ATI FUNDAMENTALS 2019 B FOR RN

ATI FUNDAMENTALS 2019 B – FOR RN

(REVISION GUIDE)

• A nurse is reaching a client and his family how to care for the client’s tracheostomy at home.

Which of the following should the nurse include in the teaching?

• Use tracheostomy covers when outdoors
• A home health nurse is performing a follow-up visit for a client who has a gastrostomy tube

through which they receive intermittent feedings and medications. The client has recently developed diarrhea. Which of the following findings should the nurse identify as a possible cause of the diarrhea?

• The client’s care giver washed out the feeding bag once every 24 hours with

warm water

• A nurse is talking with an older adult client who is contemplating retirement. The client states, “I

keep thinking about how much I enjoy my job. I’m not sure I want to retire.” Which of the following responses should the nurse make?

• Let’s talk about how the change in your job status will affect you.
• A nurse is assessing a client who reports increased pain following pt. Which of the following

questions should the nurse ask When assessing the quality of the client’s pain?

• Sharp & dull
• A nurse is caring for a client who is expressing anger about his diagnosis of colorectal cancer.

Which of the following actions should the nurse take?

• Reassure the client that this is an expected response to grief.
• A nurse on a medical-surgical unit is caring for a client who has a new prescription for wrist

restraints. Which of the following actions should the nurse take?

• Pad the client’s wrist before applying the restraints
• A nurse is performing a home safety assessment for a client who is receiving supplemental

oxygen. Which of the following observations should the nurse identify as proper safety protocol?

• The client uses no acetone nail polish remover.
• Nurse caring for a client who has a respiratory infection. What technique should she use when

preforming nasotracheal suctioning?

• Apply intermittent suction when withdrawing the catheter.
• Nurse is preparing for change of shift. Which document or tools should the nurse use to

communicate?

• SBAR
• Nurse is planning care for a client who had a stroke. What should be assigned to the assistive

personal? (SATA)

• -Assist the client with a partial bed bath.
• -Measure the client’s BP after the nurse administers antihypertensive meds.
• -Use a communication board to ask what the client wants for lunch.
• Nurse caring for a client who has dementia. What interventions should be taken to minimize risk

for injury?

• Use bed exit alarm system
• Nurse performing a skin assessment for a client who expresses concern about skin cancer. What

findings should the nurse identify as a potential indication of a skin malignancy?

• A mole with an asymmetrical appearance

• Nurse is administering optic ear medication on an adult client. Which action should be done to

ensure the medication reached the inner ear?

• Press gently on the tragus of the client’s ear.
• Nurse is planning strategies to manage time effectively for client care. What should the nurse

implement?

• Use the planning step of the nursing process to prioritize client care delivery.
• Nurse caring for a client who has a sodium level of 125. What findings should the nurse expect?
• Abdominal cramping
• Nurse is preparing an education program for staff about advocacy. What information should the

nurse include?

• Advocacy ensures clients’ safety, health, and rights.
• Nurse is preparing to administer enoxaparin subcutaneously. Which of the following actions

should the nurse take?

• Administer the medication with the needle at a 45-degree angle.
• A nurse is initiating a protective environment for a client who has had an allogenic stem cell

transplant. Which precaution should the nurse plan for this client?

• Make sure the client wears a mask when outside her room if there is

construction in the area.

• Nurse providing discharge instructions for client who will be using a walker. Which statement

indicates an understanding of the teaching?

• I will hire someone to trim the tree that hands low over the stairs of my front porch.
• Nurse planning to insert IV for an older adult client. What actions should the nurse plan to take?
• Place the client’s arm in a dependent position.
• A nurse is admitting a client who is having an exacerbation of heart failure. In planning this

client’s care, when should the nurse initiate discharge planning?

• During the admission process
• A nurse is educating a client who has a terminal illness about declining resuscitation in a living

will. The client asks, “What would happen if I arrived at the ED and I had a difficulty breathing?” Which of the following responses should the nurse make?

• We would give you oxygen through a tube in your nose.
• A nurse is caring for a client who requires an NG tube for stomach decompression. Which of the

following actions should the nurse take when inserting the NG tube?

