ATI RN
ATI Fundamentals 2023 Retake Questions
Extract:
Question 1 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?
Correct Answer: C
Rationale: The correct answer is C: Inject 5.1 cm (2 in) away from the umbilicus. This instruction is crucial as heparin injections should be administered subcutaneously at least 2 inches away from the umbilicus to prevent injury to internal organs. Option A is incorrect as heparin is typically administered using a smaller gauge needle, such as a 25-26 gauge. Option B is incorrect as massaging the injection site can lead to bruising or irritation. Option D is incorrect as expelling air bubbles before injecting medication is important to prevent air embolism, but it is not specific to heparin administration.
Question 2 of 5
A nurse is planning to change a client's tracheostomy ties. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Cut the old ties after the new ties are secured. This is the correct action because it ensures that the tracheostomy tube remains secure during the tie change process. By securing the new ties first before cutting the old ties, the nurse maintains the stability of the tracheostomy tube to prevent accidental dislodgment.
Choice A is incorrect because allowing space for three fingers under the ties may not provide adequate security.
Choice C is incorrect as using a quick-release knot may lead to accidental loosening of the ties.
Choice D is incorrect as extending the client's neck may cause discomfort or compromise the airway. It is essential to prioritize the safety and security of the tracheostomy tube during tie changes.
Question 3 of 5
A nurse is preparing to perform an anthropometric assessment on a client. Which of the following client data should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: Weight. Anthropometric assessment involves measuring body dimensions like weight, height, and body composition to evaluate a client's health status. Weight provides valuable information on nutritional status, hydration levels, and overall health. Level of orientation (
A) is related to cognitive function, not anthropometric assessment. Current pain level (
B) is important for pain management but not for anthropometric assessment. Respiratory rate (
D) is a vital sign and not typically part of anthropometric assessment. Weight is the most relevant data for this assessment.
Question 4 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: C
Rationale: The correct answer is C: "I will walk three times per week." Walking is weight-bearing exercise, which helps build bone density and reduce the risk of osteoporosis. This statement shows understanding of the importance of physical activity in preventing osteoporosis.
Choice A is incorrect because the recommended daily calcium intake for older adults is higher than 250mg.
Choice B is incorrect because dairy products are a good source of calcium, essential for bone health.
Choice D is incorrect because sun exposure is needed for vitamin D synthesis, which is important for calcium absorption.
Question 5 of 5
A nurse is reviewing a medication prescription that reads, 'Morphine 5 mg IV bolus for pain'. Which of the following components should the nurse clarify with the provider?
Correct Answer: B
Rationale: The correct answer is B: Time. The nurse should clarify the time for administering the medication as it is missing from the prescription. Without a specified time, the nurse cannot ensure timely and appropriate administration. The other components (A: Dose, C: Medication, D: Route) are clearly stated in the prescription and do not require clarification. Time is a crucial factor in medication administration, affecting the effectiveness and safety of the medication. Clarifying the time ensures accurate and timely administration, preventing errors.