ATI Fundamentals Test Exam 5 2026
A nurse is administering 1 L of 0.9% sodium chloride to a client who is
postoperative and has fluid volume deficit. Which of the following changes
should the nurse identify as an indication that the treatment was successful?
Increase in hematocrit
increase in respiratory
rate Decrease in heart
rate
Decrease in capillary refill time - Correct Answer:
Decrease in heart rate
Fluid volume deficit causes tachycardia. With correction of the imbalance, the
heart rate should return to the expected range.
Incorrect Answers:
Increase in hematocrit:
Fluid volume deficit causes an increase in hematocrit level due to depletion of
extracellular fluid. With correction of the imbalance, the hematocrit level should
decrease.
increase in respiratory rate
Fluid volume deficit causes an increase in respiratory rate. With correction of
the imbalance, the respiratory rate should return to the expected range.
Decrease in capillary refill time
Fluid volume deficit slows capillary refill. With correction of the imbalance,
capillary refill time should return to the expected range.
A nurse is caring for a client who is scheduled to be transferred to a long-term
care facility. The client's family questions the nurse about the reasons for the
transfer. Which of the following responses made by the nurse is appropriate?
"The transfer of your family member is being done because the provider knows
what's best." "Would you like it if we discussed the transfer with your family
member?"
"Why are you so concerned about this transfer?"
"I know how you feel. My parent had to be transferred to a long-term care
facility." - Correct Answer:
"Would you like it if we discussed the transfer with your family member?"
This response facilitates therapeutic communication and provides general leads
while maintaining client confidentiality.
Incorrect Answers:
"The transfer of your family member is being done because the provider knows
what's best." This is a defensive response which can hinder further
,communication.
"Why are you so concerned about this transfer?"
Asking a why question can make the recipient defensive which can hinder
further communication.
"I know how you feel. My parent had to be transferred to a long-term care
facility."
This is a sympathetic response, which can interfere with a therapeutic
relationship.
A nurse is reviewing the laboratory results of a female client who has
hypovolemia. Which of the following laboratory result would be a priority for
the nurse report to the provider?
BUN 21 mg/dL (10 to 20 mg/dL)
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
Sodium 132 mEq/L (136 to 145 mEq/L)
Potassium 5.8 mEq/L (3.5 to 5 mEq/L) - Correct Answer:
Potassium 5.8 mEq/L (3.5 to 5 mEq/L)
When using the urgent versus nonurgent approach to client care, the nurse
should determine that this potassium level is above the expected reference range
and should be reported to the provider. Potassium affects the contractility of the
heart and this client would be at risk for developing dysrhythmias.
Incorrect answers:
BUN 21 mg/dL (10 to 20 mg/dL)
This BUN level is slightly above the expected reference range and is an
expected non-urgent finding for a client who has hypovolemia; therefore, there
is another laboratory result that is a priority for the nurse to report to the
provider.
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
This creatinine level is slightly above the expected reference range and is an
expected non- urgent finding for a client who has hypovolemia; therefore, there
is another laboratory result that is a a priority for the nurse to report to the
provider.
Sodium 132 mEq/L (136 to 145 mEq/L)
This sodium level is slightly below the expected reference range and is an
expected non- urgent finding for a client who has hypovolemia; therefore, there
is another laboratory result that is a priority for the nurse to report to the
provider.
A nurse is caring for a client who reports difficulty falling asleep. Which of the
following recommendations should the nurse make?
,"Drink a cup of hot cocoa before bedtime."
"Maintain a consistent time to wake up each
day." "Exercise 1 hour before going to bed."
"Watch a television program in bed before going to sleep." - Correct
Answer: "Maintain a consistent time to wake up each day."
The client should maintain a consistent time for waking up and going to sleep.
This helps to establish an internal sense of sleep and waking on a daily basis
and helps to maintain it over time. This will help promote sleep for the client.
Incorrect Answers:
"Drink a cup of hot cocoa before bedtime."
Cocoa contains caffeine, which is a stimulant that can interfere with sleep.
"Exercise 1 hour before going to bed."
Exercising within 2 hr of bedtime can interfere with sleep.
"Watch a television program in bed before going to sleep."
The client should avoid watching television in bed before going to sleep to
reduce stimulation in order to promote rest.
A nurse on a medical-surgical unit is caring for a client who has a new
prescription for wrist restraints. Which of following actions should the nurse
take?
Pad the client's wrist before applying the restraints.
Evaluate the client's circulation every 8 hr after
application.
Remove the restraints every 4 hr to evaluate the client's
status. Secure the restraint ties to the bed's side rails. -
Correct Answer: Pad the client's wrist before applying
the restraints.
