ATI PN fundamentals 2023 Exam 2

Extract:

Question 1 of 5

A nurse is preparing to set up a sterile field to change a sterile dressing on a client's abdominal wound. Identify the sequence of steps the nurse should take.

A. Prepare a dry work surface above the waist level. B. Open the outside cover of the sterile kit and remove the dust cover. C. Grasp the outermost flap of the sterile kit while opening away from the body. D. Open each side flap of the sterile kit individually while pulling to the side. E. Open the innermost lower flap of the sterile kit while standing away from the sterile field.

Correct Answer: A,B,C,D,E

Rationale: This sequence (A,B,C,D,E) maintains sterility by preparing, opening away, and avoiding contamination.

Question 2 of 5

A nurse is caring for a client who requires a sterile dressing change. The nurse should recognize that the surgical field has been contaminated if which of the following actions occur?

A. Unnecessary sterile items are placed on the field. B. The sterile solution is poured with the bottle held over the field. C. The handle of a pair of sterile scissors is resting 5 cm (2 in) from the field's edge. D. A pair of sterile forceps is allowed to rest in a container of sterile water on the field.

Correct Answer: B

Rationale: Pouring over the field risks contamination from the bottle, breaching sterility.

Question 3 of 5

A nurse is performing a wound irrigation for a client who has methicillin-resistant Staphylococcus aureus. When removing personal protective equipment, which of the following pieces should the nurse remove first?

A. Gloves B. Gown C. Goggles D. Mask

Correct Answer: A

Rationale: Removing gloves first prevents hand contamination when removing other PPE.

Question 4 of 5

A nurse is caring for an adult client who has acute lymphocytic leukemia. The client is refusing blood products. Which of the following responses should the nurse make?

A. Not receiving blood will slow down your recovery. B. You need to talk with your doctor about this. C. Why are you refusing to receive blood products? D. I understand that you decided not to receive blood products.

Correct Answer: D

Rationale: Acknowledging the refusal respects autonomy and builds trust, avoiding confrontation.

Question 5 of 5

A nurse is caring for a client who refuses their morning dose of antihypertensive medication. The client tells the nurse, 'I'm not going to take this medication because it makes me sick and dizzy.' Which of the following actions should the nurse take first?

A. Notify the provider of the client's refusal. B. Document the refusal in the client's medical record. C. Inform the client of the potential consequences of their refusal. D. Return the medication to the medication cabinet.

Correct Answer: C

Rationale: Informing about consequences first educates the client, supporting informed decision-making.

ATI PN fundamentals 2023 Exam 2 | Nurselytic

Nurselytic

ATI LPN

ATI LPN