ATI RN
ATI Fundamental Proctored Exam 2024-2025 Online Practice 250 Simulated Exam Questions Questions
Extract:
Question 1 of 5
A nurse is caring for a client receiving IV therapy in the left forearm and notices that the site is red, swollen, and warm. Which of the following actions should the nurse perform first?
Correct Answer: B
Rationale: The correct action is to discontinue the existing IV infusion (
Choice
B) first. The redness, swelling, and warmth at the IV site indicate phlebitis, which is inflammation of the vein. Discontinuing the infusion is crucial to prevent further damage and infection. This step helps to stop the irritant (IV solution) from causing more harm. Inserting an IV catheter in the opposite extremity (
Choice
A) does not address the current issue and may lead to the same problem. Applying warm, moist compresses (
Choice
C) could potentially worsen the inflammation. Elevating the extremity (
Choice
D) may provide some relief, but it does not address the root cause.
Therefore, discontinuing the existing IV infusion is the most appropriate immediate action to take in this situation.
Question 2 of 5
A nurse is caring for a client who has a prescription for a stool guaiac test. The client asks the nurse about the purpose of the test. The nurse should respond by stating that the stool guaiac is testing for which of the following findings in the client's feces?
Correct Answer: C
Rationale: The correct answer is C: Blood. A stool guaiac test is used to detect the presence of occult (hidden) blood in the feces, which may indicate gastrointestinal bleeding. This test helps in diagnosing various gastrointestinal conditions such as ulcers, polyps, or colorectal cancer. Detecting blood in the stool is crucial for early diagnosis and intervention.
Choices A, B, and D are incorrect as stool guaiac test specifically looks for blood, not bacteria, parasites, or fat in the feces. Blood in the stool is a significant finding that requires further investigation, making it the appropriate response in this scenario.
Question 3 of 5
A nurse is attending a social gathering when another guest suddenly coughs weakly once, grasps her throat with her hands, and cannot talk. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Perform the Heimlich maneuver on the guest. This is the appropriate action for a choking individual who is unable to speak or breathe. The Heimlich maneuver helps dislodge the obstruction from the airway by applying abdominal thrusts. It is crucial to act quickly in such situations to prevent further complications like loss of consciousness or asphyxiation.
Choice A is incorrect as mouth-to-mouth resuscitation is not appropriate for a choking victim.
Choice B is incorrect as observing without taking immediate action can be dangerous if the individual's airway is completely blocked.
Choice D is incorrect as slapping the back may not effectively dislodge the obstruction. It is essential to prioritize the Heimlich maneuver to clear the airway and restore breathing.
Question 4 of 5
A nurse is observing the IV catheter insertion site of a client who is receiving continuous IV therapy. Which of the following manifestations should the nurse identify as an indication that the client has developed phlebitis?
Correct Answer: A
Rationale: The correct answer is A: Erythema. Phlebitis is inflammation of the vein, which commonly presents with redness (erythema) at the site. This is due to the body's response to the irritation caused by the IV catheter. Pallor (choice
B) and coolness (choice
C) are not typical signs of phlebitis, as they suggest decreased blood flow rather than inflammation. Drainage (choice
D) may indicate an infection but is not specific to phlebitis. In summary, erythema is the key indicator of phlebitis due to the inflammatory response in the vein.
Question 5 of 5
A nurse is assisting with the care of a client who has developed cardiogenic shock. When evaluating circulation to the client's brain, which of the following pulse sites should the nurse use?
Correct Answer: B
Rationale: The correct answer is B: Carotid. The carotid pulse site should be used when assessing circulation to the brain in a client with cardiogenic shock because it is the closest pulse site to the brain. The carotid artery supplies blood directly to the brain, making it the most accurate site to assess perfusion to this vital organ.
A: Femoral, C: Popliteal, and D: Radial are not ideal pulse sites for assessing circulation to the brain in a client with cardiogenic shock because they are further away from the brain compared to the carotid artery. Using these sites may not provide an accurate representation of cerebral perfusion in this critical situation.