ATI RN
ATI Fundamentals Proctored Exam Study Guide 3 Questions
Extract:
Question 1 of 5
Nurse caring for client just admitted after falling. This client is oriented 3x & can follow directions. Which action(s) by nurse are appropriate to decrease risk of fall? (Select all that apply.)
Correct Answer: C,D,E
Rationale:
Correct
Answer: C, D, E
Rationale:
C: Ensuring the client's call light is within reach allows them to easily call for assistance, reducing the risk of falls.
D: Providing the client with nonskid footwear enhances traction, decreasing the likelihood of slipping and falling.
E: Completing a fall-risk assessment helps identify specific factors contributing to the client's fall risk, enabling tailored interventions for prevention.
Incorrect
Choices:
A: Placing a belt restraint on the client when sitting on the commode can lead to loss of autonomy and increase agitation, potentially escalating fall risk.
B: Keeping the bed in a low position with full side rails up may restrict the client's movement and independence, leading to frustration and potential attempts to climb out, increasing the risk of falls.
Question 2 of 5
Nurse manager is reviewing care of client with seizures with nurses on unit. Which statements by nurse requires more instruction?
Correct Answer: B
Rationale: The correct answer is B because leaving the client during a seizure to go to the nurses' station for assistance is unsafe. The nurse should stay with the client to ensure safety. A: Placing the client on their side helps prevent aspiration. C: Administering prescribed meds is appropriate. D: Being prepared to insert an airway is essential in case of respiratory compromise.
Question 3 of 5
Nurse observes smoke coming from under door of staff lounge. Which is priority action by the nurse?
Correct Answer: C
Rationale: The priority action for the nurse in this scenario is to evacuate the clients (
Choice
C). This is because ensuring the safety of the clients is the most critical responsibility in a healthcare setting. Evacuating them immediately helps prevent harm and ensures their well-being. Pulling the fire alarm (
Choice
B) may be necessary but not the top priority as it does not directly ensure client safety. Extinguishing the fire (
Choice
A) may put the nurse at risk and delay client evacuation. Closing doors (
Choice
D) may contain the fire but does not address the immediate need of client safety.
Question 4 of 5
Charge nurse is designating room assignments for clients. Based on her knowledge of fall prevention, which should be assigned to room closest to nursing station?
Correct Answer: D
Rationale: The correct answer is D. The 79 yo client post-op following below-the-knee amputation should be assigned to a room closest to the nursing station for fall prevention. This client may have mobility challenges, increased risk of falls due to recent surgery, and may require closer monitoring and immediate assistance if needed. Placing the client near the nursing station allows for quick response to any fall risk or postoperative complications.
A: The 43 yo client post-op following laparoscopic cholecystectomy is not at high risk for falls compared to the amputee.
B: The 61 yo client being admitted for telemetry to rule out MI does not necessarily have a higher fall risk than the amputee.
C: The 50 yo client post-op following open reduction internal fixation of ankle may have mobility limitations but is not as high risk for falls as the amputee.
Question 5 of 5
Nurse is caring for newly admitted client with history of falls. Which is priority action by nurse?
Correct Answer: A
Rationale: The correct answer is A, complete fall-risk assessment. This is the priority action because it helps identify specific risks the client faces, allowing for tailored interventions to prevent falls. Educating the client and family (
B) is important but assessing risk comes first. Completing a physical assessment (
C) is also important but not the priority in this case. Surveying belongings (
D) is not as urgent as assessing the client's fall risk.