ATI CMS Fundamentals Practice
QUESTIONS AND VERIFIED ANSWERS|
100% CORRECT
A nurse is giving chance-of shift report about a client they admitted earlier that day
who has pneumonia. Which of
the following pieces of information is the priority for the nurse to provide?
a) Admitting diagnosis.
b) Breath sounds.
c) Body temperature.
d) Diagnostic results. - ANSWER Correct ANSWER : B.
Breath sounds - When using the airway, breathing, circulation approach to client
care, the nurse
should determine that the priority information to provide is the current status of the
client's breath sounds.
A nurse is caring for a client who has an NG tube and is receiving intermittent
feedings through an open system.
Which of the following actions should the nurse take first?
a) Rinse the feeding bag with water between feedings.
b) Tell the client to keep the head of the bed elevated at least 30°.
c) Make sure the enteral formula is at room temperature.
d) Wipe the top of the formula can with alcohol. - ANSWER
Correct ANSWER : B. - The first action the nurse should take when using the
airway, breathing, circulation approach to
client care is to prevent aspiration of the enteral formula; therefore, the priority
intervention is to keep the head of the
bed elevated at least 30° to prevent reflux of the formula into the esophagus
,A nurse is caring for a client who has tuberculosis. Which of the following actions
should the nurse take?
a) Place the client in a room with negative-pressure airflow
b) Wear gloves when assisting the client with oral care.
c) Limit each visitor to 2-hr increments.
d) Wear a surgical mask when providing client care.
e) Use antimicrobial sanitizer for hand hygiene - ANSWER Correct
ANSWER : A, B, E. - Place the client in a room with negative-pressure airflow is
correct. The nurse should place the
client in a room with negative-pressure airflow to meet the requirements of
airborne precautions. Wear gloves when
assisting the client with oral care is correct. The nurse should wear gloves when
assisting the client with oral care to meet
the requirements of standard precautions, which the nurse must adhere to for all
clients regardless of their diagnosis.
The nurse should wear gloves whenever their hands might come in contact with a
client's bodily fluids, such as saliva,
and the mucous membranes in the mouth. Limit each visitor to 2-hr increments is
incorrect. The nurse does not need to
limit the client's visitors. However, the nurse should limit the client's presence
outside the room and the client should
wear a surgical mask when outside of the room. Wear a surgical mask when
providing client care is incorrect. The nurse
should wear an N95 respirator during client care to meet the requirements of
airborne precautions. Use antimicrobial
sanitizer for hand hygiene is correct. The nurse should use antimicrobial sanitizer
for routine hand hygiene when caring
for a client who has tuberculosis. Nurses should also wash their hands with soap
and water when their hands are visibly
soiled.
A nurse is performing a Romberg test during a physical assessment of a client.
Which of the following techniques
should the nurse use?
a) Touch the face with a cotton ball.
b) Apply a vibrating tuning fork to the client's forehead.
c) Have the client stand with their arms at their sides and their feet together.
, d) Perform direct percussion over the area of the kidneys. - ANSWER
Correct ANSWER : C - A Romberg test helps identify alterations in balance. The
nurse should have the client stand with
their arms at their sides and their feet together to observe for swaying and a loss of
balance.
To obtain an accurate blood pressure measurement, - ANSWER the
nurse should inflate the cuff 30 mm Hg
beyond the point at which the nurse was last able to palpate the pulse. If the nurse
last palpated the pulse at 92 mm Hg,
then this would be the correct pressure to which the nurse should inflate the cuff.
The nurse has accepted a verbal prescription "for three tenths of a milligram of
levothyroxine IV stat" for a client
who has myxedema coma. How should the nuse transcribe the dosage of this
medication in the medical record?
a) .3 mg
b) 0.3 mg
c) 0.30 mg
d) 3/10 mg - ANSWER Correct ANSWER : B - The use and
placement of a decimal point can potentially cause a medication error if
documented
incorrectly. A zero should precede a decimal point, as in 0.3 mg, but should not
follow a decimal point unless a whole
number follows the zero, as in 2.05 mg
A nurse is discussing the use of herbal supplements for health promotion with a
client. Which of the following client
statements indicates an understanding of herbal supplement use?
a) "I can take echinacea to improve my immune system."
b) "I can take feverfew to reduce my level of anxiety."
c) "I can take ginger to improve my memory."
