ATI Predictor Practice Exam 1

A nurse is providing teaching to the parent of a child who has a permanent tracheostomy. Identify the sequence of steps that the parent should follow to perform tracheostomy care Remove the soiled dressing Remove the inner cannula Clean the stoma with 0.9% sodium chloride irrigate Change the tracheostomy collar

1. Remove the inner cannula 2. Remove the soiled dressing 3. Clean the stoma with 0.9% sodium chloride irrigation 4. Change the tracheostomy collar

A nurse is teaching a client about foods high in Vitamin A. Which of the following foods should the nurse recommend as havin the highest amount of vitamin A? a. 1 medium raw carrot b. 1/2 cup cooked spinach c. 1/2 cup cooked butternut squash d. 1 cup sliced cantaloupe

a. 1 medium raw carrot The nurse determines that carrots are the best source to recommend bc 1 medium raw carrot contains 2,025 mcg/dL of vitamin A

A nurse is caring for a newborn whose parents asks why the baby is receiving vitamin K. The newborn should receive vit K to prevent which of the following? a. Bleeding b. Potassium deficiency c. Infection d. Hyperbilirubinemia

a. Bleeding Newborns should receive vit K at birth bc they have low levels of it, which can lead to bleeding

A nurse is assessing a client who has schizophrenia & is taking chlorpromazine. which of the following findings is the priority for the nurse to report to the provider? a. Temperature 39.4 degrees Celsius (103 degrees Fahrenheit) b. Headache c. Constipation d. Vomiting

a. Temperature 39.4 degrees Celsius (103 degrees Fahrenheit) The greatest risk to this client is injury from neuroleptic malignant syndrome, a potentially life-threatening adverse effect of chlorpromazine in which the client can have a high temperature, dysrhythmia, decreased LOC, and a labile BP. Therefore, the priority finding for the nurse to report to the provider is hyperpyrexia

A nurse is teaching the parent of a school aged child about the admin of ear drops. Which of the following responses by the parent indicates an understanding of the teaching? a. "I should administer the ear drops as soon as a remove them from the fridge." b. "I should pull the top of the ear upward and back while instilling the med." c. "I should massage behind her ear after i instill the drops." d. " I should have her lie on the affected side for a few min after I put the drops in her ear."

b. "I should pull the top of the ear upward and back while instilling the med." The nurse should instruct the parent to pull the pinna upward and back in children older than 3 years to straighten the ear canal and allow the medication to reach the entire canal.

A nurse is assessing a client who is experiencing autonomic dysreflexia. Which of the following findings should the nurse expect? (Select all that apply) a. Nystagmus b. Facial flushing c. Diplopia d. Nasal congestion e. Headache

b. Facial flushing d. Nasal congestion e. Headache

A nurse is caring for a client who has a deficit w/ CN II. Which of the following actions should the nurse plan? a. Keep the client resting in bed b. Ask the client to restate directions c. Clear objects from the client's walking area d. Evaluate the client's ability to swallow

c. Clear objects from the client's walking area The nurse should plan to clearobjects from teh client's walking area because a CN 2 deficit can result in visual impairment and lead to falls

A Rn is planning care for a group of clients and is working with a LPN and an AP. Which of the following tasks should the RN delegate to the LPN? a. Collection of stool specimen b. Prep of a client's post-op bed c. Administration of a unit of packed RBC's d. Insertion of an NG tube

d. Insertion of an NG tube The nurse should delegate the insertion of a NG tube to the LPN bc this task is within their scope of practice

A charge nurse is observing a new nurse admin enteral feeding via an NG tube. Which of the following actions by the new nurse indicates understanding of the procedure? a. Instills 100 mL of air into the NG tube after checking residual b. FLushes NG tube with 0.9% sodium chloride irrigation every 2 hours c. Adds 20 mL of blue dye to feeding to detect aspiration d. Keeps the HOB elevated to 45 degrees for 1 hour after feedings

d. Keeps head of bed elevated to 45 degrees for 1 hour after feedings. The nurse should keep the clients head elevated to 45 degrees for 1 hour after feedings to decrease the risk of aspiration

A nurse is caring for a client who is receiving TPN solution by a continuous IV infusion at 60 mL/hr. The nurse discovers that infusion pump has stopped working. Which of the following actions should the nurse take while waiting for a new infusion pump? a. Admin the TPN solution at the same rate using manual drip tubing b. Offer the client oral fluids in place of TPN c. Infuse 0.9% NaCl using manual drip tubing at 30 mL/hr d. Provide dextrose 10% in water solution using manual drip tubing at 60 mL/hr

d. Provide dextrose 10% in water solution using manual drip tubing at 60 mL/hr

A nurse on a med-surg unit is caring for a client prior to a surgical procedure. Which of the following findings should indicate to the nurse that the client has the ability to sign the informed consent? a. The client's partner tells the nurse that the client understands the procedure b. The nurse locates the provider's prescription for the surgical procedure c. The nurse witnesses the provider's explanation of the procedure. d. The client is able to accurately describe the upcoming procedure

d. The client is able to accurately describe the upcoming procedure