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Exam (elaborations)

ATI Fundamentals Exam TESTS COMBINED WITH QUESTIONS WELL ILLUSTRATED & CORRECTLY ANSWERED

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ATI Fundamentals Exam TESTS COMBINED WITH QUESTIONS WELL ILLUSTRATED & CORRECTLY ANSWERED 1. When entering a client's room to change a surgical dressing, a nurse notes that the client is coughing and sneezing. When preparing the sterile field, it is important that the nurse A. keep the sterile field at least 6 ft away from the client's bedside. B. instruct the client to refrain from coughing and sneezing during the dressing change. C. place a mask on the client to limit the spread of micro-organisms into the surgical wound. D. keep a box of facial tissues nearby for the client to use during the dressing change. - ANSWER C. place a mask on the client to limit the spread of micro-organisms into the surgical wound. 2. A nurse is wearing sterile gloves in preparation for performing a sterile procedure. Which of the following objects may the nurse touch without breaching sterile technique? (Select all that apply.) A. A bottle containing a sterile solution B. The edge of the sterile drape at the base of the field C. The inner wrapping of an item on the sterile field D. An irrigation syringe on the sterile field E. One gloved hand with the other gloved hand - ANSWER C. The inner wrapping of an item on the sterile field D. An irrigation syringe on the sterile field E. One gloved hand with the other gloved hand 3. A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following flaps should the nurse unfold first? A. The flap closest to the body B. The right side flap C. The left side flap D. The flap farthest from the body - ANSWER D. The flap farthest from the body Unless the nurse pulls *the top flap [the one furthest from her body]* away from her body first, she risks touching part of the inner surface of the wrap and thus contaminating it. 4. A nurse is reviewing hand hygiene techniques with a group of assistive personnel (AP). Which of the following instructions should the nurse include when discussing handwashing? (Select all that apply.) A. Apply 3 to 5 mL of liquid soap to dry hands. B. Wash the hands with soap and water for at least 15 seconds. C. Rinse the hands with hot water. D. Use a clean paper towel to turn off hand faucets. E. Allow the hands to air dry after washing. - ANSWER B. Wash the hands with soap and water for at least 15 seconds. D. Use a clean paper towel to turn off hand faucets. 5. A nurse has prepared a sterile field for assisting a provider with a chest tube insertion. Which of the following events should the nurse recognize as contaminating the sterile field? (Select all that apply.) A. The provider drops a sterile instrument onto the near side of the sterile field. B. The nurse moistens a cotton ball with sterile normal saline and places it on the sterile field. C. The procedure is delayed 1 hr because the provider receives an emergency call. D. The nurse turns to speak to someone who enters through the door behind the nurse. E. The client's hand brushes against the outer edge of the sterile field. - ANSWER B. The nurse *moistens* a cotton ball with sterile normal saline and places it on the sterile field. C. The procedure is *delayed* 1 hr because the provider receives an emergency call. D. The nurse *turns* to speak to someone who enters through the door behind the nurse. 6. A nurse is caring for a client with a latex allergy. What steps should the nurse take when initiating an IV line on this client? – ANSWER • Label client's room as "latex-free" and keep latex-safe supply cart available in client's area • Use latex-safe gloves • Use latex-free equipment and supplies o Latex-safe syringes o Latex-safe IV tubing o Plastic or silk tape o Medications from glass ampules o No rubber injection ports o No medications w/a rubber stopper requiring puncture w/needle • Ensure epi and airway equipment at the ready in case of a reaction 7. Mobility and immobility assessment focuses on: - ANSWER - mobility; - range of motion (ROM); - gait; - exercise status; - activity tolerance; - body alignment while standing, sitting, and lying


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