ATI Fundamentals Exam

A nurse is using an open irrigation technique to irrigate a client's indwelling urinary catheter. Which of the following actions should the nurse take? 1. place the client in side-lying position 2. instill 15mL of irrigation fluid into the catheter with each flush 3. subtract the amount of irrigant used from client's urine output 4. perform the irrigation using 20mL syringe

3. subtract the amount of irrigant used from client's urine output

A nurse is preparing to apply a dressing for a client who has a stage 2 pressure injury. Which of the following types of dressing should the nurse use? 1. alginate 2. gauze 3. transparent 4. hydrocolloid

4. hydrocolloid (promotes healing by creating a moist wound bed)

A nurse is planning care for a client who has had a stroke, resulting in aphasia and dysphagia. Which of the following task should the nurse assign to an assistive personnel (AP)? 1. assist the client with partial bed bath 2. measure client's BP after the nurse administers an antihypertensive medication 3. test client's swallowing ability by providing thickening liquids 4. use a communication board to ask what the client wants for lunch 5. irrigate client's indwelling urinary catheter

1. assist the client with partial bed bath 2. measure client's BP after the nurse administers an antihypertensive medication 4. use a communication board to ask what the client wants for lunch

A nurse in a long-term care facility is caring for a client who dies during the nurse's shift. What is the sequence in which the nurse should perform?

1. obtain pronouncement of death from the provider 2. remove tubes and indwelling lines 3. wash client's body 4. ask client's family members if they would like to view the body 5. place a name tag on the body

A nurse is administering an otic medication to an older adult client. Which of the following actions should the nurse take to ensure that the medication reaches the inner ear? 1. press gently on the tragus of the client's ear 2. pack a small piece of cotton deep into client's ear canal 3. move the client's auricle down and back toward head 4. tilt the head backward for 5 min

1. press gently on the tragus of the client's ear

A nurse is initiating a protective environment for a client who has had an allogeneic stem cell transplant. Which of the following precautions should the nurse plan for this client? 1. make sure the client's room has at least six air exchanges per hour 2. make sure the client wears a mask when outside her room if there is construction in the area 3. place the client in a private room with negative-pressure airflow 4. wear an N95 respirator when giving client direct care

2. make sure the client wears a mask when outside her room if there is construction in the area

A nurse is caring for a client who is postoperative following a knee arthroplasty and requires the use of thigh-length sequential compression sleeves. Which of the following actions should the nurse take? 1. assist the client into a prone position 2. place a sleeve over the top of each leg with the opening at the knee 3. make sure two fingers can fit under the sleeves 4. set the ankle pressure at 65 mmHg

3. make sure two fingers can fit under the sleeves

A nurse is caring for a client who requires an NG tube for stomach decompression. Which of the following actions should the nurse take when inserting the NG tube? 1. position the client with the HOB elevated to 30 degrees prior to insertion of NG tube 2. remove NG tube if client begins to gag or choke 3. apply suction to the NG tube prior to insertion 4. have the client take sips of water to promote insertion of NG tube into esophagus

4. have the client take sips of water to promote insertion of NG tube into esophagus

A nurse is caring for a client who is expressing anger about his diagnosis of colorectal cancer. Which of the following actions should the nurse take? 1. discuss risk factors for colon cancer 2. focus teaching on what the client will need to do in the future to manage his illness 3. provide the client with written information about the phases of loss and grief 4. reassure the client that this an expected response to grief

4. reassure the client that this an expected response to grief