• Help the client take sips of water to promote insertion of the NG tube
• Nurse auscultating anterior chest who is newly admitted. Listen
• Normal breathing sounds
• Caring for a client who died
• Obtain order
• Remove tubes
• Wash client
• Ask family
• Place the tags
• A nurse is providing discharge teaching to a client about self-administering heparin.
• Administer medication in abdomen

• A nurse caring for a client who asks about the purpose of advance directives
• Indicate form of treatment a client is willing to accept
• Nurse is assessing an older adult for risk for falls (SATA)
• Pupil clarity, visual fields, visual acuity
• Nurse assessing a client who
• is on bed rest for past month. Indication of thrombophlebitis
• Calf Swelling

• Deep tendon reflex -- patellar reflex
• Knee picture
• Postop client with fluid volume deficit. Changes indicate successful treatment
• Decrease in heart rate
• Nurse is reviewing EBP about administration of O2 therapy
• Regulate O2 via nasal canula no more than 6L
• Nurse responding to call light and finds client on bathroom floor. FIRST
• Check client for injuries
• Nurse caring for client prescribed blood transfusion. Parents refuse due to religious beliefs. What

should the nurse do?

• Examine personal values about the issues.
• Nurse caring for client approaching death. SOB, noisy respirations. What should they do?
• Turn client 2 hours
• Nurse is assessing readiness to learn about insulin self-administration. What indicates the client

is ready to learn?

• I can concentrate best in morning.
• Nurse receives report about a client getting IV fluids infusing 125ml/hr but notes he has only

gotten 80 mL over the last 2 hours. What should nurse do first?

• Check IV tubing for obstruction
• A nurse is preparing an injection for opioid medication. Draws 1mL from 2mL vial, what should

the nurse do?

• Ask another nurse to observe medication waste?
• Nurse caring for a group of clients. Prevent spread of infection
• Place a client with TB in negative pressure room.
• Nurse caring for client at end of life. Which statement by client’s partner is effective coping?
• I am relying on support from out family during this time
• Nurse caring for postop client following knee arthroplasty and requires thigh high compression

sleeves. What should the nurse do?

• Make sure two fingers can fit under the sleeve.
• Nurse using an open irrigation technique for client’s catheter. What action should nurse take?
• Subtract amount of irritant used from client’s urine output.
• Nurse is caring for a client who has pharyngeal diphtheria. Transmission precautions?
• Droplet
• Postop, signs of hemorrhagic shack. Nurse notifies surgeon and he said to continue to monitor

vitals every 15 minutes and report in one hour. What should the nurse do next?

• Notify nurse manager
• Reviewing client’s fluid and electrolytes status. What should nurse report to provider?
• Potassium 5.4

• Nurse caring for client postop. When nurse prepares to change dressing, client says it hurts.

Which intervention is the nurse’s priority action?

• Administer pain meds 45 minutes prior to dressing change.
• Nurse admitting new client. Medication reconciliation?
• Compare the client’s home medications to the providers prescriptions
• Nurse admitting client with abdominal wound. Which precaution?
• Contact precaution
• Nurse lifting bedside cabinet. Prevent self-injury by?
• Standing close to cabinet when lifting
• Preparing to apply dressing to stage 2 pressure injury. Which type of dressing should the nurse

use?

• Hydrocolloid
• Nurse talking with a client’s partner. She is having frustrations about managing responsibilities

and care. What type of role performance stress is this?

• Role overload
• Nurse is evaluating a client’s use of cane. What is the correct use?
• Client holds the cane on the stronger side of the body.
• Math Question – 7 hours
• 107 mL/hr.
• Nurse manager is reviewing medication documentation. Which of the following statements

should the nurse plan to include in teaching?

• Use the complete name of the medication magnesium sulfate.
• Nurse caring for client who has herpes zoster. Client asks about complementary and alternative

therapies for pain control. Nurse should inform client that this condition is a contraindication for which of the following therapies?

• Acupuncture
• Nurse caring for a client who has the poops due to shigella. Precautions to implement?
• Wear a gown when caring for the client.
• Nurse caring for client postop refuses to use incentive spirometer following major abdominal

surgery. Nurse’s priority?

• Determine the reason why the client is refusing to use IS.
• Client postop is verbalizing pain at a 2 on a scale from 0-10. Indication that client understands

pain management?

• It might help me to listen to music while lying in bed.
• A nurse is assessing 4 adult clients. Which of the following physical assessment techniques

should the nurse use?

• Ensure the bladder of the BP cuff surrounds 80% of their arm.
• Nurse caring for client who has prostate cancer. Provider discusses treatment options and leaves

room. Client declines to talk about concerns. Which of the following statements should the nurse make?

• I am available to talk if you should change your mind.