ATI RN
ATI RN VATI Fundamentals S 2019 Final Questions
Extract:
Question 1 of 5
A nurse is caring for a group of clients. Which of the following client-care situations requires the nurse to complete an incident report?
Correct Answer: A
Rationale: Administering enoxaparin in the deltoid is incorrect (should be abdomen or thigh) requiring an incident report for protocol deviation. Catheter advancement wound cleansing and tube flushing are standard practices.
Question 2 of 5
A nurse is reviewing transmission precautions with an assistive personnel (AP) who is providing care for a client who has a Clostridium difficile infection. Which of the following statements by the AP indicates an understanding of the teaching?
Correct Answer: D
Rationale: Wearing gloves when changing the gown prevents transmission of C. difficile spores which spread through contact. Isopropyl alcohol and alcohol-based sanitizers are ineffective against C. difficile requiring sporicidal disinfectants and soap-and-water handwashing. Masks are unnecessary as C. difficile is not airborne.
Question 3 of 5
A nurse is admitting a client who reports having diarrhea for the past 72 hr. Which of the following actions is the nurse's priority?
Correct Answer: A
Rationale: Providing oral replacement solution is the priority to address dehydration and electrolyte imbalances from prolonged diarrhea. Antidiarrheal medication sitz baths and stool collection are secondary to stabilizing hydration status.
Question 4 of 5
A nurse is preparing to notify the provider about a change in a client's status. Which of the following information should the nurse plan to include in the 'background' portion of the Situation,Background,Assessment,Recommendation (SBAR) Communication tool?
Correct Answer: A
Rationale: In the 'background' portion of the SBAR tool the nurse should include the client's present condition to provide context and a baseline for the provider. Suggestions and physical findings belong in the 'assessment' or 'recommendation' sections. Previous treatments may be relevant but are secondary to the current condition in the 'background' section.
Question 5 of 5
A nurse is caring for a client who is at risk for pressure injury formation due to immobility. The nurse should place the client in which of the following positions to reduce pressure on the client's bony prominences?
Correct Answer: A
Rationale: The 30° lateral position distributes weight evenly reducing pressure on bony prominences. Semi-prone supine and Fowler’s positions increase pressure on areas like the sacrum and heels heightening pressure injury risk.