ATI Fundamentals Proctored Exam Patient Care and Safety Part 1
To give 20 mg using 12.5 mg/5 mL syrup, the nurse calculates and administers 8 mL (rounded to the nearest whole number). When a client expresses concern about losing a valuable item like a wedding ring, the nurse should ensure its safety by placing it in a locked storage unit, following hospital policy. Restraints should only be used when a client poses a threat to themselves or others, not for convenience or non-threatening behaviors.
A nurse is preparing to administer diphenhydramine 20 mg orally to a 6-year-old child who has difficulty swallowing pills. Available is diphenhydramine 12.5mg/5ml oral syrup. Which of the following images indicates the correct number of mL the nurse should administer? (round answer to the nearest whole number.)
DOSAGE CALCULATION
8ml
Key Terms
A nurse is preparing to administer diphenhydramine 20 mg orally to a 6-year-old child who has difficulty swallowing pills. Available is diphenhydramine 12.5mg/5ml oral syrup. Which of the following images indicates the correct number of mL the nurse should administer? (round answer to the nearest whole number.)
DOSAGE CALCULATION
8ml
A nurse is admitting a client who is malnourished. The client states, "My wedding ring is loose and I'm worried I will lose it if it falls off."Which of the following is an appropriate response by the nurse?
a. " I will place it in your drawer so it won't get lost."
b. I can pin it to your hospital gown so you won't lose it."
c. "I will hold onto it until a family member can take it home."
d. I can put it in a locked storage unit for you
d
A charge nurse is teaching a group of newly licensed nurses about the use of restraints. In which of the following clinical situations should the nurse apply restraints?
a. If the client is pacing in the hallway
b. As a part of a fall prevention program
c. At the request of the client's family
d. When the client poses a threat to self
d
To ensure client safety, a nurse manager is planning to observe a newly licensed nurse perform a straight catheterization on a client. In which of the following roles is the nurse manager functioning?
a. Case manager
b. Client educator
c. Client care provider
d. Client advocate
d
A charge nurse in a long-term care facility is preparing an educational program about delirium for newly hired nurses. Which of the following statements should the nurse plan to include?
a. "Delirium does not affect a client's perception of her environment."
b. "Delirium does not affect a client's sleep cycle."
c. "Delirium has an abrupt onset."
d. "Delirium has a slow progression."
c
A nurse is speaking with a client who has recently received a diagnosis of a chronic illness. The client states, " The doctor must be wrong. I can't be that sick". The nurse should inform the client that their reaction is an example of which of the following expected responses to grief?
a. Acceptance
b. Denial
c. Anger
d. Depression
b
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| Term | Definition |
|---|---|
A nurse is preparing to administer diphenhydramine 20 mg orally to a 6-year-old child who has difficulty swallowing pills. Available is diphenhydramine 12.5mg/5ml oral syrup. Which of the following images indicates the correct number of mL the nurse should administer? (round answer to the nearest whole number.) | 8ml |
A nurse is admitting a client who is malnourished. The client states, "My wedding ring is loose and I'm worried I will lose it if it falls off."Which of the following is an appropriate response by the nurse? | d |
A charge nurse is teaching a group of newly licensed nurses about the use of restraints. In which of the following clinical situations should the nurse apply restraints? | d |
To ensure client safety, a nurse manager is planning to observe a newly licensed nurse perform a straight catheterization on a client. In which of the following roles is the nurse manager functioning? | d |
A charge nurse in a long-term care facility is preparing an educational program about delirium for newly hired nurses. Which of the following statements should the nurse plan to include? | c |
A nurse is speaking with a client who has recently received a diagnosis of a chronic illness. The client states, " The doctor must be wrong. I can't be that sick". The nurse should inform the client that their reaction is an example of which of the following expected responses to grief? | b |
A Nurse on a medical-surgical unit is providing care for four clients. The nurse should identify which of the following situations as an ethical dilemma? | d |
A nurse is teaching a client about performing breast self-examinations. Which of the following statements by the clients indicates an understanding of the teaching? | d |
A nurse is preparing to transfer a client who is partially weight bearing from the bed to the chair. Which of the following actions should the nurse take? | d |
A nurse is caring for a client following a laparoscopic cholecystectomy. The client has a prescription for ondansetron 4mg IV bolus every 6hr PRN for nausea and vomiting. Identify the sequence of steps the nurse should follow to administer the medication. ( Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) | 1. perform hand hygiene |
A nurse is teaching a client who has diabetes mellitus about mixing regular and NPH insulin. | d |
A nurse is assessing the body temperature of an adult client using a temporal artery thermometer. Which of the following actions should the nurse take? (Select all that apply) | a, c |
A nurse is preparing to insert a peripheral IV catheter into the client's arm. Which of the following actions should the nurse take to help dilate the vein? | b |
A nurse is preparing to suction a client's tracheostomy tube. Which of the following actions should the nurse plan to take? | a |
A nurse is assessing a client who received morphine for severe pain 30 mins ago. Which of the following finding is the nurse's priority? | d |
A nurse is caring for a client who has been treated multiple times for STIs. Which of the following responses should the nurse take? | c |
A nurse enters the room of a client who has a seizure disorder. The client is sitting in a chair and begins to experience a seizure. Which of the following actions should the nurse take first? | c |
A nurse is testing a client for conduction deafness by performing Weber's test. Which of the following actions should the nurse take when performing this test? | c |
