ATI FUNDAMENTALS PRACTICE QUESTIONS AND ANSWERS (VERIFIED) AND
DESCRIPTIVE RATIONALES
A nurse is caring for a client who is postoperative and has paralytic ileus. Which of the following
abdominal assessments should the nurse expect?
A. Frequent bowel sounds with flatus
B. Absent bowel sounds with distention
C. Hyperactive bowel sounds with diarrhea.
D. Normal bowel sounds with decreased peristalsis
B. Absent bowel sounds with distention
With this disorder, bowel sounds are absent and the abdomen is distended. There is no flatus or
stool.
A nurse has completed the Braden scale on four clients who are at risk for alterations in skin
integrity. Which of the following clients should the nurse recognize as having the greatest risk
for altered skin integrity?
A. Score of 9
B. Score of 23
C. Score of 12
D. Score of 15
A.
The lowest score a client can receive on the Braden scale is a 6, the highest 23. The lower the
score, the greater risk for alterations in skin and tissue integrity
A nurse is caring for a client who has a deep foot wound with minimal exudate and necrotized
tissue. For which of the following dressing types should the nurse anticipate a prescription to
cover the wound?
A. Hydrofiber
B. Alginate
C. Hydrogel
D. Transparent Film
C. Hydrogel
Hydrogel can be used successfully for the debridement of wounds with necrotized tissue and
eschar
Hydrogel dressings are used for moderate and highly exudative wounds. Hydrofiber dressings
provide high absorbency and can stay in the wound for several days.
Alginate dressings are made from algae and are recommended for moderate to high exudative
wounds. They provide hemostasis and can remain in a wound for several days, thus requiring
less frequent changes
,A nurse is monitoring a client following a cholecystectomy. Which of the following findings
should the nurse identify as a potential manifestation of sepsis?
A. Hypertension
B. Increased blood glucose
C. Decreased WBC count
D. Increased BUN
B.
Blood glucose is a potential manifestation of sepsis
Hypotension, not hypertension is a potential manifestation of sepsis
A surgical nurse is discussing the time-out procedure with a newly licensed nurse. The nurse
should indicate that a time-out is performed at which of the following times?
A. Once at the beginning of the procedure.
B. Several times throughout the procedure
C. Once at the end of the procedure
D. After anesthesia has been performed.
B.
A time-out is performed at the beginning of the procedure, prior to any additional procedures
performed, and at the completion of the procedure.
A nurse is preparing to start an IV for a client who has a high risk for bleeding. Which of the
following actions should the nurse take?
A. Apply a cold compress to an IV site
B. Ask the client to hold the extremity up prior to searching for an IV
C. Ask the client to spread the fingers of the selected extremity.
D. Apply a blood pressure cuff set to 30 mm HG
D
Instead of using a tourniquet, the nurse should apply a blood pressure cuff set to 30 mm Hg prior
to starting an IV for this client. This will help protect the client's extremity from bruising and
bleeding
A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. Which
of the following findings should the nurse plan to monitor for and report to the provider
immediately.
A. slurred speech
B. Irregular pulse
C. Dependent edema
D. persistent fatigue.
A. slurred speech. The greatest risk to this patient is injury from an embolus caused by the
pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate
circulation to the brain because of an embolus. Therefore, the nurse should report this finding to
, the provider immediately.
B. An irregular pulse is an expected finding for a client with atrial fibrillation
C. Dependent edema is not the priority finding; although it is an expected finding of HF
D. Fatigue is an expected finding, but not the priority.
A nurse is teaching a client who is starting to take an ace inhibitor to treat hypertension. the
nurse should instruct the client to notify his provider if he experiences which of the following
adverse effects of this medication
A- Persistent Cough
B- Frequent Urination
C- Constipation
D- Tendon Pain
B. Persistent cough
A. Tendonitis is an adverse effect of fluoroquinolone antibiotics
B. A persistent cough is an adverse effect of ACE inhibitors
C. Frequent urination is an expected result of this medication.
D. Constipation is an expected adverse effect but it does not have to be reported to the provider/
A nurse is caring for a client who was admitted for a treatment of left-sided heart failure with
intravenous loop diuretics and digitalis therapy. the client is experiencing weakness and an
irregular heart rate. which of the following actions should the nurse take first?
A- obtain clients current weight
B-Determine the time of the last digoxin dose
C- Check the clients urine output
D- Review serum electrolyte Values
D- Review serum electrolyte Value
weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte
imbalance, an adverse effect of loop diuretics. the first action the nurse should take is to review
the client's electrolyte values, particularly the potassium level, because the client is at risk for
dysrhythmias for hypokalemia
A nurse is monitoring a client ECG monitor and notes the client’s rhythm has change from
normal signs rhythm to supraventricular tachycardia. the nurse should prepare to assist with
which of the following interventions
A. Initiate chest compressions
B. Vagal stimulation
C. Administration of atropine IV
D. Defibrillation
B.
