ATI Fundamentals 2023 Retake

Extract:

Question 1 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?

A. Use trochanter rolls beside the client's legs.B. Place the client's arms at their side when turning them.C. Logroll the client every 4 hr.D. Cross the client's ankles when lying supine.

Correct Answer: A

Rationale: Trochanter rolls (
A) prevent hip rotation and injury. Arms cross the chest (B incorrect), logrolling (
C) is for spinal issues, and crossing ankles (
D) risks pressure.

Question 2 of 5

A nurse is caring for a client who has influenza and isolation precautions in place. Which of the following actions should the nurse take to prevent the spread of infection?

A. Don protective eyewear before entering the room.B. Wear a mask when working within 3 feet of the client.C. Place the client in a negative airflow room.D. Administer metronidazole.

Correct Answer: B

Rationale: A mask within 3 ft (
B) prevents droplet spread of influenza. Eyewear (
A) is for splashes, negative airflow (
C) is for airborne diseases, and metronidazole (
D) is irrelevant.

Question 3 of 5

A nurse is teaching a client how to self-administer heparin. Which of the following instructions should the nurse include in the teaching?

A. Use an 18-gauge, 1-inch needle to administer the medication.B. Massage the injection site after withdrawing the needle.C. Inject 5.1 cm (2 in) away from the umbilicus.D. Expel air bubble before injecting medication.

Correct Answer: C

Rationale: Injecting 2 in from the umbilicus (
C) ensures safe subcutaneous administration. 18-gauge (
A) is too large, massaging (
B) risks bleeding, and air bubble (
D) stays in prefilled syringes.

Question 4 of 5

A nurse is assessing a client who has left-sided weakness following a stroke. Which of the following findings is the nurse's priority?

A. The client's blood pressure is 142/94 mm Hg.B. The client coughs frequently while eating.C. The client leans to the left side while sitting.D. The client is consuming 25% of their meals.

Correct Answer: B

Rationale: Frequent coughing while eating (
B) risks aspiration, a priority per ABCs. BP (
A), leaning (
C), and intake (
D) are less immediate.

Question 5 of 5

A nurse is planning to change a client's tracheostomy ties. Which of the following actions should the nurse take?

A. Allow space for three fingers under the ties when securing.B. Cut the old ties after the new ties are secured.C. Use a quick-release knot to secure the ties.D. Extend the client's neck while securing the ties.

Correct Answer: B

Rationale: Cutting old ties after securing new ones (
B) prevents tube dislodgement. Three fingers (
A) is too loose, quick-release (
C) is optional, and neck extension (
D) risks discomfort.

ATI Fundamentals 2023 Retake | Nurselytic

Nurselytic

ATI RN

ATI RN