ATI Test Question for Test #4

A nurse is preparing to administer an intradermal injection to a client. At which of the following degree angles should the nurse insert the needle?

D. 10 degree angle

A nurse is caring for a client who has delivered a healthy newborn. The client is tense, refuses to hold the baby, and tells the nurse, "I have no idea how to handle having a baby. I wish this pregnancy had never happened." Which of the following statements should the nurse make?

"Becoming a parent is a new experience for you. Let's talk about your concerns."

A nurse is assisting with teaching a client about homeopathy. Which of the following client statements indicates an understanding of the teaching?

"Homeopathy believes a substance that can cause a disease can also cure it."

A staff nurse is evaluating a newly licensed nurse's understanding of telephone prescriptions. Which of the following statements by the newly licensed nurse indicates an understanding of the information?

"I can take a telephone prescription if a provider is directing a cide for an unresponsive client."

A nurse is reinforcing teaching about traditional Chinese medicine (TCM) to a client. Which of the following statements by the client demonstrates an understanding of the teaching?

"I will practice Tai Chi every day."

A nurse is assisting with teaching a client, who has a history of alcohol use disorder and is to be discharged following cataract surgery, about non-pharmacological therapies. Which of the following client statements indicates an understanding of the teaching?

"I will practice meditating when I feel stressed."

A nurse has received a prescription to administer a medication STAT to a client. Which of the following actions should the nurse take?

D. Administer the medication within 30 min of the health care provider prescribing the medication

A nurse is caring for a college student admitted for acute alcohol intoxication. The client reports feeling overwhelmed and expresses an inability to cope with stressors at school. Which of the following statements should the nurse make?

"Let's talk about the coping methods that have worked for you in the past."

A nurse is evaluating a client after measures to promote comfort have been implemented. Which of the following statements by the client indicates that the client has been comforted?

"My health care team has helped me to feel safe during my stay".

A nurse is reviewing the concept of comfort with an assistive personnel (AP). Which of the following statements by the AP indicates and understanding of comfort.

"Providing comfort to a client involves alleviating the client's physical, mental, and emotional distress using warmth and empathy."

A nurse is assisting with providing an in-service for staff members about complementary and integrative health. Which of the following statements by a staff member indicates an understanding of the teaching?

"Scented oils might decrease discomfort."

A nurse manager is conducting an in service about the physiological functions of sleep for a group of staff nurses. Which of the following statements by one of the nurses indicates an understanding of the teaching?

"The brain and neurons continue to communicate with each other during sleep to remove toxins that built up in the brain while awake."

A nurse is reviewing the documentation of a newly licensed nurse. Which of the entries should the nurse identify as meeting the American Nurses Association (ANA) standards of documentation?

"The client vomited 240 mL of clear emesis but denies pain or nausea"

A nurse is caring for a client who is scheduled for an emergency appendectomy and reports increasing anxiety. Which of the following statements should the nurse make to implement a complementary health strategy?

"Try to take slow, deep breaths in and out."

A nurse is caring for a client who has migraine headaches and reports that they are "getting worse." Which of the following questions should the nurse ask the client to determine if the headaches are a stress-related disorder? (Select all that apply.)

"What is the intensity of your migraine headaches?" "How often do the migraine headaches occur?" "What type of support is available to you when you have a migraine headache?" "What coping strategies do you use when you experience a migraine headache?"

A nurse is interviewing a client who is in distress and tells the nurse, "My ex-partner is suing for full custody of my children. I am so worried and don't know what to do." Which of the following questions should the nurse ask to evaluate the client's coping skills?

"What strategies have you used in the past to deal with stress?"

A nurse is preparing to administer medications to a client. The nurse should identify that which of the following factors contributes to medication errors?

- Administering medication outside of prescribed time intervals is correct. - Failing to administer a medication is correct. - Incorrect dose of the prescribed medication administered to the client is correct.

A nurse is reviewing the pharmacokinetics of medications with a newly licensed nurse. The nurse should include that which of the following factors can affect the rate of absorption?

