ATI RN
ATI RN Fundamentals 2019 with NGN Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has a tracheostomy. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Securing tracheostomy ties to allow one finger to fit snugly ensures the tube is stable without being too tight, preventing skin breakdown or dislodgement. Normal saline is not typically used for stoma cleaning (sterile solutions are preferred), soaking the outer cannula in soapy water is not recommended, and cotton tip applicators risk leaving fibers in the cannula. Applying a warm compress is incorrect, as it may promote infection or irritation.
Question 2 of 5
A nurse is preparing to insert an IV catheter for a client following a right mastectomy. Which of the following veins should the nurse select when initiating IV therapy?
Correct Answer: B
Rationale: The cephalic vein in the left distal forearm is appropriate, as IVs should be placed on the opposite side of a mastectomy to avoid lymphedema risk. Right-sided veins and the radial vein are less suitable. The median vein in the right forearm is also incorrect due to lymphedema risk.
Question 3 of 5
A nurse is delegating client care tasks to assistive personnel. Which of the following tasks should the nurse delegate?
Correct Answer: B
Rationale: Performing a simple dressing change is within the scope of assistive personnel, freeing the nurse for more complex tasks. Changing IV tubing, inserting an NG tube, evaluating healing, and administering medications require a licensed nurse’s expertise.
Extract:
A nurse is caring for a client who has a prescription for a 250 mL IV fluid bolus. The nurse administers a 500 mL IV bolus.
Question 4 of 5
Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: Assessing the client for adverse reactions is the priority because administering an excessive IV fluid bolus (500 mL instead of 250 mL) can lead to immediate complications such as fluid overload, pulmonary edema, or electrolyte imbalances. The nurse must first ensure the client's safety by checking for signs of these adverse effects (e.g., respiratory distress, edema, or changes in mental status). Obtaining vital signs, notifying the provider, and documenting are important but secondary to immediate client assessment. Increasing the IV flow rate is incorrect as it would exacerbate the fluid overload risk.
Extract:
Question 5 of 5
A community health nurse is teaching a group of clients about Kegel exercises to prevent urinary incontinence. Which of the following instructions should the nurse include?
Correct Answer: B
Rationale: Contracting the pelvic floor muscles is the core of Kegel exercises, strengthening muscles to prevent incontinence. Holding breath, tightening buttocks, or expecting quick results are incorrect. Kegels can be performed in any position, not only lying flat.