DESCRIPTIVE RATIONALES
A nurse is caring for a client who is postoperative and has paralytic ileus. Which of the following
abdominal assessments should the nurse expect?
A. Frequent bowel sounds with flatus
B. Absent bowel sounds with distention
C. Hyperactive bowel sounds with diarrhea.
D. Normal bowel sounds with decreased peristalsis
B. Absent bowel sounds with distention
With this disorder, bowel sounds are absent and the abdomen is distended. There is no flatus or
stool.
A nurse has completed the Braden scale on four clients who are at risk for alterations in skin
integrity. Which of the following clients should the nurse recognize as having the greatest risk
for altered skin integrity?
A. Score of 9
B. Score of 23
C. Score of 12
D. Score of 15
A.
The lowest score a client can receive on the Braden scale is a 6, the highest 23. The lower the
score, the greater risk for alterations in skin and tissue integrity
A nurse is caring for a client who has a deep foot wound with minimal exudate and necrotized
tissue. For which of the following dressing types should the nurse anticipate a prescription to
cover the wound?
A. Hydrofiber
B. Alginate
C. Hydrogel
D. Transparent Film
C. Hydrogel
Hydrogel can be used successfully for the debridement of wounds with necrotized tissue and
eschar
Hydrogel dressings are used for moderate and highly exudative wounds. Hydrofiber dressings
provide high absorbency and can stay in the wound for several days.
Alginate dressings are made from algae and are recommended for moderate to high exudative
wounds. They provide hemostasis and can remain in a wound for several days, thus requiring
less frequent changes
,A nurse is monitoring a client following a cholecystectomy. Which of the following findings
should the nurse identify as a potential manifestation of sepsis?
A. Hypertension
B. Increased blood glucose
C. Decreased WBC count
D. Increased BUN
B.
Blood glucose is a potential manifestation of sepsis
Hypotension, not hypertension is a potential manifestation of sepsis
A surgical nurse is discussing the time-out procedure with a newly licensed nurse. The nurse
should indicate that a time-out is performed at which of the following times?
A. Once at the beginning of the procedure.
B. Several times throughout the procedure
C. Once at the end of the procedure
D. After anesthesia has been performed.
B.
A time-out is performed at the beginning of the procedure, prior to any additional procedures
performed, and at the completion of the procedure.
A nurse is preparing to start an IV for a client who has a high risk for bleeding. Which of the
following actions should the nurse take?
A. Apply a cold compress to an IV site
B. Ask the client to hold the extremity up prior to searching for an IV
C. Ask the client to spread the fingers of the selected extremity.
D. Apply a blood pressure cuff set to 30 mm HG
D
Instead of using a tourniquet, the nurse should apply a blood pressure cuff set to 30 mm Hg prior
to starting an IV for this client. This will help protect the client's extremity from bruising and
bleeding
A nurse is caring for a client who has heart failure and is experiencing atrial fibrillation. Which
of the following findings should the nurse plan to monitor for and report to the provider
immediately.
A. slurred speech
B. Irregular pulse
C. Dependent edema
D. persistent fatigue.
A. slurred speech. The greatest risk to this patient is injury from an embolus caused by the
pooling of blood that can occur with atrial fibrillation. Slurred speech can indicate inadequate
circulation to the brain because of an embolus. Therefore, the nurse should report this finding to
, the provider immediately.
B. An irregular pulse is an expected finding for a client with atrial fibrillation
C. Dependent edema is not the priority finding; although it is an expected finding of HF
D. Fatigue is an expected finding, but not the priority.
A nurse is teaching a client who is starting to take an ace inhibitor to treat hypertension. the
nurse should instruct the client to notify his provider if he experiences which of the following
adverse effects of this medication
A- Persistent Cough
B- Frequent Urination
C- Constipation
D- Tendon Pain
B. Persistent cough
A. Tendonitis is an adverse effect of fluoroquinolone antibiotics
B. A persistent cough is an adverse effect of ACE inhibitors
C. Frequent urination is an expected result of this medication.
D. Constipation is an expected adverse effect but it does not have to be reported to the provider/
A nurse is caring for a client who was admitted for a treatment of left-sided heart failure with
intravenous loop diuretics and digitalis therapy. the client is experiencing weakness and an
irregular heart rate. which of the following actions should the nurse take first?
A- obtain clients current weight
B-Determine the time of the last digoxin dose
C- Check the clients urine output
D- Review serum electrolyte Values
D- Review serum electrolyte Value
weakness and irregular heart rate indicate that the client is at the greatest risk for electrolyte
imbalance, an adverse effect of loop diuretics. the first action the nurse should take is to review
the client's electrolyte values, particularly the potassium level, because the client is at risk for
dysrhythmias for hypokalemia
A nurse is monitoring a client ECG monitor and notes the client’s rhythm has change from
normal signs rhythm to supraventricular tachycardia. the nurse should prepare to assist with
which of the following interventions
A. Initiate chest compressions
B. Vagal stimulation
C. Administration of atropine IV
D. Defibrillation
B.
