ATI Fundamentals of Nursing Practice Exam With Answers (465 Solved Questions)

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Rationale: Morphine can cause respiratory depression if given too much. Also youshould ALWAYS ASSESS the patient first when a med error is performed to makesure med errordoesn‟t put theclient‟s health inrisk.4.A nurse is preparing to administer diphenhydramine 20 mg orally to a 6-year-old child whohas difficulty swallowing pills. Available is diphenhydramine 12.5 mg/5 mL oral syrup.Which of the following images shows the correct # of mL the nurse should administer?(Round the answer to the nearest whole number.)Click on the syringe that has 8 mL of med.20mgx(5mL/12.5mg)= 8 mL5.A nurse is caring for a 6-year-old child who has a new prescription for cefoxitin 80mg/kg/day administered intravenously every 6 hour. The child weighs 20 kg. How muchcefoxitin should the nurse administer with eachdose? (Round the answer to the nearest wholenumber. Use a leading zero if it applies. Do not use a trailing zero.)So it says each dose for the final answer, but we are given 80 mg/kg/day.80x20 =1600 / 4 (doseis given every6 hoursaday)=400mgRationale: 80 mg x 20 kg = 1,6001,600/4 x day (q6h) = 400 mg6.A nurse is preparing to administer IV fluids to a client. The nurse notes sparks when pluggingin the IV pump. Which of the following actions should the nurse take first?a.Label the pump with a defective equipment sticker.b.Unplugthepump.c.Obtain a replacement pump.d.Notified the biomedical department to fix the pump.Rationale: Prioritization question. YOU WILL FIRST UNPLUG the IV pump to avoidcausing a fire.7.A nurse is caring for a client who has a surgical wound. Which of the following laboratoryvalues places the client at risk for poor wound healing?a.Serumalbumin 3g/dL

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b.Total lymphocyte count 2400 mm3c.HCT 42%d.HGB 16g/dLRationale: Albumin in low. Normal range is 3.5 to 5.5 g/dL. Low albumin places theclient at risk forpoor wound healing. The other lab values are within normal limits.8.A nurse is preparing to check a client's blood pressure. Which of the following actions shouldthe nurse take?Chapter 27 Vitals signs page 244a.Applythecuffabovetheclient‟santecubitalfossa.b.Use a cuff with a width that is about 60% of the client's arm circumference. - width of thecuff should be 40 % of arm circumferencec.How the clients sit with his arm resting above the level of his heart. - MUST BE ATHEART LEVELd.Release the pressure on the client's arm 5 to 6 mm per second. - pressure release shouldnot be more than 2 to 3 mm hg per secondRationale: ATI FUNDA says 40% of the arm circumference pg. 139. Release thepressure no faster than 2 to 3 mm Hg per second. Apply the BP cuff 2.5 cm (1 in) abovethe antecubital space with the brachial artery in line with the marking on the cuff.Applythe BP cuff 2.5 cm (1 in) above the antecubital space with the brachial artery in line withthe marking on the cuff.9.A nurse is preparing to perform nasal tracheal suctioning for a client. Which of the followingis an appropriate action for the nurse to take?Chapter 53 Airway management page 563a.Hold the suction catheter with the clean non-dominant hand.b.Apply suctioning for 20 to 30 seconds.- 10 -15 seconds is the maximum.c.Place the catheter in a location that is clean and dry for later use new line.- NEVEREVER REUSE THE SUCTION CATHETER . you throw it away after being used.d.Use surgical asepsis when performing the procedure.- book say medical asepsiswhich is maybe the same thing .Rationale: sterile technique for trachea

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Rationale: ATI FUNDA. PG. 316 Use surgical asepsis for all types of suctioning. Nolonger than 10-15 seconds to avoid hypoxemia10.A nurse is documenting client care. Which of the following abbreviations should the nurseuse?ati book was not thorough so i had to go on different sites for charts-not confident with this,pleasedouble check.a.“SS”for sliding scaleb.“BRP”for bathroom privilegesc.“OJ”for orange juice- do notd.“SQ”for subcutaneous- do not11.MISSING12.A nurse is collecting A blood pressure reading from a client who is sitting in a chair periodthe nurse determines that the clients BP is 158/96 mmhg. which of the following actions shouldthenursetake?a.Ensure that the width of the BP cuff is 50% of theclient‟supper arm circumference. Itsays 40%b.Reposition the client Supine and recheck her BP.BP. → ORTHOSTATICHYPOTENSIONc.Recheck the clients BP and her other arm for comparison.d.Request that another nurse check the the clients BP in 30 minutes.→ 15minutes13.A nurse is caring for a client who has left lower atelectasis. in which of the followingpositions should the nurse place the client for postural drainage?Chapter 53 AirwayManagement page 562e.Supine and low-Fowler's positionf.RightlateralinTrendelenburgpositiong.Side lying with the right side of the chest elevatedh.Prone with pillows under the extremities

