ATI RN
ATI RN Fundamentals 2019 with NGN Questions
Extract:
Question 1 of 5
A nurse is planning care for a client who has a latex allergy and is scheduled for surgery. Which of the following actions is appropriate to include in the client's plan of care?
Correct Answer: D
Rationale: Scheduling the client as the first procedure minimizes latex exposure in the surgical suite. Stopcock removal and povidone-iodine cleansing are unrelated to latex, powdered gloves contain latex, and latex-based tape would trigger an allergic reaction.
Question 2 of 5
A nurse is providing teaching for a client who is scheduled for an allogeneic stem cell transplant. Which of the following information should the nurse include?
Correct Answer: C
Rationale: Wearing a mask when outside the room is crucial for a client undergoing an allogeneic stem cell transplant due to their immunocompromised state, protecting against infections. Visitors wearing gowns is secondary, semi-private rooms are avoided to reduce infection risk, and negative-airflow rooms are used to protect others, not the patient. Daily antibiotics are not standard unless infection is present.
Question 3 of 5
A nurse is preparing to insert an IV catheter for a client following a right mastectomy. Which of the following veins should the nurse select when initiating IV therapy?
Correct Answer: B
Rationale: The cephalic vein in the left distal forearm is appropriate, as IVs should be placed on the opposite side of a mastectomy to avoid lymphedema risk. Right-sided veins and the radial vein are less suitable. The median vein in the right forearm is also incorrect due to lymphedema risk.
Question 4 of 5
A nurse is caring for a client who is receiving continuous enteral feeding via NG tube. Which of the following is an unexpected finding?
Correct Answer: A
Rationale: A gastric residual of 300 mL at the end of the shift is unexpected, as residuals exceeding 500 mL every 6 hours may indicate poor gastric emptying or intolerance to feeding, requiring further assessment. Weight gain is expected, a blood glucose level of 110 mg/dL is normal, and one episode of diarrhea is not uncommon with enteral feeding. Abdominal distension would be unexpected but is not listed as a finding here.
Extract:
A nurse is caring for a client. Exhibit 1 Vital Signs 0800: Exhibit 2 Temperature 37.6°C (99.7°F) Blood pressure 108/56 mm Hg Heart rate 66/min Respiratory rate 18/min Pulse oximetry 97% on room air 0830: Temperature 37.5°C (99.5°F) Blood pressure 88/56 mm Hg Heart rate 104/min Respiratory rate 24/min Pulse oximetry 93% on room air
Question 5 of 5
Select the 4 findings that require immediate follow-up.
Correct Answer: B,D,E
Rationale: The findings requiring immediate follow-up are blood pressure (significant drop from 108/56 to 88/56 mm Hg, indicating possible hypotension), pulse oximetry (decrease from 97% to 93%, suggesting reduced oxygen saturation), heart rate (increase from 66/min to 104/min, indicating tachycardia), and level of consciousness (always critical to monitor for changes in clinical status). Temperature and respiratory rate changes are within normal ranges, and skin color/temperature data is not provided. Skin color and temperature do not require immediate follow-up without specific abnormal findings.