QUESTIONS AND VERIFIED ANSWERS|
100% CORRECT
A nurse is giving chance-of shift report about a client they admitted earlier that day
who has pneumonia. Which of
the following pieces of information is the priority for the nurse to provide?
a) Admitting diagnosis.
b) Breath sounds.
c) Body temperature.
d) Diagnostic results. - ANSWER Correct ANSWER : B.
Breath sounds - When using the airway, breathing, circulation approach to client
care, the nurse
should determine that the priority information to provide is the current status of the
client's breath sounds.
A nurse is caring for a client who has an NG tube and is receiving intermittent
feedings through an open system.
Which of the following actions should the nurse take first?
a) Rinse the feeding bag with water between feedings.
b) Tell the client to keep the head of the bed elevated at least 30°.
c) Make sure the enteral formula is at room temperature.
d) Wipe the top of the formula can with alcohol. - ANSWER
Correct ANSWER : B. - The first action the nurse should take when using the
airway, breathing, circulation approach to
client care is to prevent aspiration of the enteral formula; therefore, the priority
intervention is to keep the head of the
bed elevated at least 30° to prevent reflux of the formula into the esophagus
,A nurse is caring for a client who has tuberculosis. Which of the following actions
should the nurse take?
a) Place the client in a room with negative-pressure airflow
b) Wear gloves when assisting the client with oral care.
c) Limit each visitor to 2-hr increments.
d) Wear a surgical mask when providing client care.
e) Use antimicrobial sanitizer for hand hygiene - ANSWER Correct
ANSWER : A, B, E. - Place the client in a room with negative-pressure airflow is
correct. The nurse should place the
client in a room with negative-pressure airflow to meet the requirements of
airborne precautions. Wear gloves when
assisting the client with oral care is correct. The nurse should wear gloves when
assisting the client with oral care to meet
the requirements of standard precautions, which the nurse must adhere to for all
clients regardless of their diagnosis.
The nurse should wear gloves whenever their hands might come in contact with a
client's bodily fluids, such as saliva,
and the mucous membranes in the mouth. Limit each visitor to 2-hr increments is
incorrect. The nurse does not need to
limit the client's visitors. However, the nurse should limit the client's presence
outside the room and the client should
wear a surgical mask when outside of the room. Wear a surgical mask when
providing client care is incorrect. The nurse
should wear an N95 respirator during client care to meet the requirements of
airborne precautions. Use antimicrobial
sanitizer for hand hygiene is correct. The nurse should use antimicrobial sanitizer
for routine hand hygiene when caring
for a client who has tuberculosis. Nurses should also wash their hands with soap
and water when their hands are visibly
soiled.
A nurse is performing a Romberg test during a physical assessment of a client.
Which of the following techniques
should the nurse use?
a) Touch the face with a cotton ball.
b) Apply a vibrating tuning fork to the client's forehead.
c) Have the client stand with their arms at their sides and their feet together.
, d) Perform direct percussion over the area of the kidneys. - ANSWER
Correct ANSWER : C - A Romberg test helps identify alterations in balance. The
nurse should have the client stand with
their arms at their sides and their feet together to observe for swaying and a loss of
balance.
To obtain an accurate blood pressure measurement, - ANSWER the
nurse should inflate the cuff 30 mm Hg
beyond the point at which the nurse was last able to palpate the pulse. If the nurse
last palpated the pulse at 92 mm Hg,
then this would be the correct pressure to which the nurse should inflate the cuff.
The nurse has accepted a verbal prescription "for three tenths of a milligram of
levothyroxine IV stat" for a client
who has myxedema coma. How should the nuse transcribe the dosage of this
medication in the medical record?
a) .3 mg
b) 0.3 mg
c) 0.30 mg
d) 3/10 mg - ANSWER Correct ANSWER : B - The use and
placement of a decimal point can potentially cause a medication error if
documented
incorrectly. A zero should precede a decimal point, as in 0.3 mg, but should not
follow a decimal point unless a whole
number follows the zero, as in 2.05 mg
A nurse is discussing the use of herbal supplements for health promotion with a
client. Which of the following client
statements indicates an understanding of herbal supplement use?
a) "I can take echinacea to improve my immune system."
b) "I can take feverfew to reduce my level of anxiety."
c) "I can take ginger to improve my memory."