The use of restraints without padding can abrade the client's skin, resulting in
client injury.
Incorrect Answers:
Evaluate the client's circulation every 8 hr after application.
The nurse should evaluate the client's circulation, range of motion, vital signs,
and overall status every 15 min after initial application of restraints.
Remove the restraints every 4 hr to evaluate the client's status.
The nurse should remove the restraints at least every 2 hr to reposition the client
and assess needs for hygiene and toileting.
Secure the restraint ties to the bed's side rails.
The nurse should secure the restraint ties to a part of the bed frame that moves
with the client to reduce the risk of injury.
A client who is nonambulatory notifies the nurse that their 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. - Correct Answer:
Evacuate the client.
According to the RACE mnemonic, the first action in response to a fire is
to rescue the clients, moving them to a safe area.
Incorrect Answers:
Activate the emergency fire alarm.
According to the RACE mnemonic, the second action in response to a fire is to
activate the alarm.
Extinguish the fire.
According to the RACE mnemonic, the fourth action in response to a fire is to
attempt to extinguish the fire.
Confine the fire.
According to the RACE mnemonic, the third action in response to a fire is to
contain the fire by closing all the doors and windows in the area. The nurse
should also turn off oxygen and electrical equipment in the area of the fire.
A nurse is preparing to administer 0.9% sodium chloride 750 mL IV to infuse
over 7 hr. The nurse should set the infusion pump to deliver how many mL/hr? -
107 mL/hr
A nurse is assessing four adult clients. Which of the following physical
assessment techniques should the nurse use?
Use the Face, Legs, Activity, Cry, and Consolability (FLACC) pain rating scale
for a client who is experiencing pain.
Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm.
Obtain an apical heart rate by auscultating at the third intercostal space left of
the sternum. Palpate the client's abdomen before auscultating bowel sounds. -
Correct Answer:
Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm.
The nurse should use a blood pressure cuff with a bladder that surrounds 80% of
the client's arm circumference to give an accurate reading.
Incorrect Answers:
Use the Face, Legs, Activity, Cry, and Consolability (FLACC) pain rating scale
for a client who is experiencing pain.
The nurse should use an age-appropriate pain-rating scale, such as the visual
analog or numerical scale, when assessing the pain level of an adult. The
A nurse is administering 1 L of 0.9% sodium chloride to a client who is
postoperative and has fluid volume deficit. Which of the following changes
should the nurse identify as an indication that the treatment was successful?
Increase in hematocrit
increase in respiratory
rate Decrease in heart
rate
Decrease in capillary refill time - Correct Answer:
Decrease in heart rate
Fluid volume deficit causes tachycardia. With correction of the imbalance, the
heart rate should return to the expected range.
Incorrect Answers:
Increase in hematocrit:
Fluid volume deficit causes an increase in hematocrit level due to depletion of
extracellular fluid. With correction of the imbalance, the hematocrit level should
decrease.
increase in respiratory rate
Fluid volume deficit causes an increase in respiratory rate. With correction of
the imbalance, the respiratory rate should return to the expected range.
Decrease in capillary refill time
Fluid volume deficit slows capillary refill. With correction of the imbalance,
capillary refill time should return to the expected range.
A nurse is caring for a client who is scheduled to be transferred to a long-term
care facility. The client's family questions the nurse about the reasons for the
transfer. Which of the following responses made by the nurse is appropriate?
"The transfer of your family member is being done because the provider knows
what's best." "Would you like it if we discussed the transfer with your family
member?"
"Why are you so concerned about this transfer?"
"I know how you feel. My parent had to be transferred to a long-term care
facility." - Correct Answer:
"Would you like it if we discussed the transfer with your family member?"
This response facilitates therapeutic communication and provides general leads
while maintaining client confidentiality.
Incorrect Answers:
"The transfer of your family member is being done because the provider knows
what's best." This is a defensive response which can hinder further
,communication.
"Why are you so concerned about this transfer?"
Asking a why question can make the recipient defensive which can hinder
further communication.
"I know how you feel. My parent had to be transferred to a long-term care
facility."
This is a sympathetic response, which can interfere with a therapeutic
relationship.
A nurse is reviewing the laboratory results of a female client who has
hypovolemia. Which of the following laboratory result would be a priority for
the nurse report to the provider?
BUN 21 mg/dL (10 to 20 mg/dL)
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
Sodium 132 mEq/L (136 to 145 mEq/L)
Potassium 5.8 mEq/L (3.5 to 5 mEq/L) - Correct Answer:
Potassium 5.8 mEq/L (3.5 to 5 mEq/L)
When using the urgent versus nonurgent approach to client care, the nurse
should determine that this potassium level is above the expected reference range
and should be reported to the provider. Potassium affects the contractility of the
heart and this client would be at risk for developing dysrhythmias.
