ATI CMS Fundamentals Practice Exam Questions With Verified Solutions | Latest Updates With Rationales

ATI CMS Fundamentals Practice Exam Questions With Verified Solutions | Latest Updates With Rationales A nurse is giving chance-of shift report about a client they admitted earlier that day who has pneumonia. Which of the following pieces of information is the priority for the nurse to provide? a) Admitting diagnosis. b) Breath sounds. c) Body temperature. d) Diagnostic results. - ANSWER Correct answer: B. Breath sounds - When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority information to provide is the current status of the client's breath sounds. A nurse is caring for a client who has an NG tube and is receiving intermittent feedings through an open system. Which of the following actions should the nurse take first? a) Rinse the feeding bag with water between feedings. b) Tell the client to keep the head of the bed elevated at least 30°. c) Make sure the enteral formula is at room temperature. d) Wipe the top of the formula can with alcohol. - ANSWER Correct answer: B. - The first action the nurse should take when using the airway, breathing, circulation approach to client care is to prevent aspiration of the enteral formula; therefore, the priority intervention is to keep the head of the bed elevated at least 30° to prevent reflux of the formula into the esophagus A nurse is caring for a client who has tuberculosis. Which of the following actions should the nurse take? a) Place the client in a room with negative-pressure airflow b) Wear gloves when assisting the client with oral care. c) Limit each visitor to 2-hr increments. d) Wear a surgical mask when providing client care. e) Use antimicrobial sanitizer for hand hygiene - ANSWER Correct answer: A, B, E. - Place the client in a room with negative-pressure airflow is correct. The nurse should place the client in a room with negative-pressure airflow to meet the requirements of airborne precautions. Wear gloves when assisting the client with oral care is correct. The nurse should wear gloves when assisting the client with oral care to meet the requirements of standard precautions, which the nurse must adhere to for all clients regardless of their diagnosis. The nurse should wear gloves whenever their hands might come in contact with a client's bodily fluids, such as saliva, and the mucous membranes in the mouth. Limit each visitor to 2- hr increments is incorrect. The nurse does not need to limit the client's visitors. However, the nurse should limit the client's presence outside the room and the client should wear a surgical mask when outside of the room. Wear a surgical mask when providing client care is incorrect. The nurse should wear an N95 respirator during A nurse is performing a Romberg test during a physical assessment of a client. Which of the following techniques should the nurse use? a) Touch the face with a cotton ball. b) Apply a vibrating tuning fork to the client's forehead. c) Have the client stand with their arms at their sides and their feet together. d) Perform direct percussion over the area of the kidneys. - ANSWER Correct answer: C - A Romberg test helps identify alterations in balance. The nurse should have the client stand with their arms at their sides and their feet together to observe for swaying and a loss of balance. To obtain an accurate blood pressure measurement, - ANSWER the nurse should inflate the cuff 30 mm Hg beyond the point at which the nurse was last able to palpate the pulse. If the nurse last palpated the pulse at 92 mm Hg, then this would be the correct pressure to which the nurse should inflate the cuff. The 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 nuse transcribe the dosage of this medication in the