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ATI RN COMPREHENSIVE FINAL EXAM
LATEST REAL QUESTIONS AND
CORRECT ANSWERS GRADE A
A nurse is assessing a client who received 2 units of packed RBCs 48 hrs ago. Which of the following findings should indicate to the nurse that the therapy has been effective? - CORRECT ANSWER hemoglobin 14.9 g/dL A nurse is caring for a client who has a fracture of the left hip and is in skeletal traction. Which of the following actions should the nurse take? A. Increase the amount of weight if the client experiences muscle spasms. B. Remove the traction weights when bathing the client. C. Ensure there is no space between the traction weights and the bed. D. Provide a trapeze for the client to aid movement in bed. - CORRECT ANSWER D. Provide a trapeze for the client to aid movement in bed. A nurse who is trained as an interpreter has agreed to translate for an older adult client who is assigned to another nurse. Which of the following statements by the nurse who is translating indicates understanding of this role? A. "I will let the client know that I am available as the interpreter."
B. "I will receive a small fee for interpreting for this client." C. "I will let the client know that an interpreter is unavailable during the night shift." D. "I am glad I am available today, but when I'm not, you can use a family member." - CORRECT ANSWER A. "I will let the client know that I am available as the interpreter." A nurse on an inpatient eating disorder unit is assessing an adolescent client who has anorexia nervosa and a BMI of 16.5. Which of the following findings should the nurse expect? A. Menorrhagia B. Potassium 4.2 mEq/L C. Blood pressure 132/86 mm Hg D. Lanug - CORRECT ANSWER A. Menorrhagia / D Lanugo A client is requesting information from a nurse about a nitrazine test. Which of the following statements should the nurse make? A. "Your bladder should be full prior to me performing this test." B. "I will be taking a blood sample to test for changes in your hormone levels." C. "This test will determine if there is leaking amniotic fluid." D. "If this test is positive you will be required to have a non-stress test." - CORRECT ANSWER C. "This test will determine if there is leaking amniotic fluid." A nurse is providing dietary teaching to a client who had an exacerbation of COPD. Which of the following information should the nurse include in the teaching? A. "You should eat hot foods to reduce your sense of fullness during a meal." B. "Lunch should be your largest meal of the day."
B. Opens the sterile kit by unfolding the flap closest to her first. C. Provides perineal care prior to opening the catheter kit using clean gloves. D. Uses nondominant hand to expose urethral meatus by spreading the labia. - CORRECT ANSWER B. Opens the sterile kit by unfolding the flap closest to her first. A community health nurse is conducting a class about body mechanics for county office workers. Which of the following instructions should the nurse include? (Select all that apply.) - CORRECT ANSWER 1. Sit with your back supported 2. Keep your knees at hip level 3. Use ergonomically designed computer keyboard A nurse on an oncology unit receives report at the beginning of her shift about four clients who are postoperative. Which of the following clients should the nurse see first? pt1-A client who is 2 days postoperative following a colectomy d/t colorectal cancer and has an ostomy bag full of bright red, bloody drainage. pt 2- 2 days post op with wound suction with 20ml serosang drainage = normal pt 3- 1 day post op with bladder tumor and a continues bladder irrigation w 300ml red pink urine= normal pt 4- 1 day post lobectomy with chest tube ith 35 ml bright red drainage= normal
- CORRECT ANSWER pt1-A client who is 2 days postoperative following a colectomy d/t colorectal cancer and has an ostomy bag full of bright red, bloody drainage. A nurse is teaching a client who has chronic kidney disease about predialysis dietary recommendations. The nurse should include information about restricting his intake of which of the following nutrients? - CORRECT ANSWER Protein
A nurse on a pediatric mental health unit is caring for a schoolage child. Which of the following questions or statements should the nurse make to foster rapport and engage him in conversation? a) do you like school b) we have another child your age on the unit c) would you like your friends to come and visit you d)"Tell me about your favorite video game." - CORRECT ANSWER d)"Tell me about your favorite video game." A nurse is teaching a client who has coronary artery disease about the difference between angina pectoris and a myocardial infarction. Which of the following manifestations should the nurse identify as indications of an MI? (Select all that apply)
- N/V
- Diaphoresis and dizziness
- chest and left arm pain that subsides with rest 4.Anxiety and feelings of doom
- bounding pulse and bradypnea - CORRECT ANSWER 1. N/V
- Diaphoresis and dizziness 4.Anxiety and feelings of doom A nurse in the emergency department is reviewing laboratory results for several children who have manifestations of influenza. Which of the following children should the nurse report to the provider immediately? a)An infant whose WBC count is 24,000/mm3. b)toddler w a bun of 25 and crt of .5 ( this indicates dehydration which is expected w the flu c) adolescent w beta human chorionic gonadotric is postive d) child with urine sp gravity is 1.035 - CORRECT ANSWER a)An infant whose WBC count is 24,000/mm3.