- Age of the client is correct - Lipid solubility of a medication is correct. - Route of administration is correct.

A nurse is assisting with teaching a client who has a new prescription for a nitroglycerin patch. Which of the following actions should the nurse take?

- Ask the client what they know about the nitroglycerin patch is correct. - Determine the client's ability to apply the patch is correct. - Check the client's reading comprehension level is correct.

A nurse is participating in a committee to reduce medication errors on a medical unit. Which of the following interventions should the nurse recommend?

- Mark the area around the automated medication dispensing system - Double check dosages of high-alert medications is correct. - Provide the nurse administering medications with a vest is correct.

A nurse is performing a medication reconcillation for a client who is being transferred to a long-term care facility. which of the following actions should the nurse take?

- Place the medication reconciliation form with the client's transfer documents is correct. - Reinforce teaching about the medications with the client upon discharge is correct. - Include over-the-counter medications in the medication reconciliation is correct. - Compare the client's home medications with prescribed discharge medications is correct.

A nurse is teaching a client about food choices that promote immunity and healing. Which of the following foods is the best source of vitamin C?

1 cup strawberries

A nurse is preparing to administer acetaminophen 320 mg oral solution to a school-age child. The amount available to acetaminophen oral solution 160 mg/5mL. How many mL should the nurse administer?

10 mL

A nurse is preparing to administer phenytoin suspension 300 mg PO, twice per day. The amount available is phenytoin suspension 125 mg/D mL. How many mL should the nurse administer per dose?

12 mL

A nurse is preparing to administer clindamycin 0.3 g IM to a client. Available is clindamycin 150 mg/mL. How many Ml should the nurse administer?

2 mL

A nurse is preparing to administer amikacin 7 mg/kg/day IM to a client who weighs 165 pounds. Available is amikacin 250 mg/mL solution for injection. How many Ml should the nurse administer per dose?

2.1 mL

A nurse is assisting a massage therapist to identify the best client for massage therapy. Which of the following clients should the nurse recommend?

A client who has postpartum depression

A nurse is assisting in recommending clients for chiropractic treatment. Which of the following clients should the nurse recommend?

A client who has shoulder pain

A nurse is reviewing documentation principals with a group of newly hired assistive personnel (AP). Which of the following should the nurse include?

A nurse who delegates a task to an AP will review the charting for that task

A nurse is assisting with teaching a class about U.S. Food and Drug Administration (FDA) regulation of nutritional supplements. Which of the following information should the nurse include in the teaching?

A nutritional supplement contains at least one nutritional component.

A nurse is discussing problem-oriented medical records with a group of newly licensed nurses. Which of the following information should the nurse include?

A problem-oriented medical record uses progress notes, which promotes information sharing among members of the interdisciplinary team.

A nurse is reviewing measurement systems to perform dosage calculations with a newly licensed nurse. Which of the following instructions should the nurse include?

A. To convert g to mg, move the decimal point 3 places to the right.

A nurse in a community clinic is interviewing a client who is distressed and reports being unable to sleep following a neighborhood fire several days ago. The client has hypertension, tachycardia, and is diaphoretic. The nurse should identify that the client is experiencing which of the following types of stress?

Acute stress

A nurse is interviewing a client who recently experienced an act of workplace violence when an armed person held the workers at gunpoint before police intervened. The client now reports being anxious and fears the gunman might return. The nurse should identify that the client is experiencing which of the following types of crisis?

Adventitious

A nurse in a health clinic is interviewing a client who is upset and reports that their stress "is too much to handle." The client is unemployed, a single guardian to young children, and has periodic asthma attacks. Which of the following stress-related conditions is the client experiencing?

Allostatic load

A nurse is caring for a client who has a sunburn. The nurse should identify that which of the following herbal supplements is used to treat sunburns?

Aloe vera

A nurse is caring for a client who has a new prescription for a non-benzodiazepine hypnotic to promote sleep. For which of the following adverse effects should the nurse monitor the client?

