ATI RN
ATI RN Fundamentals 2023 I Questions
Extract:
Question 1 of 5
A nurse is admitting a client who is at risk for falls to a medical-surgical unit. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Provide the client with a night light. This is important to reduce the risk of falls during nighttime when visibility is reduced. Placing the bedside table away from the bed (choice
A) does not directly address fall risk. Elevating full-length side rails (choice
C) may restrict the client's movement and increase the risk of injury. Keeping the room temperature at 18°C (choice
D) is important for comfort but does not directly impact fall risk.
Question 2 of 5
A nurse is caring for a client who is postoperative and is on bed rest. Which of the following actions should the nurse take to decrease the client’s risk of developing a pressure injury?
Correct Answer: C
Rationale: The correct answer is C: Ensure the client’s heels are not touching the mattress. This is important because pressure injuries commonly occur on bony prominences, such as the heels, due to prolonged pressure and friction. By ensuring the client’s heels are elevated off the mattress, the nurse can reduce the risk of pressure injury development in this area. Repositioning the client every 4 hours (choice
A) is important but may not specifically address the risk of pressure injury on the heels. Raising the head of the client’s bed to a 60° angle (choice
B) is more related to preventing aspiration in a postoperative client than preventing pressure injuries. Massaging the client’s bony prominences (choice
D) can actually increase the risk of skin breakdown due to friction and shearing forces.
Question 3 of 5
A nurse is preparing to perform an anthropometric assessment on a client. Which of the following client data should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: Weight. In an anthropometric assessment, weight is a crucial measurement to assess a client's nutritional status, growth patterns, and overall health. Weight can indicate changes in fluid balance, muscle mass, and fat stores. It helps in monitoring progress, setting goals, and evaluating the effectiveness of interventions. The other choices are incorrect because: A - Level of orientation is related to cognitive status, not anthropometric assessment; B - Respiratory rate is a vital sign indicating respiratory function, not part of anthropometric assessment; D - Current pain level is important for pain management but not relevant to anthropometric assessment.
Question 4 of 5
A nurse is caring for a client who has severe rheumatoid arthritis in her hands and is unable to feed herself. For which of the following health care team members should the nurse request a referral from the provider?
Correct Answer: B
Rationale: The correct answer is B: Occupational therapist. The nurse should request a referral to an occupational therapist for the client with severe rheumatoid arthritis in her hands because an occupational therapist specializes in helping individuals regain independence in activities of daily living, such as feeding oneself. An occupational therapist can provide interventions to improve hand function and teach adaptive techniques to help the client feed herself.
Choice A, a social worker, focuses on psychosocial needs and support services rather than physical rehabilitation.
Choice C, a physician assistant, typically provides medical care but may not have the specialized skills in hand therapy.
Choice D, a physical therapist, focuses more on overall mobility and physical function rather than specific hand function in feeding.
Question 5 of 5
A nurse is reviewing the laboratory results of a female client who has liver dysfunction and is receiving a continuous tube feeding. Which of the following findings should the nurse identify as a protein deficiency?
Correct Answer: A
Rationale: The correct answer is A: Albumin 3.1 g/dL. Albumin is the main protein in the blood and is produced by the liver. In liver dysfunction, the synthesis of albumin is decreased, leading to low levels in the blood, indicating protein deficiency. Transferrin (
B) is a protein involved in iron transport, not a direct indicator of protein deficiency. Uric acid (
C) and total iron-binding capacity (
D) are not specific markers for protein deficiency.