ATI Nur 231 Fundamentals Exam | Nurselytic

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ATI Nur 231 Fundamentals Exam Questions

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Question 1 of 5

A nurse is caring for a client who has dementia. The client is agitated and is having difficulty staying in his chair. Which of the following actions should the nurse take first?

Correct Answer: A

Rationale: The correct answer is A: Place a seat alarm in the client's chair. This is the first action the nurse should take because it promotes safety by alerting staff if the client attempts to get out of the chair, preventing falls. Option B, administering lorazepam, should not be the first action as it does not address the underlying cause of the agitation and may have adverse effects in older adults. Option C, applying a vest restraint, is not recommended as restraints should be used as a last resort due to the risk of increased agitation and injury. Option D, placing the client in bed with raised side rails, is not appropriate without attempting less restrictive measures first.

Question 2 of 5

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Question 3 of 5

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Question 4 of 5

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Question 5 of 5

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