ATI RN
ATI N103N103 Fundamentals Final Exam Questions
Extract:
Question 1 of 5
A nurse is planning care for a client who has manifestations of a Clostridium difficile (C. difficile) infection. Which action should the nurse plan to take?
Correct Answer: B
Rationale: Gown and gloves prevent contact transmission of C. difficile. Masks are unnecessary, alcohol-based sanitizers are ineffective against spores, and blood tests don’t diagnose C. difficile.
Question 2 of 5
A nurse is teaching a client who has left-sided weakness after a stroke on how to use a cane. What instructions should the nurse include?
Correct Answer: A
Rationale: Holding the cane on the right side supports the weaker left leg, enhancing balance. Advancing the strong leg with the cane, removing the rubber tip, or placing the cane too far ahead reduces stability.
Question 3 of 5
A nurse is caring for a client at risk for fluid volume overload with an order to infuse 1 unit of blood. The health care provider specified the rate of infusion must be 8 hours to prevent the effects of fluid volume overload in this client. Which intervention should the nurse implement for this client?
Correct Answer: C
Rationale: Blood transfusions must be completed within 4 hours to prevent bacterial growth and complications per AABB/CDC guidelines. An 8-hour infusion (A
D) is unsafe and splitting the unit (
B) is not standard without specific protocols. Questioning the order (
C) ensures patient safety.
Question 4 of 5
A nurse is caring for a client who is complaining of thick respiratory secretions that are difficult to clear. What should the nurse encourage the client to do to help clear those secretions?
Correct Answer: A
Rationale: Increased fluid intake thins mucus aiding clearance. Antitussives (
B) suppress cough deep breathing (
C) is secondary and position changes (
D) are less effective for thinning secretions.
Question 5 of 5
A nurse is assessing a client’s cranial nerves. Which methods should the nurse use to assess cranial nerve V?
Correct Answer: A
Rationale: Cranial nerve V (trigeminal) is assessed by testing motor function (clenching teeth to evaluate masseter/temporalis strength) and sensory function (light touch on facial areas). Clenching teeth (
B) assesses motor function but sensory assessment is also required for a complete evaluation making A (clench teeth and assess sensation) the standard. Listening to speech (
A) reading a Snellen chart (
C) and raising eyebrows (
D) assess other cranial nerves.