Hallucinations

A charge nurse is reviewing routes of medication administration with a newly licensed nurse when providing care to a client. Which of the following routes of administration should the charge nurse include as having the slowest onset of action?

B. Oral

A nurse is collecting data on a client who is receiving vancomycin IV. the nurse observes the client has a rash on their neck, chest, and back. Which of the following actions should the nurse take first?

B. Stop the infusion of the vancomycin

A nurse is assisting with teaching a client about self-administration of insulin. which of the following actions should the nurse take?

B. have the client perform a return demonstration of the procedure

A nurse is preparing to administer morphine 15 mg PO every 4 hr PRN pain for a client who has a new prescription. By which of the following routes should the nurse plan to administer the medication?

By mouth

A nurse is caring for a group of clients. Which of the following clients should the nurse identify is at the greatest risk of developing medication toxicity?

C. A client who has impaired kidney function

A nurse is preparing to administer a medication to a client who has an enteral feeding tube. which of the following actions should the nurse take?

C. Administer the medication to the client in a liquid form

A nurse is preparing to administer insulin to a client. Which of the following actions should the nurse take first?

C. Have a second nurse confirm the insulin dose

A nurse is discussing computerized provider order entry systems with staff. Which of the following statements from a staff member indicates an understanding of a CPOE system?

CPOE systems can increase the speed of care delivery

A newly licensed nurse is orienting to a facilities documentation process. The facility requires staff to on,y document variations from an expected set of findings when performing a physical assessment. The nurse should identify this system as which of the following documentation methods?

Charting by exception

A nurse is reviewing the concepts of central sleep apnea with a colleague. Which of the following statements by the colleague indicates an understanding of central sleep apnea?

Common causes of central sleep apnea are opioid overdose and congestive heart failure.

A nurse is caring for a client who is in crisis following the breakup of a long-term relationship. The client tells the nurse, "I might as well just die. My life is over." Which of the following actions should the nurse take first?

Conduct a suicidal risk evaluation.

A nurse is caring for an older adult client who is having difficulty sleeping and has a new prescription for a medication to help them sleep. Which of the following medications should the nurse identify as a first-line sleep aid for older adults?

Controlled-release melatonin

A nurse is planning to use the teach-back method to educate a client about a new antihypertensive medication. which of the following should the nurse include to demonstrate this method?

D. Ask the client to explain to information using their own words.

A nurse is scheduled to administer a medication to a client who is currently in the bathroom. which of the following actions should the nurse plan to take?

D. Come back in a few minutes to administer the medication.

A nurse is providing discharge teaching to a client. Which of the following strategies should the nurse include?

D. Encourage the client to ask questions

A nurse is preparing to administer medications ot a preschooler. which of the following information should the nurse keep in mind when administering medications to this client?

D. The deltoid muscle can be used to administer intramuscular injections in preschoolers as well as in adults

A nurse is assisting with teaching a newly licensed nurse about administering a transdermal nitroglycerin patch to a client. Which of the following instructions should the nurse include?

D. Wear clean gloves to apply the transdermal medication

A nurse is reinforcing reaching with a client who has a new prescription for an antibiotic to treat a urinary tract infection. Which of the following statements should the nurse make?

D. finish the entire course of the prescription

A nurse is preparing to administer medications to a client who is not wearing an identification bracelet. Which of the following actions should the nurse take before administering the medication?

D. have the client confirm their name and date of birth

A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment. The client is experiencing significant weight loss and fatigue, but when the nurse asks how they are feeling, they respond with, "Great! I'm going to beat this cancer." Which of the following defense mechanisms is the client using?

Denial

A nurse is caring for an older adult client who reports being stressed about their health status due to problems with short-term memory, slower reaction times when driving, and urinary frequency. The nurse should recognize that the client is experiencing which of the following types of stressors?

Developmental stressors

A nurse is caring for a client who works overnight shifts. The nurse should identify that individuals who perform shift work are at an increased risk for developing which of the following conditions?

