ATI RN
ATI Nurs 104 Fundamentals Quiz Questions
Question 1 of 5
A nurse is preparing to teach a client who has a low literacy level. Which of the following methods should the nurse plan to include?
Correct Answer: B
Rationale: The correct answer is B: Have short teaching sessions. This method is appropriate for a client with low literacy level as it helps in maintaining attention and comprehension. Short sessions prevent overwhelming the client with too much information at once, making it easier for them to grasp the content effectively. Emphasizing four important points at each session (
Choice
A) may be too much for a client with low literacy level. Referring to the client in the third person (
Choice
C) can create a sense of distance and may not foster a comfortable learning environment. Using a passive voice (
Choice
D) can make the information more complex and harder to understand for someone with low literacy.
Question 2 of 5
A nurse is completing a client assessment for admission to the medical unit. Which of the following abdominal assessment findings require further investigation by the nurse?
Correct Answer: C
Rationale: The correct answer is C: Ecchymosis. This finding indicates possible internal bleeding or trauma, requiring immediate investigation. A: Bilateral bowel sounds in lower quadrants are normal. B: Symmetrical convex sphere shape indicates normal abdominal contour. D: Concave umbilicus is a normal variation.
Question 3 of 5
A nurse is measuring a client's oral temperature. The client informs the nurse that he has just eaten some ice chips. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Wait 30 min and return to measure the oral temperature. After consuming ice chips, the client's oral temperature may be temporarily affected, leading to inaccurate readings. Waiting for 30 minutes allows the oral cavity to return to a more stable temperature, providing a more accurate measurement.
A: Documenting inability to measure the temperature is premature as waiting is a better option.
C: Proceeding to measure the temperature immediately may result in inaccurate readings.
D: Providing warm water may help normalize the oral cavity temperature, but waiting is still necessary for accurate results.
Question 4 of 5
A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?
Correct Answer: A
Rationale: The correct answer is A: Wheezes. Wheezes are continuous high-pitched squeaking sounds heard on expiration, typically associated with asthma. They are caused by narrowed airways due to inflammation and constriction, leading to turbulent airflow. Rhonchi (
B) are low-pitched continuous sounds heard on inspiration and expiration, often associated with secretions in larger airways. Crackles (
C) are discontinuous, crackling or popping sounds heard on inspiration, suggestive of fluid in the smaller airways. Stridor (
D) is a high-pitched crowing sound heard on inspiration, indicating upper airway obstruction.
Question 5 of 5
A nurse is assessing for cyanosis in a client who has dark skin. Which of the following sites should the nurse examine to identify cyanosis in this client?
Correct Answer: B
Rationale: The correct answer is B: Conjunctivae. Dark skin can make it challenging to identify cyanosis, a bluish discoloration indicating inadequate oxygenation. The conjunctivae, the inner lining of the eyelids, is a reliable site to assess for cyanosis in dark-skinned individuals due to the mucous membrane's transparency. Other sites like the dorsal surface of the foot (
A), hand (
C), and pinnae of the ears (
D) may not accurately show cyanosis in dark skin due to pigmentation. Examining the conjunctivae allows for a more accurate assessment of cyanosis in individuals with dark skin.