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14.A nurse is receiving the prescription for a client who is experiencingdysphagia following astroke.Which of the following prescriptions should the nurse clarify?a.Dietitian consultb.Speech therapy referralc.Oral suction at the bedsided.Clearliquids-liquidsmustbeTHICK.ClearliquidscancauseaspirationRationale: ATI MS. Pg. 83 food levels for dysphagia include pureed, mechanicallyaltered, advanced/mechanically soft, and regular.15.A nurse is administering a large volume enema to a client. Identify the sequence of steps thenurseshouldfollowafter preparationandlubricatingtheenemaset.(atifundsvideoenema)1.Administer the enema solution.(2)2.Remove the enema tube from the clients rectum.(4)3.Wrap the end of the enema tube with a disposable tissue.(5)4.Insert the enema tube into the client's rectum.(1)5.Clamp the enema tube.(3)16.Anurse is inserting an NG tube for a client who requires gastric decompression. Which of thefollowingactions should thenursetaketoverify properplacementof the tube?a.Place the end of the NG tube in water to observe for bubbling.b.Auscultate 2.5 cm (1 in) above the umbilicus while injecting 15 mL of sterile water. AIRNOT WATER OR BY ASPIRATING GASTRIC FOR PH.c.Assess the client's gag reflex.d.MeasurethepHofthegastricaspirate.17.A nurse is teaching a group of newly licensed nurses about the Braden Scale. Which of thefollowing responses by the newly licensed nurse indicates an understanding of the teaching?a.“Theclient‟sage is part of themeasurement.”- rationale is same as b.b.“Thescalemeasuressixelements.”Rationale:The six elements are 1. Sensory Perception, 2. Moisture, 4. activity, 5.mobility ,6. nutrition , 7. friction and shear.

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c.“The higher the score, the higher the pressure ulcer risk.”- the higher the score the betterchance the patient has of NOT getting an ulcer . score of 12 or less is high risk.Anything above 18 is healthy.d.“Eachelement has a range from 1 to 5points.”- each elements is scored from 1-4 actually.18.A nurse is caring from a client who has a tracheostomy. Which of the following actionsshould the nurse take?a.Cleantheskinaroundthestomawithnormalsaline.b.Secure the tracheostomy ties with one finger to fit snugly underneath. → 2 snug fingerswidths under neck strapc.Soak the outer cannula in warm tap water. STERILE NSd.Use a cotton tip applicator to clean the inside in theinnercannula. <to clean OUTERcannula surfaces, cllity-approved solution>ean the inside with the faciRationale: according to POTTER, funda pg. 866 using NS-saturated cotton-tippedsterile swabs and 4x4 gauze, clean exposed outer cannula surfaces and soma underfaceplate, extending 5-10cm (2-4in) in all directions from stoma.19.Anurseisdocumentinginaclient‟smedicalrecord.Whichofthefollowingentriesshouldthenurserecord?a.“Incisionwithout redness ordrainage.”b.“Drinkadequate amounts of fluid withmeals.”WHATS THE AMOUNTc.“Oraltemperature slightly elevated at0800.”WHATS THE TEMPd.“Administeredpainmedication.”<Any action & change to theclient‟scondition should be recorded>20.A staff nurse is teaching a newly hired nurse about alternatives to the use of restraints onclients who are confused. Which of the following instructions should the nurse include?a.“Usefull-length side rails on theclient‟sbed.”b.“Checkon the client frequently while he is in therestroom.”c.“Encouragephysical activitythroughoutthedaytoexpand energy.”