tachycardia, diaphoresis, weight loss, insomnia, exopthalmia hypothyroidism has dry corase hair, bradycardia, and periorbital edema a nurse is assessing a school age child who has bacterial meningitis. which of the following findings should the nurse expect? - CORRECT ANSWER nuchal rigidity also weight loss a nurse is assessing a newborn's heart rate. which of the following actions should the nurse take? - CORRECT ANSWER auscultate the apical pulse at least 1 min a nurse is preparing to assist with a thoracentesis for a client who has pleurisy. the nurse should plan to perform which of the following actions? - CORRECT ANSWER instruct the client to avoid coughing during the procedure a nurse is the emergency department is assessing a preschooler who has a facial laceration. the nurse should identify which of the following findings as a potential indication of child sexual abuse? - CORRECT ANSWER the child exhibits discomfort while walking a nurse is preparing to teach about dietary management to a client who has crohn's disease and an enteroenteric fistula. which of the following nutrients should the nurse instruct the client to decrease in their diet? - CORRECT ANSWER fiber - reduce diarrhea and inflammation
a nurse is caring for a client who has a prescription for a continuous passive motion CPM machine following a total knee arthroplasty. which of the following actions should the nurse take?
- CORRECT ANSWER Turn off the CPM machine during mealtime promote client comfort and dietary intake a nurse is preparing to initiate IV access for an older adult client. Which of the following sites should the nurse select when initiating the IV for this client? - CORRECT ANSWER radial vein of the inner arm a nurse is developing a client education program about osteoporosis for older adult clients. the nurse should include which of the following variables as a risk factor for osteoporosis? - CORRECT ANSWER sedentary lifestyle also, small framed body with a thin build, estrogen deficiency a nurse in an emergency department is caring for a child who has a fever and fluid filled vesicles on the trunk and extremities. which of the following interventions should the nurse identify as the priority? - CORRECT ANSWER initiate transmission based precautions a nurse is caring for a client who has a clogged percutaneous gastrostomy feeding tube. which of the following actions should the nurse take first? - CORRECT ANSWER change the position of the client a home health care nurse is developing a teaching plan for a client who has a new ileostomy. which of the following instructions
the nurse take? - CORRECT ANSWER irrigate the catheter with 0.9% sodium chloride irrigation a nurse is assessing a client who has COPD. which of the following findings should the nurse expect? - CORRECT ANSWER pH 7. a nurse in a community center is providing an educational session to a group of client about ovarian cancer. which of the following manifestations of ovarian cancer should the nurse include in the teaching? - CORRECT ANSWER abdominal bloating increase in abdominal girth, pelvic or abdominal pain, early satiety, urinary frequency of urgency a nurse is caring for a client who has active tuberculosis TB. which of the following actions should the nurse plan to take to prevent the transmission of the disease? - CORRECT ANSWER Have the client wear a surgical mask while being transported outside the room a nurse is caring for a group of clients. which of the following clients should the nurse attend to first? - CORRECT ANSWER an older adult client who is anxious and attempting to pull out an IV line an RN is observing a licensed practical nurse LPN and an assistive personnel AP move a client up in bed. for which of the following situations should the nurse intervene? - CORRECT
ANSWER The LPN and the AP grasp the client under his arms to lift him up in bed a nurse is preparing to administer insulin to a client via a pen device. which of the following actions should the nurse take? - CORRECT ANSWER hold the insulin pen device perpendicular to the client's skin to inject the medication a nurse is caring for a client who has immunosuppression and a continuous IV infusion. which of the following actions should the nurse take? - CORRECT ANSWER monitor the client's mouth every 8 hours a nurse is providing teaching about advance directives to a middle adult client. which of the following client responses indicates an understanding of the teaching? - CORRECT ANSWER "I can designate my partner as my health care surrogate" a nurse is assessing a client following a vaginal delivery and notes heavy lochia and a boggy fundus. which of the following medications should the nurse expect to administer? - CORRECT ANSWER oxytocin a nurse manager is planning to use a democratic leadership style with the nurses on the unit. Which of the following actions by the nurse manager demonstrates a democratic leadership style? - CORRECT ANSWER seeks input from the other nurses a nurse is assigning task roles for a group of clients in a community mental health clinic. which of the following tasks should the nurse assign to the member of the group functioning