Diabetes mellitus

A nurse is caring for a client who asks about naturopathy. The nurse should include that which of the following is a component of naturopathy? (Select all that apply.)

Dietary supplements Exercise Traditional Chinese medicine Homeopathy

A nurse is explaining the practice of Ayurveda to a newly licensed nurse. The nurse should include that Ayurveda is based on establishing a balance between the body, mind, and spirit with which of the following elements? (Select all that apply.)

Earth Water Sky

A nurse is caring for a client who has delivered a healthy newborn. The client tells the nurse that while they are somewhat stressed about being a new parent, they are thrilled by the birth of their child. The nurse should identify that the client is experiencing which of the following types of stress?

Eustress

A nurse is discussing legal regulations regarding medical records with a newly hired assistive personnel (AP). Which of the following information should the nurse include?

Facilities can establish their own rules for documentation methods

A nurse is completing a preoperative health history for a client who reports taking several herbal supplements. Which of the following herbal supplements is the priority for the nurse to report?

Ginkgo biloba

A nurse is assisting with teaching a class about using holistic nursing interventions to care for clients. Which of the following information should the nurse include?

Holistic nurses empower clients to actively participate in their own care.

A nurse is contributing to a presentation about hypersomnia. Which of the following information should the nurse recommend including in the presentation?

Hypersomnia does not improve with increased sleep.

A nurse is caring for a client whose partner was recently hospitalized with COVID-19. The client is experiencing manifestations related to the alarm stage of general adaptation syndrome (GAS). For which of the following manifestations should the nurse monitor? (Select all that apply.)

Hypertension Dilated pupils Increased state of arousal

A nurse is caring for a client who has narcolepsy (NT1) with cataplexy. The nurse should identify that this condition is caused by a lack of which of the following hormones?

Hypocretin

A nurse is conducting an educational session for clients who report experiencing stress-related disorders. A client asks the nurse which part of the body activates the stress response. Which of the following responses should the nurse provide?

Hypothalamus

A nurse is talking with a client about the electronic health record at the facility. Which of the following client statements indicates an understanding of EHRs?

I will be able to track my health information

A charge nurse is discussing health records with a newly licensed nurse. Which of the following information should the nurse identify as a component of a health record?

Immunization data

A nurse is reviewing the plan of care for a client who was admitted with insomnia and recent weight gain. Which of the following is a benefit of increased sleep that could help prevent further weight gain for the client?

Increased leptin production

A nurse is assessing a client who was sexually assaulted 6 months ago and has been diagnosed with post-traumatic stress disorder (PTSD). Which of the following manifestations should the nurse expect? (Select all that apply.)

Intrusive memories of the event Flashbacks of the event Exaggerated startle response when reminded of the event

A nurse is assessing a client who is working at home due to COVID-19 restrictions. The client reports abdominal cramping and bloating with diarrhea and states, "I am completely stressed out from working at home." The nurse should identify that the client is experiencing manifestations of which of the following stress-related conditions?

Irritable bowel syndrome

A nurse is reviewing documentation guidelines with a newly licensed nurse. Which of the following abbreviations should the nurse note as being on the joint commissions do not use list?

MSO4, IU, qhs

A nurse is planning complementary therapy for a client who has breast cancer. Which of the following treatments is a complementary therapy that the nurse can implement?

Massage therapy

A nurse is assisting with an in-service for staff members about culturally competent care. Which of the following information should the nurse include about traditional Native American beliefs?

Music can produce healing energy.

A nurse is assessing a client who reports difficulty staying awake during the day and experiencing involuntary episodes of lost muscle tone. The nurse should identify that these are manifestations of which of the following conditions?

Narcolepsy (NT1)

A nurse is caring for an older client who reports that they wake up frequently during the night. The nurse should identify that which of the following is a characteristic of older adult sleep patterns that might explain the client's frequent awakenings?

Older adults tend to spend more time in stage 2 sleep.