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d.“Removeclocks from theclient‟sroom.”21.A nurse in an emergency department is assessing a client who reports RIGHT lower quadrantpain, nausea and vomiting for the past 48 hr. Which of the following actions should the nursetake first?a.Auscultatebowelsounds.b.Administer an antiemetic.c.Offer a pain med.d.Palpate the abdomen.Possible appendicitis“nausea/vomiting”with RLQ pain.(IAPP) INSPECTION. AUSCULTATE. PERCUSS. PALPATE- FOR BOWEL22.A nurse is assessing aclient‟sextraocular eye movements. Which of the following should thenurse take?a.Instructtheclientstofollowafingerthroughthesixcardinalfieldsof gaze.Rationale: Cardinal fields of gaze test for cranial nerves 3, 4, and 6 which are for eyemovementb.Hold a finger 46 cm (18 in) in front of theclient‟s eyes.c.Ask the clients to cover her right eye during assessment of her left eye.d.Position theclient‟s6.1 m (20 feet) away from the Snellen chart. (This is for cranialnerve 2)23.A nurse is providing a teaching to a client who had a new medication prescription. Which ofthe following manifestations of amild allergic reactionshould the nurse include?a.Urticariab.Ptosisc.Nausead.Hematuria

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24.A provider prescribes cold application for a client who reports ankle joint stiffness. Which ofthe following assessments findings should the nurse identify as acontraindicationto theapplication of cold?a.Caprefill4seconds-ITSCONTRAINDICATEDTOUSEAPPLICATIONOFCOLDb.7.5 cm (3 in) diameter bruise on the ankle IT HELPS ON BRUISEc.Warts on the affected ankled.2+ pitting edema -HELPS REDUCE INFLAMMATION (EDEMA)25.A nurse is caring for a client who has TB. Which of the following precautions should thenurse plan to implement when working with the client? Chapter 11 fundamentals 9.0 infectioncontrolpage 52a.AirborneRationale:measle, varicella, pulmonary or laryngeal tuberculosisb.Droplet-streptococcal pharyngitis or pneumonia, Haemophilus influenzae type B, scarletfever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia andsepsis, pneumonic plague).c.Protectived.Contact26.A nurse is performing a dressing change on a client and observes granulation tissue. Whichof the following findings should the nurse document? Chapter 55 Pressure ulcers, wounds andwound management? fundamentals pdfpage 330a.Stringy, white tissue- same as slough. Means that it is sepatated from the body.b.Translucent,redtissue-red means healthyanditshealingc.Soft, yellow tissue= means presence of slough and drainage.d.Thick, black tissue- black is necrotic = eschar is present and needs removal27.A nurse is screening several clients at a neighborhood health fair. Which of the followingassessments findings is thepriorityfor referral for further care?

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a.Bloodglucose45mg/dLRationale:low/hypoglycemia may lead to shocklevel is abnormally low, [74-106 mmol/L]b.Blood pressure 148/92 mm Hg STAGE 1 HYPERTENSIONc.Body mass index 28 kg/m2 OVERWEIGHTd.Heart rate 105/min28.A nurse is planning care for a client who has a new prescription for parenteral nutrition (PN)in 20% dextrose and fat emulsions. Which of the following is an appropriate action to include intheplan ofcare?a.Obtain a random blood glucose daily.b.Change the PN infusion bag every 48 hr. CHANGE Q24HRc.Prepare the client for a central venous line.d.Administer the PN and fat emulsion separately.ATI FUNDA PG. 298 Administer separate IV line below the filter using a Y-connector or as aadmixture to PN solution (3-in-1 admixture consisting dextrose, AA, and Lipids29.A nurse is providing teaching about health promotion guidelines to a group of young adultmaleclients. Which ofthe followingguidelines should thenurseinclude?a.“Obtaina tetanus booster every 5years.”b.“Obtaina herpes zoster immunization by age50.”c.“Have a dental examination every 6 months.”(funds atipg 201 says they need dentalcause they are prone to infection)d.“Havea testicular examination every 2years.”30.A home health nurse is teaching a new caregiver how to care for a client who has had atracheostomy for 1 year. Which of the following instructions should the nurse include?a.“Usetracheostomy covers when goingoutdoors.”Googleb.“Maintainsteriletechniquewhenperformingtracheostomycare.”c.“Removethe outer cannula for routinecleaning.”d.“Cleanaround the stoma with povidone-iodine.”NS

