ATI Fundamentals Proctored Exam Study Guide 3 -Nurselytic

Correct Answer: D

Rationale: The correct answer is D because listening for background noises can provide critical information about the location or nature of the threat, which can assist in assessing the level of danger and informing the appropriate response. This step is crucial in bomb threat situations as it can help security officers make informed decisions to protect the safety of the facility and its occupants.


Choice A is incorrect because abruptly ending the call can hinder gathering important details.
Choice B is incorrect as overhead paging can cause panic and potentially aid the perpetrator.
Choice C is incorrect since listening and gathering information is vital in assessing the threat.

Correct Answer: C

Rationale: The correct answer is C: Bone scan that is scheduled for today. This information is crucial for the oncoming shift as it pertains to the client's immediate care needs. Including the bone scan in the report ensures that the next nurse is aware of any specific preparations or precautions that need to be taken for the client.

A: While client's input & output is important, it is more relevant for ongoing monitoring than for immediate shift handover.
B: Client's blood pressure from the previous day may not be as urgent or pertinent for the upcoming shift.
D: Med routine from Med Admin Record is important but can be accessed directly from the record by the next nurse.

In summary, the bone scan scheduled for today is the most pertinent information to include in the change-of-shift report as it directly impacts the client's current care needs.

Correct Answer: A

Rationale: The correct answer is A: Hypotension. In heat stroke, the body's cooling system fails, leading to a rapid rise in body temperature. This can cause vasodilation, leading to decreased blood pressure (hypotension) as the body tries to cool down. Bradycardia (
B) is unlikely because the body typically increases heart rate to try to cool itself down. Clammy skin (
C) is a common symptom of heat exhaustion, not heat stroke. Bradypnea (
D) refers to slow breathing, which is not typically associated with heat stroke. Overall, hypotension is the most relevant response as it directly relates to the body's response to heat stroke and the failure of its cooling mechanisms.

Correct Answer: C

Rationale: The priority action by the nurse in this scenario is to evacuate the clients (choice
C). This is because ensuring the safety of the clients is the top priority in any emergency situation. Evacuating the clients will remove them from potential harm and allow them to be in a safe environment. Pulling the fire alarm (choice
B) is important but should come after ensuring the clients' safety. Extinguishing the fire (choice
A) may put the nurse at risk and should be left to the fire department. Closing all open doors on the unit (choice
D) may help contain the fire but is not as critical as evacuating the clients.

Correct Answer: A

Rationale: The correct answer is A: basic. The nurse in this scenario demonstrated basic critical thinking by following the surgeon's request without questioning or analyzing it further. She simply relayed the information and implemented the prescribed full liquid diet. The other choices are incorrect because: B: commitment implies a higher level of dedication and involvement, C: complex involves analyzing and synthesizing information which was not demonstrated in this situation, and D: integrity relates to honesty and ethical behavior rather than critical thinking level.