ATI PN Fundamentals 2023 Exam 4

Extract:

Question 1 of 5

A nurse in a long-term care facility is preparing to administer medications to a client who has advanced dementia and does not have an identification band. Which of the following actions should the nurse take to verify the client's identity?

A. Review the client's photograph in the medical record. B. Request an assistive personnel to identify the client. C. Ask the client to state their room number. D. Have the client state their phone number.

Correct Answer: A

Rationale: A photograph ensures accurate identification, critical for a client with dementia unable to self-identify.

Question 2 of 5

A nurse is participating in a group discussion about complicated grief associated with loss. Which of the following should the nurse identify as an example of exaggerated grief?

A. A client whose grief response is repressed. B. A client whose grief response begins following a terminal diagnosis. C. A client whose grief response leads to self-destructive behaviors. D. A client whose grief response is triggered by a secondary loss.

Correct Answer: C

Rationale: Exaggerated grief involves intense, harmful reactions like self-destructive behaviors, impairing function.

Question 3 of 5

A nurse is observing an assistive personnel (AP) apply a belt restraint to a client. Which of the following actions by the AP requires intervention by the nurse?

A. Using a quick-release tie to secure the restraint. B. Tying the restraint to the bed frame. C. Placing the restraint across the client's chest. D. Applying the restraint over the client's gown.

Correct Answer: C

Rationale: Placing the restraint across the chest restricts breathing and is unsafe, requiring intervention.

Question 4 of 5

A charge nurse is observing a newly licensed nurse who is caring for a group of clients. Which of the following statements by the newly licensed nurse indicates an understanding of infection control principles?

A. I will use disinfectant to clean the blood pressure cuff after use on a client. B. I will double-bag a client's linens each day. C. I will wear sterile gloves when bathing a client who is incontinent. D. I will rinse the contaminants from a bedpan with hot water.

Correct Answer: A

Rationale: Disinfecting the cuff reduces cross-contamination, aligning with infection control standards.

Question 5 of 5

A nurse is preparing to provide tracheostomy care to a client who has a chronic tracheostomy. In which order should the nurse complete the following steps?

Order the Items

Source Container

Unlock and remove the inner cannula.

Pour 2.54 cm (1 in) of 0.9% sodium chloride solution into the sterile basin.

Scrub the inside and outside of the inner cannula with a small brush.

Wipe the inside of the inner cannula with a folded pipe cleaner.

Cleanse the stoma site with 0.9% sodium chloride solution.

Correct Answer: B,A,C,D,E

Rationale: B: Prepare solution. A: Remove cannula. C: Scrub cannula. D: Wipe cannula. E: Cleanse stoma maintains sterility.

ATI PN Fundamentals 2023 Exam 4 | Nurselytic

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ATI LPN

ATI LPN