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31.A nurse in the emergency department is measuring a client‟s oral temperature using anelectronic thermometer. Which of the following actions should the nurse take?Chapter 27 Vitalsigsn p.133a.Provide oral hygiene prior to measuring theclient‟stemperature.b.Ask the client if he has smoked within the past 30 minc.Attach the red tip probe to the thermometer unit.d.Place the tip of the probe along theclient‟sbuccal mucosa.- must be unde the tongue inthe posterior sublingual pocket lateral to the center of the lower jaw.32.A nurse is caring for a client who had a stroke andrequires assistance with morning ADLs.Which of the following interprofessional team members should the nurse consult?a.Registered dietician- helps with healthy food planning.b.Occupationaltherapistchapter2page7theinterprofessionalteam.c.Speech-language pathologist- yes the question said stroke , but the question wants whowill help him with every day ADLS. speech patho help them if they have a hard timeswallowing.d.Physical therapist- is used of the patients cannot even move his muscles.33.MISSING34.A nurse overhears a colleague informing a client thathe will administer her medication byinjection if she refuses to swallow her pills. The nurse should recognize that the colleague iscommitting which of the following torts?a.) Defamation- you embarass someone by making fun of them.b.) Malpractice- you did something by accidentc.)Assault-verbalthreateningd.) Battery- actually causing physical harm or trauma.35.A nurse is caring for clients who is prescribed a buccal medication. Which of the followingclient statements indicates that the client understands how to take this medication?

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a.“Iwill first dissolve the tablet inwater.”b.“Iwillinsertthetabletbetween mycheekandteeth.”c.“Iwill place the tablet under mytongue.”- this is sublinguald.“Iwill chewthe tablet.”- this is oral36.A nurse is admitting a client who is malnourished. The client states my wedding ring is looseand I'm worried I will lose it if it falls off. Which of the following is an appropriate response bythe nurse?a.“Ican pin it to your hospital gown, so you won't loseit.”b.“Iwill place it in your drawer, so it won't getlost.”c.“Iwill hold onto it until a family member can takeit home.”d.“Ican putitin alockedstorageunitforyou.”37.A nurse is changing a client's colostomy pouch and notices peristomal skin irritation. Whichof the following actions should the nurse take?a.Change the pouch once every 24 hour.b.Apply the pouch while the skin Barrier is still damp.(no )c.Rub the peristomal skin dry after cleaning. (No it will irritate skin more )d. Ensure the pouch is 0.32 cm (1/8 in) larger than the stoma.rationale : ATI FUNDA PG 24138.A nurse is preparing change of shift report after the night shift using one sbar communicationtool. which of the following data should the nurse include when reportingbackgroundinformation?a.“Bloodpressure 160/92 mmHg”- part of ASSESSMENTb.“Startfirst dose of penicillin at1200”-c.“Painrating of 5 on a scale from 0to 10”d.“Codestatus:do-not-resuscitate”39.A nurse is caring for a client who has extracellular fluid volume deficit. Which of thefollowingfindingsshouldthenurseexpect?Chapter57fluidvolumeimbalancespage343.

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a.Postural hypotensionb.Distended neck veinsc.Dependent edemad.Bradycardia - would be TACHY since SNS system kicks in when detects low bloodvolumeTACHYCARDIA is for fluid overload.Isnt wherever the water goes the sodium follows. The lady on ati gave me a remediationhw about manifestation of hypernatremia: hyperthermia, tachycardia, and orthostatichypotension. Thereforeit‟sopposite→ bradycardia.TBC by the group40.A nurse is teaching a client how to self-administer daily low-dose heparin injections. Whichof the following factors is most likely increase theclient‟smotivation to learn?a.The nurse empathy about the client having to self-injectb.Theclient'sbelief thathisneedswillbemetthrougheducationc.The client seeking family approval by agreeing to a teaching pland.The nurse explaining the need for education to the client41.A nurse is conducting a Weber test on a client. Which of the following is an appropriateaction for the nurse to take?a.Deliver a series of high-pitched sounds at random intervals.b.Placeanactivatedtuning forkinthemiddleoftheclient'sforehead.c.Hold and activated tuning fork against the client's mastoid process.d.Whisper a series of words softly into one ear.42.A home health nurse is teaching a client about home safety. Which of the followingstatements by the client indicates an understanding of the teaching? Select all that apply.a.“Ineedtocheckmymedicationsforexpirationdates.”b.“I will use the grab bars when getting in and out of the bathtub.”c.“Ineedtohavea fireescapeplanwithmy family.”d.“Ineed to set my hot water heater to 140 degreesFahrenheit.”- no more than 120 degreese.“Iwillapplytapesoverfrayedareasof electricalcord.”

