ATI PN fundamentals 2023 Exam 2

Extract:

Question 1 of 5

A nurse is assisting in the care of a client who just started receiving a blood transfusion 5 min ago. Which of the following findings should be reported first to the provider?

A. HeadacheB. DyspneaC. HyperthermiaD. Urticaria

Correct Answer: B

Rationale: Dyspnea may indicate a severe transfusion reaction like TRALI, requiring urgent reporting.

Question 2 of 5

A nurse is caring for an adult client who has acute lymphocytic leukemia. The client is refusing blood products. Which of the following responses should the nurse make?

A. Not receiving blood will slow down your recovery.B. You need to talk with your doctor about this.C. Why are you refusing to receive blood products?D. I understand that you decided not to receive blood products.

Correct Answer: D

Rationale: Acknowledging the refusal respects autonomy and builds trust, avoiding confrontation.

Question 3 of 5

A nurse is reinforcing discharge teaching with a male client who has an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching?

A. I will empty my drainage bag once a day.B. I will apply antiseptic ointment to the tip of my penis.C. I will keep the drainage bag below the level of my waist.D. I will clamp the tube when I go for a walk.

Correct Answer: C

Rationale: Keeping the bag below waist level prevents urine backflow, reducing infection risk.

Question 4 of 5

A nurse is caring for a client who has insomnia. Which of the following actions should the nurse take?

A. Use overhead lighting when checking equipment.B. Keep the door to the client's room closed.C. Provide the client with snug-fitting nightwear.D. Administer prescribed diuretics in the evening.

Correct Answer: B

Rationale: Closing the door reduces noise, promoting a sleep-conducive environment.

Question 5 of 5

A nurse is caring for a client who requires a sterile dressing change. The nurse should recognize that the surgical field has been contaminated if which of the following actions occur?

A. Unnecessary sterile items are placed on the field.B. The sterile solution is poured with the bottle held over the field.C. The handle of a pair of sterile scissors is resting 5 cm (2 in) from the field's edge.D. A pair of sterile forceps is allowed to rest in a container of sterile water on the field.

Correct Answer: B

Rationale: Pouring over the field risks contamination from the bottle, breaching sterility.

ATI PN fundamentals 2023 Exam 2 | Nurselytic

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ATI LPN

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