A nurse in the clinic is reviewing a clients prescriptions prior to discharge. The nurse should instruct the client that which of the following abbreviations indicates the medication can be taken as needed?

PRN

A nurse is caring for a client who asks about using aromatherapy for nausea. Which of the following scents should the nurse recommend? (Select all that apply.)

Peppermint Ginger Orange

A nurse is preparing an in-service about HIPAA. Which of the following information should the nurse plan to include?

Personnel can be terminated for breaching a client's confidentiality

A nurse is providing discharge teaching about health promotion to a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply).

Practice mindful breathing Start each day with a to-do list Develop habits to mitigate stress.

A nurse is talking about implementing self-care strategies to cope with the stress of caregiving with the partner of a client who has dementia. Which of the following strategies reported by the partner should the nurse identify as an example of effective coping?

Practicing deep breathing while sitting outside

A nurse is caring for a client who has been charged with partner violence against their spouse. The client is angry, pacing, and yells out, "I wouldn't lose my temper if my spouse would just leave me alone. It's their fault." The nurse should identify the client is displaying which of the following defense mechanisms?

Projection

A charge nurse is reviewing soap documentation with a group of newly licensed nurses. Which of the following chart entries should the nurse include as an example of objective data?

Rebound tenderness noted in RLQ of the abdomen

A charge nurse is reviewing characteristics of electronic documentation with staff at a providers office. Which of the following characteristics should the charge nurse plan to include?

Reduces medical errors, makes clients medical history more easily available, increases accuracy of coding procedures

A nurse is caring for a client who follows a vegan diet and reports lethargy. Which of the following interventions should the nurse implement?

Request a prescription for vitamin B12 supplements.

A nurse is discussing the stages of the sleep cycle with a client. The nurse should include that the immune system is strengthened and tissues and bones are repaired during which of the following stages of the sleep cycle?

Stage 3

A nurse is caring for a client who reports experiencing stress over an upcoming surgical procedure. Which of the following statements describes the characteristics of stress?

Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one's state of equilibrium.

A nurse is planning care for a client who is recently divorced with two young children. The client reports difficulty sleeping, feeling hopeless, and being estranged from family. The nurse should plan to monitor the client for which of the following potential manifestations of chronic stress

Suicide

A nurse manager is reviewing the documentation of for newly licensed nurses. Which of the following medication entries should the nurse identify as being written correctly?

Synthroid 100 mg PO every morning ac

A nurse is teaching a newly licensed nurse about the development of dreams. The nurse should include that which of the following areas of the brain transmits the sensory data that is used to develop dreams?

Thalamus

A nurse is discussing the history of electronic health records (EHRs) during a staff in-service. The nurse should identify that which of the following agencies advocated for nationwide use of EHRs.

The Institute of Medicine (IoM)

A nurse is documenting information in a clients chart and makes the entry quotation mark client reports "abdominal pain on exertion". Which of the following documentation format describes this entry?

The S in soap

A nurse is caring for a client after a stroke. The nurse should recognize that which of the following individuals is allowed access to the client's medical record without obtaining special consent from the client first?

The admitting provider, the charge nurse on the unit, the client

A nurse is caring for a client who needs to be awakened for the administration of an oral medication. Which of the following findings should indicate to the nurse that the client was in stage 3 of the sleep cycle when awakened?

The client experiences mental cloudiness for 30 to 60 min.

A nurse is taking an admission history from a client who is concerned about the facility using an electronic documentation system. Which of the following should the nurse include as a benefit of electronic documentation?

The system alerts providers of possible actions that could cause client harm

A nurse is caring for a client who is receiving palliative care. Which of the following non-pharmacological nursing interventions should the nurse provide the client?

Therapeutic touch

A nurse is assisting with teaching a newly licensed nurse about holistic nursing. Which of the following information should the nurse include? (Select all that apply.)

Use deep breathing to promote relaxation in clients. Encourage clients to use guided imagery to decrease pain. Apply essential oils to treat anxiety in clients.