questions and verified answers, aligned with
current A.T.I standards ( 2025) , Graded A+
A nurse overhears two assistive personnel (AP) discussing care for a client while in the elevator.
Which of the following actions should the nurse take?
A. Contact the client's family about the incident.
B. Notify the client's provider about the incident.'C. File a complaint with the facility's ethics
committee.
D. Report the incident to the AP's charge nurse. - ANSWER D. Report the incident to the AP's
charge nurse.
A nurse is planning care for a client who is receiving hemodialysis. Which of the following
actions should the nurse include in the plan of care?
A. Withhold all medications until after dialysis
B. Rehydrate with dextrose 5% in water for orthostatic hypotension.
C. Check the vascular access site for bleeding after dialysis.
D. Give an antibiotic 30 min before dialysis. - ANSWER C. Check the vascular access site for
bleeding after dialysis.
A nurse in the emergency department is caring for a client who reports intimate partner
violence. Which of the following interventions is the nurse's priority?
A. Develop a safety plan with the client
B. (Unable) options for reporting the incident.
C. Refer the client to a community support group.
D. Determine if the client has any injuries. - ANSWER D. Determine if the client has any injuries.
,A nurse is caring for a client who is in active labor and note the FHR baseline has been 100/min
for the past 15 min. The nurse should identify which of the following conditions as a possible
cause of fetal bradycardia?
A. Maternal fever
B. Fetal anemia
C. Maternal hypoglycemia
D. Chorioamnionitis - ANSWER C. Maternal hypoglycemia
A nurse is assessing a school-age child who has a urinary tract infection. Which of the following
findings should the nurse expect?
A. Periorbital edema.
B. Decreased frequency of urination. C. Enuresis.
D. Diarrhea. - ANSWER C. Enuresis.
A nurse is caring for a client who is in active labor and requests pain management. Which of the
following actions should the nurse take?
A. Administer ondansetron.
B. Place the client in a warm shower.
C. Apply fundal pressure during contractions.
D. Assist the client to a supine position. - ANSWER B. Place the client in a warm shower.
A nurse in an emergency department is performing triage for multiple clients following a
disaster in the community. To which of the following types of injuries should the nurse assign
the highest priority?
Below-the knee amputation
Fractured tibia
95% full-thickness body burn
10cm (4in) laceration to the forearm - ANSWER Below-the knee amputation
,a nurse manager is updating protocols for the use of belt restraints. Which of the following
guidelines should the nurse include?
Remove the client's restraint every 4hr
Document the client's condition every 15 min
Attach the restrain to the bed's side rails
Request a PRN restrain prescription for clients who are aggressive - ANSWER Document the
client's condition every 15 min
A nurse is teaching an in-service about nursing leadership. Which of the following information
should the nurse include about an effective leader?
Acts as an advocate for the nursing unit.
(Unable to read) for the unit
Priorities staff request over client needs.
Provides routine client care and documentation. - ANSWER Acts as an advocate for the nursing
unit.
A nurse is reviewing the laboratory findings of a client who has diabetes mellitus and reports
that she has been following her (unable to read) care. The nurse should identify which of the
following findings indicates a need to revise the client's plan of care.
Serum sodium 144 mEq/
(Unable to read)
Hba1c10%
Random serum glucose 190 mg/dl. - ANSWER Hba1c10%
A nurse in a provider's office is reviewing the laboratory results of a group of clients. The nurse
should identify that which of the following sexually transmitted infections is a nationally
notifiable infectious disease that should be reported to the state health department?
, Chlamydia
Human papillomavirus
Candidiasis
Herps simplex virus - ANSWER Chlamydia
A nurse is teaching a newly licensed nurse about therapeutic techniques to use when leading a
group on a mental health unit. Which of the following group facilitation techniques should the
nurse include in the teaching?
a. Share personal opinions to help influence the group's values
b. Measure the accomplishments of the group against a previous group
c. Yield in situations of conflicts to maintain group harmony
d. Use modeling to help the clients improve their interpersonal skills - ANSWER d. Use modeling
to help the clients improve their interpersonal skills
A nurse is planning for a client who practices Orthodox Judaism. The client tells the nurse that
(Unable to read) Passover holiday. Which of the following action should the nurse include in the
plan of care?
a. Provide chicken with cream sauce.
b. Avoid serving fish with fins and scales.
c. Provide unleavened bread.
d. Avoid serving foods containing lamb. - ANSWER c. Provide unleavened bread.
A nurse is caring for a client who has a pulmonary embolism. The nurse should identify the
effectiveness of the treatment
A chest x-ray reveals increased density in all fields.
The client reports feeling less anxious.
Diminished breath sounds are auscultated bilaterally