a call light and finds a client lying on the bathroom floor. Which of the following actions should the nurse take first? - CORRECT ANSWER-Check the client for injuries A nurse in a clinic is caring for a middle adult client who states, "The doctor says that, since I am at an average risk for colon cancer, I should have routine screening. What does that involve?" Which of the following responses should the nurse make? - CORRECT ANSWER-"You should have a fecal occult blood test every year." A nurse manager is preparing to review medication documentation with a group of newly licensed nurses. Which of the following statements should the nurse manager plan to include in the teaching? - CORRECT ANSWER-"Use the complete name of the medication magnesium sulfate." A nurse is caring for a client who has tuberculosis. Which of the following actions should the nurse take? - CORRECT ANSWER-Place the client in a room with negativepressure airflow. Wear gloves when assisting the client with oral care. Use antimicrobial sanitizer for hand hygiene. A nurse is caring for a client who has a prescription for 5 units of regular insulin and 10 units of NPH insulin to mix together and administer subcutaneously. Determine the correct order of steps for this procedure. - CORRECT ANSWER-Air into NPH Air into Regular Draw up Regular Draw up NPH A nurse is reviewing practice guidelines with a group of newly licensed nurses. Which of the following interventions should the nurse include that is within the RN scope of practice? - CORRECT ANSWER-Initiate an enteral feeding through a gastrostomy tube. A nurse is caring for a client who requires an NG tube for stomach decompression. Which of the following actions should the nurse take when inserting the NG tube? - CORRECT ANSWER-Have the client take sips of water to promote insertion of the NG tube into the esophagus. A nurse is assessing an older client's risk for falls. Which of the following assessments should the nurse use to identify the client's safety needs? - CORRECT ANSWER-Pupil Clarity Visual Fields Visual Acuity A nurse is evaluating a client's use of a cane. Which of the following actions should the nurse identify as an indication of correct use? - CORRECT ANSWER-The client holds the cane on the stronger side of her body. A nurse is performing a peripheral vascular assessment for a client. When placing the bell of the stethoscope on the client's neck, she hears the following sound. This sound indicates which of the following? - CORRECT ANSWER-Narrowed Arterial Lumen A nurse is admitting a client who has varicella. Which of the following types of transmission precautions should the nurse initiate? - CORRECT ANSWER-Airborne A nurse is preparing to administer multiple medications to a client who has an enteral feeding tube. Which of the following actions should the nurse plan to take? - CORRECT ANSWER-Flush the tube with 15 mL of sterile water. A nurse is caring for a client who has a prescription for wound irrigation. Which of the following actions should the nurse take? - CORRECT ANSWER-Cleanse the wound from the center outward. A nurse is providing care to four clients. Which of the following situations requires the nurse the complete an incident report? - CORRECT ANSWER-A client who has an IV infusion pump receives an additional 250 mL of IV fluid. A nurse is caring for a client receiving fluid through a peripheral IV catheter. Which of the following findings at the IV site should the nurse identify as infiltration? - CORRECT ANSWER-Skin Blanching A nurse is preparing a change-of-shift report. Which of the following tools or documents should the nurse use to communicate continuity of care? - CORRECT ANSWERSituation, Background, Assessment, and Recommendation (SBAR) A nurse is admitting a client who has an abdominal wound with a large amount of purulent drainage. Which of the following types of transmission precautions should the nurse initiate? - CORRECT ANSWER-Contact Precautions A nurse is caring for a client who is having difficulty breathing. The client is lying in bed with a nasal cannula delivering oxygen. Which of the following interventions should the nurse take first? - CORRECT ANSWER-Assist the client to an upright position. A nurse is reviewing a client's fluid and electrolyte status. Which of the following findings should the nurse report to the provider? - CORRECT ANSWER-Potassium 5.4 meq/L A nurse is lifting a bedside cabinet to move it closer to a client who is sitting in a chair. To prevent self-injury, which of the following actions should the nurse take when lifting this object? - CORRECT ANSWER-Stand close to the cabinet when lifting it. A nurse is caring for a client who is refusing a blood transfusion for religious reasons. The client's partner wants the client to have the blood transfusion. Which of the following actions should the nurse take? - CORRECT ANSWER-Withhold the blood transfusion. A nurse is reviewing protocol in preparation for suctioning secretions from a client who has a new tracheostomy. Which of the following actions should the nurse plan to take? - CORRECT ANSWER-Select a suction catheter that is half the size of the lumen. A nurse in a long-term care facility is planning to perform hygiene care for a new resident. Which of the following assessment questions is the nurse's priority before beginning this procedure? - CORRECT ANSWER-"Are you able to help with your hygiene care?" A nurse is giving discharge instructions to a client who will require oxygen therapy at home. Which of the following statements should the nurse identify as an indication that the client understands how to manage this therapy at home? - CORRECT ANSWER-"I'll check the wires and cables on my TV to make sure they are in good working order." A nurse is preparing to administer an injection of an opioid medication to a client. The nurse draws out 1 mL of the medication from a 2 mL vial. Which of the following actions should the nurse take? - CORRECT ANSWER-Ask another nurse to observe the medication wastage. A nurse has accepted a verbal prescription for three tenths of a milligram of levothyroxine IV stat for a client who has myxedema coma. How should the nurse transcribe the dosage of this medication in the client's medical record? - CORRECT ANSWER-0.3 mg A nurse is caring for a client who is terminally ill. Which of the following statements should the nurse identify as an indication that the client's family member is coping effectively with the situation? - CORRECT ANSWER-"This is a difficult time, but we are helping each other through this." A nurse is preparing to transfer a client who has right-sided weakness from the bed to a chair. In what order should the nurse take the following actions to assist the client? - CORRECT ANSWER-1. Ask the client if he can bear weight. 2. Position the chair on the left side of the bed. 3. Have the client sit and dangle his feet at the bedside. 4. Use the stand-and-pivot technique to move the client to the chair. A nurse is caring for a client who reports pain. When documenting the quality of the client's pain on an initial pain assessment, the nurse should record which of the following client statements? - CORRECT ANSWER-"The pain is like a dull ache in my stomach." A nurse is caring for a client who asks about the purpose of advance directives. Which of the following statements should the nurse make? - CORRECT ANSWER-"They indicate the form of treatment a client is willing to accept in the event of a serious illness." A nurse is completing an admission assessment for a client who reports vomiting and diarrhea for the past 3 days. Which of the following assessment findings should the nurse expect? - CORRECT ANSWER-Rapid Heart Rate