Incorrect answers:
BUN 21 mg/dL (10 to 20 mg/dL)
This BUN level is slightly above the expected reference range and is an
expected non-urgent finding for a client who has hypovolemia; therefore, there
is another laboratory result that is a priority for the nurse to report to the
provider.
Creatinine 1.4 mg/dL (0.5 to 1.1 mg/dL)
This creatinine level is slightly above the expected reference range and is an
expected non- urgent finding for a client who has hypovolemia; therefore, there
is another laboratory result that is a a priority for the nurse to report to the
provider.
Sodium 132 mEq/L (136 to 145 mEq/L)
This sodium level is slightly below the expected reference range and is an
expected non- urgent finding for a client who has hypovolemia; therefore, there
is another laboratory result that is a priority for the nurse to report to the
provider.
A nurse is caring for a client who reports difficulty falling asleep. Which of the
following recommendations should the nurse make?
,"Drink a cup of hot cocoa before bedtime."
"Maintain a consistent time to wake up each
day." "Exercise 1 hour before going to bed."
"Watch a television program in bed before going to sleep." - Correct
Answer: "Maintain a consistent time to wake up each day."
The client should maintain a consistent time for waking up and going to sleep.
This helps to establish an internal sense of sleep and waking on a daily basis
and helps to maintain it over time. This will help promote sleep for the client.
Incorrect Answers:
"Drink a cup of hot cocoa before bedtime."
Cocoa contains caffeine, which is a stimulant that can interfere with sleep.
"Exercise 1 hour before going to bed."
Exercising within 2 hr of bedtime can interfere with sleep.
"Watch a television program in bed before going to sleep."
The client should avoid watching television in bed before going to sleep to
reduce stimulation in order to promote rest.
A nurse on a medical-surgical unit is caring for a client who has a new
prescription for wrist restraints. Which of following actions should the nurse
take?
Pad the client's wrist before applying the restraints.
Evaluate the client's circulation every 8 hr after
application.
Remove the restraints every 4 hr to evaluate the client's
status. Secure the restraint ties to the bed's side rails. -
Correct Answer: Pad the client's wrist before applying
the restraints.
The use of restraints without padding can abrade the client's skin, resulting in
client injury.
Incorrect Answers:
Evaluate the client's circulation every 8 hr after application.
The nurse should evaluate the client's circulation, range of motion, vital signs,
and overall status every 15 min after initial application of restraints.
Remove the restraints every 4 hr to evaluate the client's status.
The nurse should remove the restraints at least every 2 hr to reposition the client
and assess needs for hygiene and toileting.
Secure the restraint ties to the bed's side rails.
The nurse should secure the restraint ties to a part of the bed frame that moves
with the client to reduce the risk of injury.
A client who is nonambulatory notifies the nurse that their 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. - Correct Answer:
Evacuate the client.
According to the RACE mnemonic, the first action in response to a fire is
to rescue the clients, moving them to a safe area.
Incorrect Answers:
Activate the emergency fire alarm.
According to the RACE mnemonic, the second action in response to a fire is to
activate the alarm.
Extinguish the fire.
According to the RACE mnemonic, the fourth action in response to a fire is to
attempt to extinguish the fire.
Confine the fire.
According to the RACE mnemonic, the third action in response to a fire is to
contain the fire by closing all the doors and windows in the area. The nurse
should also turn off oxygen and electrical equipment in the area of the fire.
A nurse is preparing to administer 0.9% sodium chloride 750 mL IV to infuse
over 7 hr. The nurse should set the infusion pump to deliver how many mL/hr? -
107 mL/hr
A nurse is assessing four adult clients. Which of the following physical
assessment techniques should the nurse use?
Use the Face, Legs, Activity, Cry, and Consolability (FLACC) pain rating scale
for a client who is experiencing pain.
Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm.
Obtain an apical heart rate by auscultating at the third intercostal space left of
the sternum. Palpate the client's abdomen before auscultating bowel sounds. -
Correct Answer:
Ensure the bladder of the blood pressure cuff surrounds 80% of the client's arm.
The nurse should use a blood pressure cuff with a bladder that surrounds 80% of
the client's arm circumference to give an accurate reading.
Incorrect Answers:
Use the Face, Legs, Activity, Cry, and Consolability (FLACC) pain rating scale
for a client who is experiencing pain.
The nurse should use an age-appropriate pain-rating scale, such as the visual
analog or numerical scale, when assessing the pain level of an adult. The
