ATI RN
ATI RN Fundamentals 2023 I Questions
Extract:
Question 1 of 5
A nurse is providing teaching to a client about reducing the adverse effects of immobility. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: B
Rationale: The correct answer is B: I will perform ankle and knee exercises every hour. This statement indicates an understanding of the teaching because regular ankle and knee exercises help prevent muscle atrophy and improve circulation, reducing the adverse effects of immobility.
Choice A is incorrect as removing antiembolic stockings increases the risk of blood clots.
Choice C is incorrect as holding breath while rising can lead to orthostatic hypotension.
Choice D is incorrect as changing positions every 2 hours is recommended to prevent pressure ulcers.
Question 2 of 5
A charge nurse is observing a staff nurse performing a wound irrigation for a client who has a pressure injury. Which of the following actions by the staff nurse indicates an understanding of the procedure?
Correct Answer: B
Rationale: The correct answer is B because using a syringe with a catheter for wound irrigation allows for controlled and directed flow of the irrigation solution into the wound, ensuring effective cleansing and minimizing contamination. This method helps prevent trauma to the wound and surrounding tissues.
A: Using one pair of gloves for dressing removal and irrigation increases the risk of cross-contamination.
C: Administering an analgesic medication before irrigation is not a standard practice and does not demonstrate understanding of the procedure.
D: Refrigerating the solution before irrigation is unnecessary and may cause discomfort to the client.
In summary, choice B is correct as it aligns with best practices for wound irrigation, while the other choices do not demonstrate a proper understanding of the procedure.
Question 3 of 5
A nurse is teaching an older adult client about reducing the risk for osteoporosis. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: A
Rationale: The correct answer is A: "I will walk three times per week." Weight-bearing exercises like walking help improve bone density and reduce the risk of osteoporosis. Walking stimulates the bones to retain calcium, making them stronger.
Choice B is incorrect because sunlight exposure is needed for vitamin D synthesis, important for calcium absorption.
Choice C is incorrect as dairy products provide essential calcium for bone health.
Choice D is incorrect because the recommended daily calcium intake is around 1000-1200 mg for older adults.
Question 4 of 5
A nurse is preparing to provide tracheostomy care for a client. Which of the following actions should the nurse plan to take?
Correct Answer: C
Rationale: The correct answer is C: Secure the tracheostomy in place with a collar that has hook-and-loop fasteners. This is important to prevent accidental dislodgement of the tracheostomy tube. The collar provides stability and support to keep the tube in place. Cutting a gauze pad to place under the flanges (
A) is not necessary and may increase the risk of infection. Cleansing the skin with full-strength hydrogen peroxide (
B) can be irritating and damaging to the skin. Wearing clean gloves while cleaning the inner cannula (
D) is essential for infection control but is not directly related to securing the tracheostomy in place.
Question 5 of 5
A nurse is planning care for a client who has a prescription for extremity restraints to both wrists. Which of the following actions should the nurse include in the plan of care? (Select all that apply.)
Correct Answer: A,B,D
Rationale:
Correct Answer: A, B, D
Rationale:
A: Ensuring the client’s bed is in the lowest position prevents falls and minimizes injury risk if the client tries to get out of bed.
B: Assessing skin temperature and color before applying restraints ensures proper circulation and skin integrity.
D: Padding bony prominences before applying restraints prevents pressure ulcers and discomfort for the client.
Summary:
C: Attaching the restraints to the bed rail can increase the risk of injury if the client moves around.
E: Allowing three fingers to slide under the restraints is incorrect as it can lead to improper fit and ineffective restraint.