ATI RN
ATI Nursing 4650 Comprehensive Exam Questions
Extract:
Question 1 of 5
A nurse is conducting a primary survey of a client who has sustained life threatening injuries due to a motor vehicle crash. Identify the sequence of actions the nurse should take. (Move the actions into the box on the right, placing them in the selected order of performance. Use all the steps.)
Correct Answer: A,C,B,D,E
Rationale: The sequence follows the ABCDE primary survey: airway (jaw-thrust), breathing (ventilation), circulation (IV access), disability (Glasgow Coma Scale), and exposure (remove clothing).
Question 2 of 5
A nurse is administering a tap water enema to a client who is constipated. During the administration of the enema, the client states he is having abdominal cramps. Which of the following actions should the nurse take to relieve the client's discomfort?
Correct Answer: C
Rationale: Lowering the height of the solution container reduces the flow rate of the enema solution, which can help alleviate abdominal cramps by slowing the rate of distension of the bowel. Slowing the infusion rate allows the client's colon to accommodate to the enema more comfortably.
Question 3 of 5
A nurse is assessing a toddler at a well-child visit. At what point in the physical examination should the nurse examine the child's tympanic membrane?
Correct Answer: C
Rationale: Examining the tympanic membrane at the end ensures a systematic head-to-toe assessment, allowing the nurse to focus on major body systems first before specific areas like the ears.
Question 4 of 5
A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?
Correct Answer: C
Rationale: Heparin is an anticoagulant that prevents new clots from forming by inhibiting clotting factors, but it does not dissolve existing clots.
Question 5 of 5
A nurse is conducting a primary survey of a client who has sustained life threatening injuries due to a motor vehicle crash. Identify the sequence of actions the nurse should take.
Correct Answer: A,C,B,D,E
Rationale: The correct sequence follows the ABCDE primary survey approach: Open the airway (
A), assess breathing (
C), establish circulation (
B), evaluate disability via Glasgow Coma Scale (
D), and expose the client for assessment (E).