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43.A nurse is caring for a client who has a prescription for a stool specimen to be sent to thelaboratory to be tested for ova and parasites. Which of thefollowing instructions regardingspecimen collection should the nurse provide to the assistive personnel?a.Collect at least 2 inches of formed stool.b.Wear sterile gloves while obtaining the specimen.c.Use a culturette for specimen collection.d.Record thedateandtimethestool wascollected.(fundsatipg423)44.A nurse is caring for a client who has restraints to each extremity. Which of the followingassessments should the nurse perform first?a.Peripheral pulsesABCSalwaysfirstb.Comfort levelc.Elimination needsd.Skin integrity45.A nurse obtains a prescription forwrist restraintsfor a client who is trying to pull out hisNG Tube. Which of the following actions should the nurse take?a.Remove the restraints every 4 hr.b.Attach the restraints securely to the side of the client's bed.c.Apply the restraints to allow as little movement as possible.d.Allow room for two fingers to fit between the client's skin and the restraints.-forcirculation46.A nurse is assisting in the use of a fracture bedpan for a client who is immobile due to a cast.Which of the following actions should the nurse take?Page 244 and 240 chapter 44 urinaryeliminationTHIS IS CONFUSING. 244 SAYS FOR CLIENTS WHO MUST REMAIN SUPINE BUT240 SAYS THAT CLIENTS MUST HAVE Hob UP AT 30 DEGREES.a.Place the shallow end of the fracture pan under the client's buttocks.b.Hyperextend the client's back while the fracture pan is in place.

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c.Keep the bed flat while the client is on the fracture pan- head of bed must be 30 degrees.page 240d.Encourage the client to try to defecate for 20 min while on the fracture pan.47.A nurse is caring for a client who reports that she has insomnia. Which of the followinginterventions is appropriate for the nurse to recommend?a.Exercise 1 hr before bedtime.b.Eat a light carbohydrate snack before bedtime. This was on the fundamentalspracticetest on ATI funds 2013c.Drink a cup of hot cocoa before bedtime.d.Take a 30 min nap daily.48.A nurse is performing anadmission assessmentof a client. Which of the following actionsshould the nurse take when recording the client's medication?a.Council the client about medication adherence.b.Assess the client for medication reactions.c.Compilealistoftheclient'scurrentmedications.d.Evaluate the client's understanding of medications.49.During an admission history a client tells a nurse that she is under a lot of stress. Which ofthe following physiological responses should the nurse expect toincreaseas a result of stress?a.Bloodglucose-commonstressresponse.Tiamsonsaiditb.Intestinal peristalsis→per padgham? Not surec.Peripheral blood vessels diameter- should be constricted since youll have HIGH bloodpressure .d.Urine output50.A nurse is teaching a client who has diabetes mellitus about mixing regular and NPH insulin.Which of the following statements by the client indicates an understanding of the teaching?

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a.“I should roll the NPH between my hands before drawing it up.”-it says ROLL sothat makes sense , this would be wrong if it said SHAKE becasue that will break uptheproteins.b.“I should wait 10 minutes after mixing the insulin to inject it.”- i believe it is up to 5minutes but ima double check.c.“I should draw up the NPH insulin before the regular insulin.”- nope its clear to cloudyalways so you must draw up regular beofre NPHd.“I should inject air into the vial of regular insulin first.”- nope, when doing clear tocloudy, you inject AIR into NPH first51.A nurse is caring for a client who is grieving the loss of her partner. The client states I don'tsee the point of living anymore. which of the following actions should the nurse take?a.Request the client's family provide additional support.b.Asktheclientif sheplanstoharmherself.-safetyfirstc.Tell the client that this is a normal response to grief.d.Recommend that the client seek spiritual guidance.52.A nurse is providing discharge teaching about safety considerations to an older adult clientwho lives at home. The client has heart failure and a new prescription forhydrochlorothiazide.Which of the following statements by the clientindicates an understanding of the teaching?Chapter 19 pharm p. 145a.“Iwill take a hot bath before goingto bed.”- they are old also, so sensation is impaired.b.“I will take my new medication in the evening.”- this is a diueretic so this must be in theMORNINGc.“I will leave a light on in my bathroom at night.”-some clients might have to take ittwice per day usually last dose taken before 1400. You leave a light on in thebathroom because they might have to go urinate at night time ( since nocturia is apossiblesideeffect)d.“I will weigh myself once weekly.”- patients must weight themselves ONCE per dayusually upon awakening.

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