ATI RN
ATI Fundamentals 2023 Retake Questions
Extract:
Question 1 of 5
A nurse is collaborating with a risk management team about potential legal issues involving client care. The nurse should identify that which of the following situations is an example of negligence?
Correct Answer: C
Rationale: The correct answer is C: A nurse administers a medication without first identifying the client. This is a clear example of negligence because proper identification of the client is crucial in ensuring the right medication is given to the right person. Failing to verify the client's identity before administering medication can lead to serious consequences such as medication errors, allergic reactions, or adverse drug interactions. This breach in standard of care can result in harm to the client and legal ramifications for the nurse.
Other choices:
A: Starting a blood transfusion without consent is a violation of the client's rights, but it does not directly demonstrate negligence in providing care.
B: Discussing client care in a public area may breach confidentiality, but it does not directly involve negligence in client care.
D: Preventing a client from leaving the facility may be necessary for safety reasons and does not inherently constitute negligence in client care.
Question 2 of 5
A nurse is collecting a blood pressure (BP) reading from a client who is sitting in a chair. The nurse determines that the client's BP is 158/96 mm Hg. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Recheck the client's BP in her other arm for comparison. This is the best course of action because taking the BP in the other arm can help determine if the reading is accurate or if there is an issue with the equipment or technique. It is important to rule out any potential errors before taking further action.
Choice A is incorrect because waiting 30 minutes may not address the potential issue with the BP reading.
Choice B is incorrect because the width of the cuff should be appropriate for the arm size, not a specific percentage of the arm circumference.
Choice D is not necessary unless there are specific reasons to suspect positional effects on BP readings.
Question 3 of 5
A home health nurse is caring for a client who has a chronic illness and recently moved in with their adult child. Which of the following statements by the client should indicate to the nurse that the client has adapted to their new situational role?
Correct Answer: A
Rationale:
Rationale:
Choice A indicates the client has adapted to their new role by expressing appreciation for having others cook, showing acceptance of receiving care.
Choice B suggests confusion and lack of purpose, indicating difficulty adjusting.
Choice C reflects a desire for independence, not necessarily adaptation to the new role.
Choice D implies reluctance to ask for help, which may hinder adaptation. Overall, choice A demonstrates a positive attitude towards the new living situation, making it the correct answer.
Question 4 of 5
A nurse is assessing the impact of stressors on a family. Which of the following should indicate to the nurse there has been a change in family system?
Correct Answer: C
Rationale: The correct answer is C: A middle adult assumes their parent's responsibilities. This indicates a change in the family system as it suggests a shift in roles and dynamics within the family. The middle adult taking on their parent's responsibilities signifies a significant change in the family structure and functioning.
A: A young adult developing a close, personal relationship is a normal developmental milestone and does not necessarily indicate a change in the family system.
B: A young adult focusing on their career is also a typical developmental stage and does not directly relate to a change in the family system.
D: A middle adult experiencing physical changes is a part of the aging process and may not necessarily signify a change in the family system.
Therefore, choice C is the most relevant in the context of assessing the impact of stressors on a family system.
Question 5 of 5
A nurse is caring for a client who has left lower-lobe atelectasis. In which of the following positions should the nurse place the client for postural drainage?
Correct Answer: D
Rationale: The correct answer is D: Right lateral in Trendelenburg position. This position allows gravity to assist in draining secretions from the left lower lobe of the lung. Trendelenburg position promotes drainage by utilizing gravity to help move secretions towards the larger airways for removal. Side-lying with the right side elevated (
Choice
A) does not provide optimal drainage for the left lower lobe. Supine in low-Fowler's position (
Choice
B) and prone with pillows under the lower extremities (
Choice
C) do not specifically target the left lower lobe for drainage. Right lateral in Trendelenburg position (
Choice
D) is the most effective position for postural drainage in this scenario.