and has severe gestational hypertension a nurse is providing discharge teaching to a client who is to receive home oxygen therapy. which of the following instructions should the nurse include in the teaching? - CORRECT ANSWER wear clothing made with cotton fabrics while oxygen is in use use water soluble lubricant not petroleum based lubricant a nurse is providing teaching for a client who has a fracture of the right fibula with a short leg cast in place a new prescription for crutches. The client is non weight bearing for 6 weeks. which of the following instructions should the nurse include in the teaching? - CORRECT ANSWER use a three point gait a nurse is preparing to transfer a client from the ICU to the medical floor. The client was recently weaned from mechanical ventilation following a pneumonectomy. which of the following information should the nurse include in the change of shift report?
- CORRECT ANSWER The time of the client's last dose of pain medication a nurse is assessing an infant who has hydrocephalus and is 6 hr postoperative following placement of a ventriculoperitoneal VP shunt. Which of the following findings should the nurse report to the provider? - CORRECT ANSWER irritability when being held
- increased intracranial pressure a nurse is caring for a client who has a prescription for chlorpromazine. which of the following findings should the nurse identify as an indication that the medication is effective? - CORRECT ANSWER decreased hallucinations
a nurse is providing teaching about lithium to a client who has bipolar disorder. which of the following statements should the nurse include in the teaching? - CORRECT ANSWER "Notify your provider if you experience increased thirst" a nurse is caring for a client who has a fecal impaction. which of the following actions should the nurse take when digitally evacuating the stool? - CORRECT ANSWER insert a lubricated gloved finger and advance along the rectal wall a nurse is planning to delegate client care tasks to an assistive personnel AP. which of the following tasks should the nurse plan to delegate to the AP? - CORRECT ANSWER perform gastrostomy feedings through a client's established gastrostomy tube a nurse manager is preparing an educational session for nursing staff about how to provide cost effective care. which of the following methods should the nurse include in the teaching? - CORRECT ANSWER delegate non nursing tasks to ancillary staff a nurse on an inpatient mental health unit is monitoring a visit between a client who has a history of aggressive behavior and the client's partner. which of the following observations should the nurse identify as an indication for potential violence? - CORRECT ANSWER The client is pacing around the chair in which their partner is sitting a nurse is caring for a client who has signed an informed consent form to receive electroconvulsive therapy. The client states to the nurse, "I'm not sure about this now. I'm afraid it's too risky." which of the following responses should the nurse make? - CORRECT
control. for which of the following adverse effects should the nurse monitor and report? - CORRECT ANSWER jaundice a nurse is providing discharge instructions about newborn care to a client who is postpartum. which of the following statements indicates to the nurse that the client understands the teaching? select all - CORRECT ANSWER "I will cover my baby's body when I wash her hair" "I will use the bulb syringe first in her mouth then in her nose" A nurse on a mental health unit is conducting a mental status examination MSE on a newly admitted client. which of the following components of the MSE is the priority for the nurse to assess? - CORRECT ANSWER ideas of self-harm a nurse is preparing to administer lactated ringers 1,500 mL IV to infuse at 50 mL/hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? Round to nearest whole number - CORRECT ANSWER 13 a nurse is providing teaching to a client who has a new diagnosis of type 1 diabetes mellitus. the nurse should instruct the client to monitor for which of the following findings as a manifestation of hypoglycemia? - CORRECT ANSWER irritability a nurse is providing teaching to a client who is scheduled for electroconvulsive therapy ECT. The nurse should inform the client that which of the following findings is an adverse effect of ECT? - CORRECT ANSWER short term memory loss a charge nurse notices that one of the nurses on the shift frequently violates unit polices by taking an extended amount of
