ATI RN Fundamentals Practice Tests A & B
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Terms in this set (117)
A nurse is caring for a client who reports "The pain is like a dull ache in my stomach"
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?
"I am having mild pain"
"The pain is like a dull ache in my
stomach"
"I notice that the pain gets worse after I
eat"
"The pain makes me feel nauseous"
A client in non ambulatory notifies the Evacuate the client
nurse that his trash can is on fire. After the
nurse confirms the presence of the fire,
which of the following actions should the
nurse take next?
Activate the emergency fire alarm
Extinguish the fire
Evacuate the client
Confine the fire
A nurse is completing an admission Rapid heart rate
assessment for a client who reports
vomiting and diarrhea for the past 3 days.
Which of the following findings should
the nurse expect?
Neck vein distention
Urine specific gravity 1.010
Rapid Heart rate
Blood pressure 144/82 mmHg
,A nurse has accepted a verbal 0.3 mg
prescription for "thee 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?
.3 mg
0.3 mg
0.30 mg
3/10 mg
A nurse is preparing a heparin infusion for 8 ml/hour
a client who was admitted to the facility
with deep vein thrombosis. The
prescription reads: 25,000 units of heparin
in 0.9% sodium chloride 250 ml to infuse
at 800 units/hour. At what rate should the
nurse set the infusion pump?
A nurse is caring for a client who has a Cleanse the wound from the center outward
prescription for wound irrigation. Which
of the following actions should the nurse
take?
Wear sterile gloves when removing the
old dressing
Warm the irrigation solution to 40.5 C
(105 F)
Cleanse the wound from the center
outward
Use a 20 ml syringe to irrigate the wound
A nurse is caring for a client who is Skin blanching
receiving fluid through a peripheral IV
catheter. Which of the following findings
at the IV site should the nurse identify as
indicating infiltration?
Purulent exudate
Warmth
Skin blanching
Bleeding
A nurse is teaching a client whose left leg "When descending the stairs, I will first shift my weight to my right leg"
is in a cast about using crutches. Which of
the following statements should the nurse
identify as an indication that the client
understands the teaching?
"When descending the stairs, I will first
shift my weight to my right leg"
"I should place my crutches 12 inches in
front and to the side of each foot"
"As I sit down, I will hold one crutch in
each hand"
"I will make sure the shoulder rests are
snug against my armpits"
, A nurse is caring for a client who has an Tell the client to keep the head of the bed elevated at least 30 degrees
NG tube and is receiving intermittent
feedings through an open system. Which
of the following actions should the nurse
take first?
Rinse the feeding back with water
between feedings
Tell the client to keep the head of the bed
elevated at least 30 degrees
Make sure the enteral formula is at room
temperature
Wipe the top of the formula can with
alcohol
A nurse is reviewing a client's medication Medication dose
prescription that reads, "digoxin 0.25 by
mouth every day". Which of the following
components of the prescription should
the nurse verify with the provider?
Medication name
Route of administration
Medication dose
Frequency of administration
A nurse is caring for a client who has "I will be sure to remove my hearing aid before taking a shower"
recently started using a behind the ear
hearing aid. Which of the following
statements should the nurse identify as an
indication that the client understands the
use of this assistive device?
"This type of hearing aid does not allow
for fine tuning of volume"
"I shouldn't have trouble keeping the
hearing aid in place during exercise"
"I expect to hear a whistling sound when I
first insert the hearing aid"
"I will be sure to remove my hearing aid
before taking a shower"
A nurse enters a client's room and finds "Client found lying on the floor"
her on the floor. The client's roommate
reports that the client was trying to get
out of bed and fell over the side rail onto
the floor. Which of the following
statements should the nurse document
about this incident?
"Incident report completed"
"Client climbed over the side rails"
"Client found lying on the floor"
"Client was trying to get out of bed"