ATI Fundamentals Quiz Bank - Questions Answered Wrong

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A nurse is assessing a client's vascular system. Which of the following techniques should the nurse use when evaluating the carotid arteries?

auscultation of the arteries for bruits with the bell of the stethoscope

A nurse rates a client's biceps reflex as 2+. Which of the following characteristics should the nurse document about the client's reflexes?

average

A nurse is performing a focused assessment of a client's peripheral vascular system. In which of the following locations should the nurse palpate the posterior tibial pulse?

below the medial malleolus

A nurse in a provider's office is assessing a client who has heart failure. The client has gained weight since her last visit, and her ankles are edematous. Which of the following findings is another clinical manifestation of fluid volume excess?

bounding pulse

A nurse is caring for a client who is receiving total parenteral nutrition. Which of the following actions should the nurse take?

check the client's capillary blood glucose level every 4 hr

A nurse is teaching a newly licensed nurse about pain management in clients age 65 and older. Which of the following pieces of information should the nurse include in the teaching?

clients who are age 65 or older are reluctant to report pain

A nurse is caring for a client who is postoperative following abdominal surgery. Which of the following actions should the nurse perform after discovering that the client's wound has eviscereated?

cover the incision with a moist sterile dressing

A nurse is caring for an older adult client who has dysphagia following a cerebrovascular accident. Which of the following actions should the nurse take when assisting the client at mealtime?

offer the client tart or sour foods first.

A nurse is employing a thorough, systematic method while obtaining objective data about a client. Through which of the following methods should the nurse collect this information?

physical examination

A nurse is planning to collect a stool specimen for ova and parasites from a client who has diarrhea. Which of the following actions should the nurse take when collecting the specimen?

place the stool specimen collection container in a biohazard bag

A nurse is monitoring a client's laboratory results. Which of the following results should the nurse report to the provider?

potassium 3.0 mEq/L

A nurse is caring for a client who is receiving intermittent enteral feedings through an NG tube. The specific gravity of the client's urine is 1.035. Which of the following actions should the nurse take?

provide more water with feedings

A nurse is planning care for a client who has a single-lumen nasogastric tube for gastric decompression. Which of the following actions should the nurse include in the plan of care? (select all that apply)

provide oral hygiene frequently, measure the amount of drainage from the NG tube every shift, secure the NG tube to the client's gown

A nurse is performing suctioning for a client who has a tracheostomy. Which of the following actions should the nurse take?

pull suction catheter back 1 cm (0.5 in) if the client starts coughing

A nurse is changing the dressings for a client who is 3 days postoperative following a cholecystectomy. The nurse observes yellow, thick drainage on the dressing. The nurse should document this finding as which of the following types of drainage?

purulent exudate

A nurse is planning to perform passive range-of-motion exercises for a client. Which of the following actions should the nurse take?

repeat each joint motion 5 times during each session

A nurse is caring for a client who has bilateral casts on her hands. Which of the following actions should the nurse take when assisting the client with feeding?

sit at the bedside when feeding the client

A nurse is caring for a client who is dehydrated. The nurse should expects that insensible fluid loss of approximately 500 to 600 mL occurs each day through which of the following organs?

skin

A nurse is caring for a client who is exhibiting confusion. The nurse should identify that which of the following laboratory values can cause confusion?

sodium 123mEq/L

A nurse is caring for a client who is receiving IV fluid replacement. Which of the following findings should the nurse identify as infiltration of the IV infusion site?

taut skin around the IV catheter site that is cool to the touch

A nurse on a telemetry unit is caring for a client who has a myocardial infarction. The client states, "All this equipment is making me nervous." Which of the following responses should the nurse offer?

all of this equipment can be frightening

A nurse is teaching a client who is using a patient-controlled analgesia pump to administer morphine for pain management. Which of the following statements should the nurse identify as an indication that the client understands the instructions?

I can still use my transcutaneous electrical nerve stimulation unit while I'm pushing the PCA button

A nurse is using the Braden scale to predict the pressure ulcer risk of a client in a long-term care facility. Using this scale, which of the following parameters should the nurse evaluate?

nutrition

A nurse is performing a neurological assessment of a client. To promote safety during the examination, the nurse stands nearby as the client follows instructions for which of the following tests?

Romberg

A nurse is preparing to assist an older adult client with ambulation following bed rest for 3 days. Which of the following actions should the nurse take to decrease the risk of a fall?

Use a gait belt during ambulation

A nurse is caring for a client who has acute renal failure. Which of the following assessments provides the most accurate measure of the client's fluid status?

daily weight

A nurse is caring for a client who is immobile. The nurse should recognize that immobility places the client at risk of which of the following health alterations?

decreased cardiac output

A nurse is performing a mental-status examination on a client who has manifestations of dementia. Which of the following directions should the nurse give the client when evaluating the client's ability to think abstractly?

discuss the meaning of a common proverb

A nurse is providing preoperative teaching to a client who is scheduled for arthroplasty in the next month and may require a blood transfusion. The client expresses concern about the risk of acquiring infection from the blood transfusion. Which of the following statements should the nurse share with the client?

donate autologous blood before the surgery

A nurse is caring for a client who is receiving IV therapy via a peripheral catheter. The nurse should identify that which of the following findings is an indication of infiltration?

edema at the infusion site

A nurse is assessing a client who is experiencing an obstruction of the flow of the vitreous humor in the eye. This manifestation is consistent with which of the following eye disorders?

glaucoma

A nurse is changing the dressings for a client recovering from an appendectomy following a ruptured appendix. The client's surgical wound is healing by secondary intention. Which of the following observations should the nurse report to the provider?

halo of erythema on the surrounding skin

A nurse is preparing to administer an otic antibiotic to a client who has otitis media. Which of the following actions should the nurse plan to take?

hold the dropper 1 cm (0.5 in) above the ear canal during administration

A nurse is caring for a client who has a gastric ulcer. The nurse should explain that the prolonged exposure of the body to stress can also cause which of the following to occur?

hyperglycemia

A nurse is caring for a client who has a tracheostomy and requires suctioning. Which of the following actions should the nurse take?

hyperoxygenate the client before suctioning

A nurse is assessing a client who reports nausea and vomiting for 2 days. Which of the following findings should indicate to the nurse that the client is experiencing fluid volume deficit?

increased heart rate

A nurse is providing teaching about crutches to a client who has a fracture of the right foot. Which of the following instructions should the nurse include?

keep the rubber crutch tips securely in place

A nurse is providing teaching to a client regarding protein intake. Which of the following foods should the nurse include as an example of an incomplete protein?

lentils

A nurse in the emergency department is assessing a client who has deep, rapid respirations. Arterial blood gas analysis includes the following values: pH 7.25, PaCO2 40, and HCO3 -18. Which of the following acid-base imbalances should the nurse identify and report to the provider

metabolic acidosis

A nurse is preparing to administer an afternoon dose of ampicillin to a client. The client appears upset and refuses to take the medication before throwing the pill on the floor. Which of the following entries should the nurse enter into the client's medical record?

the client threw the medication on the floor

A nurse is administering an IM injection to a 5 month old infant. Which of the following injection sites should the nurse use?

vastus lateralis

A nurse is assessing a client who has a sudden onset of severe back pain of unknown origin. Which of the following questions should the nurse ask to encourage discussion with the client?

what do you think caused the onset of your pain?

A nurse is teaching a client how to perform range-of-motion exercises of the wrist. To perform adduction, which of the following instructions should the nurse include?

with your palm facing down, move your wrist sideways toward your thumb


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