time for break. Which of the following statements should the charge nurse make to address this conflict? - CORRECT ANSWER "I would like to talk to you about the unit polices regarding break time" A nurse in an emergency department is caring for a client who is at 9 weeks of gestation and reports nausea and vomiting for the past 2 days. which of the following findings should the nurse expect? - CORRECT ANSWER urine specific gravity 1. a nurse is caring for an older adult client who is experiencing chronic anorexia and is receiving enteral tube feedings. which of the following laboratory values indicates that the client needs additional nutrients added to the feedings? - CORRECT ANSWER albumin 2.8g/dL should be 3.5 to 5. A nurse is conducting group therapy with clients who have breast cancer. the nurse should recognize which of the following statements by a client as an example of altruism? - CORRECT ANSWER "I told my doctor that I would like to start a support group for other women who are sick in my community" - reaching out and helping others a nurse is providing dietary teaching to a client who has a new prescription for phenelzine. which of the following food recommendations should the nurse make? select all - CORRECT ANSWER broccoli yogurt cream cheese a nurse is assessing a client for compartment syndrome. which of the following findings should the nurse expect? - CORRECT
the following findings should the nurse expect? - CORRECT ANSWER pink frothy sputum A nurse administers an incorrect dose of medication to a client. the nurse recognizes the error immediately and completes an incident report. which of the following facts related to the incident should the nurse document in the client's medical record? - CORRECT ANSWER time the medication was given a nurse is caring for a client who is postoperative after receiving moderate (conscious) sedation. the client suddenly becomes restless and reports feeling lightheaded. which of the following actions should the nurse take? - CORRECT ANSWER check the client's oxygen saturation level a nurse in an emergency department is assessing a school age child who was brought in by their parents and has scald burns to both hands and wrists. the nurse suspects physical abuse. which of the following actions should the nurse take? - CORRECT ANSWER contact child protective services a nurse is caring for a 2 month old infant who has Hirschsprung disease HD. Which of the following areas should the nurse assess for manifestations of HD? - CORRECT ANSWER C, the abdomen for distention and visible peristalsis a nurse is admitting a client to the psychiatric unit after attempting suicide. the client states "My family does not care whether I live or die", which of the following responses should the nurse make? - CORRECT ANSWER "how does this make you feel"
a nurse is providing discharge teaching for the parents of a preschool age child who has a new prescription for amoxicillin/clavulanate suspension. which of the following instructions should the nurse include in the teaching? select all - CORRECT ANSWER "shake the medication bottle well before each dose is given" "store the medication in the refrigerator" "report diarrhea to the provider immediately" a nurse on a medical surgical unit is caring for a client who has a new diagnosis of terminal cancer. the client tells the nurse that they would like to go home to be with family and loved ones. which of the following actions should the nurse take? - CORRECT ANSWER make a referral for social services a nurse is assessing a client who has a chest tube. which of the following findings should the nurse expect? - CORRECT ANSWER occlusive dressing drainage should be less than 70 ml/hr continuous bubbling in the water seal chamber indicates an air leak a nurse is preparing to transfer a client who has had a stroke to a rehabilitation facility. the clients family tells the nurse they are concerned about the level of care the client will receive. which of the following actions should the nurse take? - CORRECT ANSWER facilitate an interdisciplinary conference at the new facility for the family a nurse is assessing a client who has major depressive disorder and is taking amitriptyline. which of the following findings should
