ATI RN
ATI RN Fundamentals 2019 II Questions
Extract:
Question 1 of 5
A nurse is preparing a sterile field to assist with suturing a client's laceration. Which of the following actions should the nurse plan to take?
Correct Answer: C
Rationale: The correct answer is C: Hold the bottle of sterile solution so that the label is facing the palm of the hand. This is important to maintain sterility by preventing contamination of the solution. Holding the bottle with the label facing the palm ensures that any potential drips or splashes will not touch the label, which could introduce contaminants when brought back to the field. Applying sterile gloves before opening the bottle (choice
A) is important but not directly related to maintaining the sterility of the solution. Placing the lid face down on the drape (choice
B) can introduce contaminants onto the lid. Pouring the solution from a height (choice
D) does not contribute to maintaining sterility and can lead to splashing.
Question 2 of 5
A nurse is preparing to administer IV fluids to a client. The nurse notes sparks when plugging in the IV pump. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct answer is A: Unplug the pump. This is the first action the nurse should take to ensure immediate safety. Sparks indicate an electrical issue that could lead to a potential hazard such as fire or electric shock. By unplugging the pump, the nurse eliminates the source of the sparks, preventing any further danger to the client or staff. Labeling the pump with a defective equipment sticker (
B) is not the priority as the immediate risk should be addressed first. Obtaining a replacement pump (
C) can be done after ensuring safety. Notifying the biomedical department (
D) can be the next step once the immediate danger is mitigated.
Question 3 of 5
A nurse is preparing to perform a physical assessment of a client's abdomen. Identify the sequence in which the nurse should perform the following steps. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Order the Items
Source Container
Correct Answer: A B C D E
Rationale: The correct order is A B C D E. First, providing adequate lighting (
A) ensures a clear view. Listening to abdominal arteries (
B) can reveal abnormal sounds. Percussing all four quadrants (
C) assesses for organ size and presence of fluid or air. Checking for tenderness (
D) identifies painful areas. Finally, locating liver and spleen borders (E) helps assess organ size and position.
Choices F and G are not relevant to the sequence of a physical assessment of the abdomen.
Question 4 of 5
A nurse is assessing a client who has diabetes mellitus prior to performing a blood glucose test. Which of the following findings should indicate to the nurse that the client has hyperglycemia?
Correct Answer: B
Rationale: The correct answer is B: Thirst. Hyperglycemia in diabetes causes increased blood sugar levels, leading to dehydration and increased thirst (polydipsia). Thirst is a classical symptom of hyperglycemia. Confusion (
A) may indicate hypoglycemia, cold skin (
C) can be due to poor circulation, and shakiness (
D) is a sign of low blood sugar.
Question 5 of 5
A nurse is caring for a client who is scheduled to have his alanine aminotransferase (ALT) level checked. The client asks the nurse to explain the laboratory test. Which of the following is an appropriate response by the nurse?
Correct Answer: C
Rationale: The correct answer is C. Alanine aminotransferase (ALT) is an enzyme found in the liver. Elevated levels of ALT in the blood indicate liver damage or disease.
Therefore, this test provides information about the function of the liver. Option A is incorrect because ALT is not related to kidney function. Option B is incorrect as ALT does not assess heart function. Option D is incorrect as ALT is not used to determine the risk of blood clots.