ATI 2019 Fundamentals Proctored Exam final

A nurse is planning care for a group of clients. Which of the following tasks should the nurse delegate to an assistive personnel? a. Changing the dressing for a client who has a stage 3 pressure injury b. Determining ...

A nurse is planning care for a group of clients. Which of the following tasks should the nurse delegate to an assistive personnel? a. Changing the dressing for a client who has a stage 3 pressure injury b. Determining a client's response to a diuretic c. Comparing radial pulses for a client who is postoperative d.Providing postmortem care to a client d A nurse is conducting a health assessment for a client who takes herbal supplements. Which of the following statements by the client indicates an understanding of the use of the supplements? A. I take ginkgo biloba for a headache B. I take echinacea to control my cholesterol C. I use ginger when I get car sick D. I use garlic for my menopausal symptoms c 00:02 01:26 A nurse is caring for a client who has influenza and isolation precautions in place. Which of the following actions should the nurse take to prevent the spread of infection? A. Wear a mask when working within 3 feet of the client B. Administer metronidazole C. Don protective eyewear before entering the room. D. Place the client in a negative airflow room. a A nurse obtains a prescription for wrist restraints for a client who is trying to pull out his NG tube. Which of the following actions should the nurse take? A. Attach the restraints securely to the side rails of the client's bed. B. Apply the restraints to allow as little movement as possible C.Allow room for two fingers to fit between the clients skin and the restraints d. remove the restraints every 4 hours c A nurse is admitting a client who has tuberculosis. Which of the following types of transmission precautions should the nurse plan to initiate? A. Droplet B. Airbornes c. protective environment d. contact b A nurse in a well-child clinic receives a telephone call from a parent who states that their child accidentally swallowed paint thinner. The child is awake and alert. Which of the following responses should the nurse make? A. Have your child drink one large glass of water. B. Hang up and call a poison control center hotline. C. Bring your child into the clinic later today. D. Induce vomiting in your child with syrup of ipecac. a A nurse is documenting a client's medical record. Which of the following entries should the nurse record. A. Oral temperature slightly elevated at 0800 B. Administered pain medication C. Incision without redness or drainage D. Drank adequate amounts of fluid with meals. b A nurse is providing oral care for a client who is unconscious. Which of the following actions should the nurse take? A. Place the client in a side-lying position. B. Brush the clients teeth daily C. Apply mineral oil to the client's lips D. Rinse the client's mouth with an alcohol-based mouthwash a A nurse is collaborating with a risk management team about potential legal issues involving client care. The nurse should identify which of the following situations is an example of negligence? A. A nurse administers a medication without first identifying the client. B. An assistive personnel discusses client care in the facility cafeteria with visitors present. C. A nurse begins a blood transfusion without obtaining consent. D. An assistive personnel prevents a client from leaving the facility. c A nurse is collecting a sputum specimen for culture from a client who has a respiratory infection. Which of the following actions should the nurse take? A. Wear sterile gloves when collecting the specimen. B. Offer the client oral hygiene after the collection C. Collect the specimen in the evening. D Collect 1 ml of sputum. b A nurse is assessing an older client. Which of the following findings should the nurse expect? a. Decreased sense of balanced b. Increased nighttime sleeping c. Heightened sense of pain d. Nighttime urinary incontinence a A nurse is completing discharge teaching about ostomy care with a client who has a new stoma. Which of the following instructions should the nurse include in the teaching? (select all that apply) a. "Cut the opening of the pouch 1⁄8 of an inch larger than the stoma " b. "Place a piece a gauze over the stoma while changing the pouch" c. "Use povidone-iodine to clean around the stoma" d. "Empty the ostomy pouch when it becomes one-third full of contents" e. expect the stoma to turn a purple-blue color as its heals" a, b, c, d A nurse is preparing to obtain informed consent from a client who speaks a different language than the nurse. Which of the following actions should the nurse take? a. "Request that an assistive personnel interpret the information for the client" b. "Use proper medical terms when giving information to the client" c. "Offer written information in the client's language" d. "Avoid using gestures when speaking to the client" c A nurse is teaching a client about home care equipment. Which of the following information should the nurse include in the teaching? (select all that apply) a. "Avoid using wool blankets when receiving oxygen" b. check the O2 delivery rate at least once a day c. align the middle of the ball in the flow meter with the line of the prescribed flow rate d. "Keep the oxygen delivery system 0.6 m (2 feet) from any heat source" e. "Lay the oxygen tank flat when storing" a, b, c A nurse is planning care for a client who reports insomnia. Which of the following actions should the nurse perform shortly before bedtime? a. Provide a late supper. b. Offer a wet washcloth for the client to wash her face c. Perform range-of-motion exercises d. Prepare hot cocoa or tea for the client a A nurse on a medical-surgical unit is receiving a change-of-shift report for four clients. Which of the following clients should the nurse see first? a. A client who has acute abdominal pain of 4 on a scale from 0 to 10 b. A client who has pneumonia and an oxygen saturation of 96% c. A client who has new onset of dyspnea 24hr after a total hip arthroplasty • d. A client who has a urinary tract infection and low-grade fever c A nurse is reviewing a client's intake and output and notes the following: 0.9% sodium chloride 600mL IV infusion, cefazolin 250 mg in dextrose 5% in water 100mL intermittent IV bolus, 200mL emesis, 40mL voided urine, and 20mL urine from straight catheterization. The nurse should record the client's net fluid intake as how many mL? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) DOSAGE CALCULATION 700 mL A nurse is discussing incident reports with a group of newly licensed nurses. The nurse should include that which if the following requires the completion of an incident report? a. A client's prescribed laboratory testing was not obtained b. A client withdrew consent for a procedure c. An oncoming nurse arrived to work late d. A nurse transfused a unit of packed RBCs in 2 hr. a A nurse is caring for a client who has a new prescription for negative-pressure therapy for a chronic wound. The nurse is unfamiliar with the procedure. Which of the following resources should the nurse consult to learn more about the intervention. a. The client's plan of care b. The nurse practice act c. The material safety data sheet d. The policy and procedure manual d A nurse is performing postural drainage with percussion and vibration for a client who has cystic fibrosis. Which of the following actions should the nurse take? a. Cover the area of percussion with a towel. b. Instruct the client to exhale quickly during vibration c. Schedule postural drainage after meals d. Perform percussion over the lower back d A nurse is preparing to administer diphenhydramine 20 mg orally to a 6-year-old child who has difficulty swallowing pills. Available is diphenhydramine 12.5mg/5ml oral syrup. Which of the following images indicates the correct number of mL the nurse should administer? (round answer to the nearest whole number.) DOSAGE CALCULATION 8ml A nurse is admitting a client who is malnourished. The client states, "My wedding ring is loose and I'm worried I will lose it if it falls off."Which of the following is an appropriate response by the nurse? a. " I will place it in your drawer so it won't get lost." b. I can pin it to your hospital gown so you won't lose it." c. "I will hold onto it until a family member can take it home." d. I can put it in a locked storage unit for you d A charge nurse is teaching a group of newly licensed nurses about the use of restraints. In which of the following clinical situations should the nurse apply restraints? a. If the client is pacing in the hallway b. As a part of a fall prevention program c. At the request of the client's family d. When the client poses a threat to self d