ATI RN
ATI RN Fundamentals Online Practice 2023 B Questions
Extract:
Question 1 of 5
A nurse is placing a patient on isolation precautions. Which of the following actions should the nurse take?
Correct Answer: A,B
Rationale: The correct answer is A and B. Wearing an N95 mask is crucial for airborne precautions to protect the nurse from inhaling infectious particles. Placing a container for soiled linens inside the patient's room prevents contamination of other areas.
Choice C is incorrect because a sterile, water-resistant gown is not necessary for isolation precautions.
Choice D is incorrect as ventilation is not a specific action for isolation precautions.
Extract:
A nurse is caring for a client who has a peripheral IV inserted for fluid replacement.
On Day 1, Lactated Ringer’s was infusing at 100 mL/hr into a 20-gauge IV catheter in the left hand. The IV dressing was dry and intact.
The IV site was without redness or swelling. The IV fluid was infusing well.
On Day 2, the IV site was edematous.
The skin surrounding the catheter site was taut, blanched, and cool to touch. The IV fluid was not infusing.
The nurse is assessing the client.
Question 2 of 5
Which of the following actions should the nurse take?
Correct Answer: A,B,C
Rationale: The correct actions for the nurse to take are A, B, and C. A: Stopping the IV infusion is necessary if there are signs of infiltration or phlebitis. B: Elevating the client's left arm helps reduce swelling and promote venous return. C: Applying heat to the client's left hand can improve circulation and comfort.
Choice D is incorrect as starting a new IV without addressing the current issue is unnecessary.
Choices E, F, and G are not provided, but based on the rationale, they would also be incorrect since the correct actions address the current problem effectively.
Extract:
A nurse is examining a patient’s medication prescription which states, “digoxin 0.25 by mouth daily.”.
Question 3 of 5
Which component of the prescription should the nurse confirm with the healthcare provider?
Correct Answer: B
Rationale: The nurse should confirm the dosage of the medication with the healthcare provider to ensure the patient receives the correct amount for effectiveness and safety. Dosage directly impacts the therapeutic effect and potential side effects. Confirming the route of administration (
A) is also important but less critical than dosage. Frequency of administration (
C) is typically included with dosage information. Confirming the name of the medication (
D) is important but not as critical as confirming the dosage.
Extract:
Nurses' Notes
The pressure injury on the sacrum was covered with slough and eschar. Debridement was performed.
The pressure injury was malodorous and at stage 4 with two tunnels present.
The pressure injury measured 10 cm (4 in) in diameter and 3 cm (1.2 in) at the deepest point.
The tunneling locations were at one and eight o’clock and measured at 6 cm (24 in) and 4 cm (1.6 in) respectively. The wound care nurse initiated negative pressure wound therapy.
Today, the client was sitting in bed, alert and oriented x. The client stated, “I can’t wait to get this thing off of me.”. The client reported pain as a 5 on a scale of 0 to 10. A PRN analgesic was prescribed.
At 0830, the client’s condition was assessed.
The client was at the bedside for a dressing change. S1 and S2 were auscultated, with a rate of 76/min. Respirations were even and regular at 16/min.
The negative pressure wound therapy dressing was removed.
Granulation tissue covered the wound bed. There was slight erythema.
The pressure injury measured 8.75 cm (3.5 in) in diameter and 2.5 cm (1 in) at the deepest point.
Two tunnels measured 5 cm (2 in) and 3 cm (1.2 in). The dressing was reapplied and sealed, with an intermittent pressure setting at 125 mm Hg. The client reported pain as a 2 on a scale from 0 to 10 and tolerated the procedure well.
Question 4 of 5
Three days ago, a client was admitted from home with a reported pressure injury. The provider and wound care nurse were at the bedside. Which statement best describes the most critical aspect of the client's pressure injury and current treatment?
Correct Answer: B
Rationale: The correct answer is B: The pressure injury was at stage 4. This is the most critical aspect because stage 4 pressure injuries are the most severe, involving extensive tissue damage. Immediate and appropriate treatment is crucial to prevent further complications and promote healing.
Choice A is not as critical because the timing of admission does not directly impact the urgency of treating a stage 4 pressure injury.
Choice C, the client's pain level, though important, is not the most critical aspect as pain can vary among individuals and may not always correlate with the severity of the injury.
Choice D, the dressing being reapplied, is a part of the treatment process but not the most critical aspect compared to identifying the stage of the pressure injury.
Extract:
Question 5 of 5
A nurse is caring for a patient who needs a nasogastric (NG) tube for stomach decompression. Which of the following steps should the nurse take when inserting the NG tube?
Correct Answer: D
Rationale:
Correct Answer: D - Encourage the patient to take sips of water to facilitate the insertion of the NG tube into the esophagus.
Rationale: Encouraging the patient to take sips of water helps lubricate the esophagus and aids in the passage of the NG tube smoothly. This technique can reduce discomfort and resistance during insertion.
Summary:
A: Positioning the patient with the head of the bed elevated is important for NG tube insertion, but it is not the immediate step during the process.
B: Removing the NG tube if the patient gags or chokes is incorrect; these are common reactions and do not necessarily indicate a need for removal.
C: Applying suction before insertion is unnecessary and can cause discomfort to the patient.