ATI RN
ATI RN Fundamentals Exam 6 Questions
Extract:
Question 1 of 5
A nurse is preparing to insert an NG tube for a client who requires enteral feedings. Which of the following instructions should the nurse give the client before beginning the procedure?
Correct Answer: C
Rationale: Raising the index finger is not a typical response for managing gagging during NG tube insertion. Bearing down during insertion is not an appropriate instruction and may increase the risk of complications. Instructing the client to say "stop" if a burning sensation is felt inside the nose allows for communication and prompt action to ensure the client's comfort and safety. Inhaling forcefully during insertion is not a recommended action and may interfere with the procedure.
Question 2 of 5
A nurse observes an assistive personnel (AP) empty an indwelling urinary catheter drainage bag while not wearing gloves. Which of the following interventions should the nurse take first?
Correct Answer: C
Rationale: Providing the AP with a copy of the unit's policy may be done but is not the first step. Direct communication is important for immediate feedback. Notifying the charge nurse is appropriate but may not be the first action when direct communication with the AP can address the issue. Talking with the AP about the technique used is the first and immediate action to address the observed lapse in infection control practices. Conducting an in-service on standard precautions is a broader intervention and may be considered after addressing the immediate concern with the AP.
Question 3 of 5
A nurse is delegating obtaining the collection of a client's oral temperature to an assistive personnel (AP). The nurse notes in the documentation that the AP obtained the client's axillary temperature. Which of the following rights of delegation should have prevented this situation from occurring?
Correct Answer: A
Rationale: The right task involves ensuring that the delegated task is appropriate for delegation. In this case obtaining an oral temperature should have been the correct task; however the AP performed the axillary temperature indicating a deviation from the right task. Right communication involves clear and effective communication between the nurse and the assistive personnel but is not directly related to the task performed. Right person involves ensuring that the task is delegated to a competent and qualified individual. The issue in this scenario is with the task itself not the competency of the individual. Right circumstance involves ensuring that the conditions are appropriate for delegation. While the circumstance is important the primary concern in this case is the mismatch between the task and the method of temperature measurement.
Question 4 of 5
A provider prescribes cold application for a client who reports ankle joint stiffness. Which of the following assessment findings should the nurse identify as a contraindication to the application of cold?
Correct Answer: C
Rationale: 2+ pitting edema is not a contraindication to cold application; in fact cold application can help reduce edema. A 7.5 cm (3 in) diameter bruise on the ankle is not a contraindication to cold application; cold can help reduce swelling and alleviate pain. Capillary refill of 4 seconds suggests compromised blood flow and cold application may further impair circulation. It is a contraindication. Warts on the affected ankle are not a contraindication to cold application.
Question 5 of 5
A nurse is providing care for a client who is scheduled for a total laryngectomy. Which of the following is the nurse's priority intervention?
Correct Answer: D
Rationale: Showing the client how to use an artificial larynx is an important aspect of post-laryngectomy care but determining the client's reading ability takes precedence as it will significantly impact communication options. Arranging a support session is important for emotional support but assessing the client's reading ability is more immediate in addressing communication needs. Demonstrating the use of esophageal speech is relevant but understanding the client's reading ability is a priority before exploring communication alternatives.