ATI RN
ATI Nsg 131 Fundamentals Exam Questions
Extract:
Question 1 of 5
A nurse is attending a social event when another guest coughs weakly once, grasps his throat with his hands, and cannot talk. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Perform the Heimlich maneuver. This is the appropriate action for a choking individual who is coughing weakly, grasping their throat, and unable to talk, indicating a partial airway obstruction. The Heimlich maneuver helps clear the airway by applying abdominal thrusts to expel the obstructing object. Observing the client (
A) may lead to a worsening situation. Slapping the client on the back (
C) can be ineffective and potentially harmful. Assisting the client to the floor for mouth-to-mouth resuscitation (
D) is not indicated for a conscious choking individual.
Question 2 of 5
A nurse is preparing a client's evening dose of risperidone when the tablet falls on the countertop. Which of the following actions should the nurse take?
Correct Answer: A
Rationale:
Correct
Answer: A - Discard the tablet and obtain another dose of medication.
Rationale: Dropping the tablet on the countertop exposes it to potential contamination.
To ensure the client's safety and prevent any risk of infection or ingestion of foreign particles, it is best to discard the fallen tablet and obtain a new dose. This guarantees the client receives the full, uncontaminated dose as prescribed.
Summary of Incorrect
Choices:
B: Using the tablet's packaging to pick it up may introduce additional contaminants from the packaging material to the tablet, compromising its purity.
C: Washing the tablet with alcohol is not recommended as it may alter the tablet's composition and effectiveness. Placing it in a clean medication cup after washing does not guarantee sterility.
D: Placing the tablet directly into a medication cup without addressing potential contamination does not ensure the tablet's cleanliness and safety for the client.
Question 3 of 5
A nurse is preparing to administer oral medications to a client. Which of the following should the nurse recognize as an acceptable client identifier? (Select All that Apply)
Correct Answer: B,E
Rationale: The correct answers are B and E. A facility-assigned identification number is a unique identifier specific to the client, ensuring accuracy. The client's full name is another acceptable identifier for verification. Provider's name (
A) may not be specific to the client. Facility room number (
C) is not a reliable identifier for a specific client. Partner's full name (
D) is not directly related to the client being administered medication.
Question 4 of 5
A nurse is caring for a client who has an infection. The nurse should use which of the following strategies to prevent the transmission of the client's infection?
Correct Answer: B
Rationale:
Correct
Answer: B - Performing hand hygiene before, during, and after direct contact with the client
Rationale: Hand hygiene is a crucial infection control measure to prevent the transmission of infections. By washing hands before, during, and after contact with the client, the nurse reduces the risk of spreading the infection to themselves or other individuals. It helps to eliminate pathogens that may be present on the hands and prevents cross-contamination. This practice is supported by evidence-based guidelines and is a fundamental aspect of infection prevention in healthcare settings.
Summary of Incorrect
Choices:
A: Encouraging a high-protein diet is important for the client's nutrition but does not directly prevent the transmission of the infection.
C: Placing the client in a room with positive-pressure airflow may be suitable for specific conditions but does not address the immediate need for infection prevention.
D: Changing the client's bed linens each day is essential for maintaining cleanliness but does not directly prevent the transmission of the infection.
Question 5 of 5
A nurse is preparing to measure a client's level of oxygen saturation and observes edema of both hands and thickened toenails. The nurse should apply the pulse oximeter probe to which of the following locations?
Correct Answer: D
Rationale: The correct answer is D: Earlobe. The nurse should apply the pulse oximeter probe to the earlobe because in this scenario, the client has edema of both hands and thickened toenails, which can affect the accuracy of readings on the fingers or toes. The earlobe is a reliable alternative site for obtaining accurate oxygen saturation readings in patients with peripheral edema or thickened nails. It provides good blood flow and is less affected by local edema or nail thickness compared to the fingers or toes. Skin folds can also be affected by edema, making them less reliable.
Therefore, the earlobe is the best choice in this situation for accurate oxygen saturation measurement.