A nurse is obtaining the medication history of a client who asks about taking ginkgo biloba. The nurse should identify which of the following medications can interact adversely with this supplement? | a |
A nurse is obtaining informed consent from a client who is scheduled for surgery. The client states, "I don't want to go through with the procedure." Which of the following actions should the nurse take? | d |
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? | d |
A nurse is caring for a client who is postoperative and has a new prescription to advance her diet to full to full liquids. Which of the following foods should the nurse offer the client as a part of a full liquid diet? | d |
A nurse is preparing a client who has terminal cancer for discharge. Which of the following questions should the nurse ask when assessing the client's psychosocial history? | d |
A nurse is performing a skin assessment on an older adult client. Which of the following findings should the nurse expect? | c |
A nurse is caring for a client who begins to cry after receiving a diagnosis of cancer. Which of the following responses should the nurse make? | c |
A nurse is preparing to obtain a health history from a client. Which of the following actions should the nurse take? | b |
A nurse is caring for a client who has brain cancer and is transferring to hospice care. The client's son tells the nurse, " I don't know what to tell my dad if he asks how he is going to die." Which of the following is an appropriate response by the nurse? | a |
A Nurse is preparing to administer several medications to a client. Which of the following data should the nurse plan to use to confirm the client's identity? | d |
A nurse is caring for a client who is prescribed a special diet. The client is concerned that he does not have the resources to purchase the food he needs to adhere to the diet at home. The nurse should notify which of the following members of the health care team. | a |
A nurse is teaching a newly licensed nurse about the care of a client who has a methicillin resistant Staphylococcus aureus (MRSA) infection. Which of the following statements by newly licensed nurse indicates an understanding of the teaching? | a |
A nurse is planning care for a client who reports having a latex allergy. Which of the following interventions should the nurse include in the plan? | a |
A nurse is caring for a client who is scheduled for surgery. While the nurse is witnessing the client's signature, the client states, " I trust my doctor, but I don't understand what is meant by resecting my intestines." Which of the following actions should the nurse take? | b |
A nurse is documenting client care. Which of the following abbreviations should the nurse use? | c |
A nurse is preparing to bathe a client who has dementia. Which of the following actions should the nurse take? | c |
A hospice nurse is caring for a client who has end stage cancer. Which of the following interventions should the nurse include to promote the client's dignity? | b |
A nurse is caring for a client who has a closed wound drainage system. Which of the following actions should the nurse take? | d |
A nurse receives a telephone prescription from a provider for a client who is experiencing pain. Which of the following responses should the nurse make? | a |
During change of shift report, a nurse discovers she overlooked a prescription for a type and cross-match of a client who is to have surgery the next day. Which of the following actions should the nurse take first? | a |
A Nurse is caring for client who has pneumonia. The nurse should recognize which of the following should be discarded in a biohazard bag? | a |
A nurse is caring for a client who is receiving enteral feedings via NG tube. Which following actions should the nurse take prior to administering the formula? | a |
A nurse is caring for a client immediately following the insertion of an NG tube. Which of the following should indicate to the nurse that the tube is placed incorrectly? | b |
A nurse is inserting an NG tube for a client who requires gastric decompression. Which of the following actions should the nurse take to verify proper placement of the tube? | b |
A nurse is caring for a client who reports a pain level of 5 on a scale from 0-10. The client informs the nurse that pain meds are not an option for managing pain. Which of the following is an appropriate response by the nurse? | a |
a nurse is caring for a client who has an extracellular fluid volume deficit. Which of the following findings should the nurse expect? | b |
A nurse is caring for a client who is immunocompromised which of the following actions should the nurse take? | b |
Which of the following veins should the nurse select when initiating iv therapy? | b |
interventions should the nurse take to prevent skin breakdown? | d |
client tells the nurse" I am looking forward to seeing my grandchildren grow up." the nurse should identify the client is experiencing which of the following stages of grief? | d |
A nurse is teaching a client about the care and use of hearing aids. Which of the following instructions should the nurse include in the teaching? | b |
A nurse is teaching a client about the care and use of hearing aids. Which of the following should the nurse take? | c |
A nurse is teaching the assistive personnel about upper body mechanics to prevent injury. Which of the following actions by the AP demonstrate an understanding of the teaching? | a |
A nurse is assessing a client who is immobile and notices a red area over the client's coccyx. Which of the following actions should the nurse take? | c |
A nurse is planning care to prevent skin breakdown for a client who is immobile and has urinary incontinence. Which of the following actions should the nurse include in the plan of care. | a |
A nurse is teaching a client who had an enucleation about care of an artificial eye. Which of the | c, d, e |
A nurse is caring for a client who is 2 days postoperative following bowel resection and reports sudden severe abdominal pain. Which of the following actions should the nurse take first? | b |
A nurse is providing care for a client who is to undergo a total laryngectomy. Which of the following interventions is the nurses priority? | d |
A home care nurse is teaching a client about home safety. Which of the following statements by the client indicates an understanding of the teaching? (select all that apply) | a, b, c |