ATI RN FUNDAMENTALS PROCTORED EXAM||
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A nurse manager of a med-surg unit is assigning care responsibilities for the
oncoming shift. A client is awaiting transfer back to the unit from the PACU
following thoracic surgery. To which staff member should the nurse assign to this
client?
A. Charge nurse
B. RN
C. LPN
D. AP - ANSWER> B. RN
A client returning from surgery requires assessment and establishment of a plan of
care. RNs are responsible for this, especially if the client is potentially unstable.
A nurse observes an AP reprimanding a client for not using the urinal properly.
The AP tells him she will put a diaper on him if he does not use the urinal more
carefully next time. Which of the following torts is the AP committing?
A. Assault
B. Battery
C. False imprisonment
D. Invasion of privacy - ANSWER> A. Assault
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By threatening the client, the AP is committing assault.
A nurse observes an AP reprimanding a client for not using the urinal properly.
The AP tells him she will put a diaper on him if he does not use the urinal more
carefully next time. Which of the following torts is the AP committing?
A. Assault
B. Battery
C. False imprisonment
D. Invasion of privacy - ANSWER> A. Assault
By threatening the client, the AP is committing assault.
An adult client who is competent tells the nurse that he is thinking about leaving
the hospital against medical advice. The nurse believes that this is not in the client's
best interest, so she administers a PRN sedative med that the client has not
requested along w/his usual meds. Which of the following tort has the nurse
committed?
A. Assault
B. False imprisonment
C. Negligence
D. Breach of confidentiality - ANSWER> B. False imprisonment
The nurse gave the med as a chemical restraint to keep the client from leaving the
facility against medical advice. The client did not consent.
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A nurse is caring for a client who is having difficulty breathing. The client is lying
in bed & is already receiving oxygen therapy via nasal cannula. Which of the
following interventions is the nurse's priority?
A. Increase the oxygen flow
B. Assist the client to Fowler's position
C. Promote removal of pulmonary secretions
D. Obtain a specimen for arterial blood gases - ANSWER> B
Fowler's facilitates better breathing
A nurse is preparing to preform endotracheal suctioning for a client. Which of the
following are appropriate guidelines for the nurse to follow? Select all.
A. Apply suction while withdrawing the catheter
B. Perform suctioning on a routine basis, Q2-3 hours
C. Maintain medical asepsis during suctioning
D. Use a new catheter for each suctioning attempt
E. Limit suctioning to 2-3 attempts - ANSWER> A, D, E
B-Suctioning is not w/out risk so it should be done as needed, not routinely.
C-endotracheal suctioning requires surgical asepsis
A nurse is preparing to preform endotracheal suctioning for a client. Which of the
following are appropriate guidelines for the nurse to follow? Select all.
A. Apply suction while withdrawing the catheter
B. Perform suctioning on a routine basis, Q2-3 hours
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C. Maintain medical asepsis during suctioning
D. Use a new catheter for each suctioning attempt
E. Limit suctioning to 2-3 attempts - ANSWER> A, D, E
B-Suctioning is not w/out risk so it should be done as needed, not routinely.
C-endotracheal suctioning requires surgical asepsis
A nurse is caring for a client who has a tracheostomy. Which of the following
actions should the nurse take each time he provides tracheostomy care? Select all.
A. Apply the oxygen source loosely if the SPO2 decreases during the procedure
B. Use surgical asepsis to remove & clean the inner cannula
C. Clean the outer surfaces in a circular motion from the stoma site onward
D. Replace the tracheostomy ties w/new ties
E. Cut a slit in gauze squares to place beneath the tube holder. - ANSWER> A, B,
C
D-only replace ties if soiled or wet
E-use a commercially prepared gauze w/slit not one nurse makes
A nurse is caring for a client who has a tracheostomy. Which of the following
actions should the nurse take each time he provides tracheostomy care? Select all.
A. Apply the oxygen source loosely if the SPO2 decreases during the procedure
B. Use surgical asepsis to remove & clean the inner cannula
C. Clean the outer surfaces in a circular motion from the stoma site onward