ATI RN
ATI Nur 231 Fundamentals Exam Questions
Question 1 of 5
A nurse is admitting a client who has hepatitis C. Which of the following precautions should the nurse implement?
Correct Answer: D
Rationale: The correct answer is D: Standard precautions. Standard precautions are used for all clients to prevent the spread of infection. This includes hand hygiene, use of gloves, gowns, masks, and eye protection as needed. Hepatitis C is transmitted through blood, so standard precautions are essential to protect both the nurse and the client. Airborne precautions (choice
A) are used for diseases like tuberculosis, droplet precautions (choice
B) for illnesses like influenza, and contact precautions (choice
C) for infections such as MRSA. These precautions are not necessary for hepatitis C.
Question 2 of 5
The nurse is notifying the HCP of the client's change in status using the SBAR format. In which order should the nurse place the statements? 1. 'I suggest that the client be transferred to the critical care unit, and I would like you to come evaluate the client.' 2. 'The client is deteriorating, and I'm afraid the client is going to arrest.' 3. 'I am calling about (client name and location). Vital signs are BP=100/50, P=120, RR=30, T=100.4°F (38°C).' 4. 'The client is becoming confused and agitated. The skin is pale, mottled, and diaphoretic. The client is very dyspneic with an oxygen saturation of 85% despite placing a nonrebreather mask.'
Correct Answer: A
Rationale: The correct order is A: 2,4,3,1. The nurse should start by stating the client's critical condition (2), followed by specific symptoms (4), vital signs (3), and finally the recommendation for transfer and evaluation (1). This sequence prioritizes urgency and provides essential information first before suggesting actions.
Choice B is incorrect as it starts with vital signs before conveying the critical condition.
Choice C is incorrect as it presents symptoms before vital signs.
Choice D is incorrect as it suggests evaluation before providing all necessary information. Thus, option A follows the SBAR format effectively.
Question 3 of 5
A nurse is caring for a client who is prescribed bedrest. The plan of care indicates that the client should perform isometric exercises every 2 hr. Which of the following actions should the nurse take as directed by the plan of care?
Correct Answer: D
Rationale: The correct answer is D: Instruct the client to tighten muscle groups for a short period, and then relax. Isometric exercises involve contracting muscles without joint movement, making them ideal for a client on bedrest to maintain muscle strength and prevent atrophy. This type of exercise can be safely performed in a bedridden position, promoting circulation and preventing blood clots. Moving the client's limbs through their complete range of motion (choice
A) and having the client move each limb independently through its complete range of motion (choice
B) are incorrect as these are isotonic exercises that are not suitable for someone on bedrest. Asking the client to move her arms and legs while applying slight resistance (choice
C) is also incorrect as it involves movement and resistance, which are not part of isometric exercises.
Question 4 of 5
A nurse is caring for a client who has active pulmonary tuberculosis (TB). The client requires airborne precautions and is receiving multidrug therapy. Which of the following precautions should the nurse take to transport the client safely to the radiology department for a chest x-ray?
Correct Answer: A
Rationale:
Correct
Answer: A: Have the client wear a mask.
Rationale: Having the client wear a mask is crucial to prevent the spread of TB bacteria through droplet transmission. This mask will help contain the infectious particles when the client coughs or speaks, reducing the risk of transmission to others. Additionally, this precaution aligns with the standard protocol for airborne precautions in TB cases.
Summary of other choices:
B: While wearing a filtration mask and gloves is important for healthcare providers, having the client wear a mask is more effective in preventing the spread of TB.
C: Notifying the x-ray department is important, but having the client wear a mask is a more direct and immediate precaution.
D: Asking the x-ray technician to come to the client's room may not be feasible or necessary for a routine chest x-ray.
E, F, G: No other choices provided.
Question 5 of 5
Which of the following is a benefit of negative pressure wound therapy (NPWT) for skin wounds?
Correct Answer: C
Rationale:
Rationale:
Choice C is correct because NPWT promotes wound healing by increasing blood flow to the wound. Negative pressure helps remove excess fluid and debris, improves oxygenation, and enhances the formation of granulation tissue. This accelerates the healing process.
Choices A, B, and D are incorrect.
Choice A is wrong because collagen production is essential for wound healing.
Choice B is incorrect as NPWT does not directly numb the wound area.
Choice D is inaccurate because while NPWT can help reduce infection risk indirectly by promoting healing, it does not create a sterile environment.