Questions 62

ATI RN

ATI RN Test Bank

ATI RN Fundamentals 2023 Questions

Extract:


Question 1 of 5

A nurse is planning care for a client who has a prescription for extremity restraints to both wrists. Which of the following actions should the nurse include in the plan of care?

Correct Answer: A,C,D

Rationale: Assessing skin ensures circulation. Bed rails risk entrapment. Lowest bed position prevents falls. Padding protects skin. Two fingers, not three, ensure proper restraint fit.

Question 2 of 5

A nurse is assessing a client who received an IM antibiotic injection 15 min ago. Which of the following findings should the nurse identify as an indication of a possible anaphylactic reaction to the medication?

Correct Answer: A

Rationale: A sharp drop in blood pressure is a hallmark of anaphylaxis, indicating systemic vasodilation and shock. Swelling in feet is less specific. Injection site pain is local, not systemic. Decreased heart rate isn’t typical; tachycardia is more common.

Question 3 of 5

A nurse is preparing to administer packed RBCs to a client who has a low hemoglobin level. Which of the following actions should the nurse take prior to the start of the infusion?

Correct Answer: D

Rationale: Lactated Ringer’s isn’t used for RBCs. Confirming identity with the technician is done earlier. A small gauge catheter isn’t ideal for blood. Checking compatibility is critical to prevent reactions.

Question 4 of 5

A nurse is prioritizing care for a client. Which of the following procedures should the nurse perform first?

Correct Answer: D

Rationale: Catheter care, feeding, and wound irrigation are important but secondary to airway management. Endotracheal suctioning ensures a patent airway, critical for oxygenation.

Question 5 of 5

A nurse is planning care for a client who is immobile. Which of the following actions should the nurse include in the plan of care?

Correct Answer: B

Rationale: Logrolling is for spinal injuries. Trochanter rolls prevent hip rotation and maintain alignment. Arms at sides may restrict movement. Crossing ankles risks pressure injuries.

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