Exam 1 Fall 2024 (ATI questions)
A nurse is preparing to administer ketorolac 0.5 mg/kg IV bolus every 6 hr to a school-age child who weighs 66 lb. The amount available is ketorolac injection 30mg/mL. How many mL should the nurse adminster per dose?
0.5 mL
A nurse is preparing to administer methylpredinsolone 60 mg by IV bolus. The amount available is methylpredinsolone injection 40 mg/mL. How many mL should the nurse administer?
1.5 mL
A nurse is preparing to administer acetaminophen 320mg PO every 4 hr PRN for pain. The amount available is acetaminophen liquid 160 mg/5 mL. How many mL should the nurse adminster per dose?
10 mL
A nurse is preparing to adminster dextrose 5% IN WATER (D5W) 1,000 mL IV to infuse over 10 hr. The nurse should set the IV infusion pump to deliver how many mL/hr?
100 mL/hr
A nurse is preparing to administer metoprolol 200 mg PO daily. The amount available is metoprolol 100 mg/tablet. How many tablets should the nurse administer?
2 tablets
A nurse is preparing to administer lactated Ringer's (LR) IV 100 mL over 15min. The nurse should set the IV infusion pump to deliver how many mL/hr?
400 mL/hr
A nurse is preparing to administer dextrose 5% in lactated Ringer's (D5LR) 1,000 mL to infuse over 6hrs. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should adjust the manual IV infusion to deliver how many gtt/min?
42 gtt/min
A nurse is preparing to administer 0.9% sodium chloride (0.9% NaCl) 250 mL IV to infuse over 30min. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should adjust the manual IV infusion to deliver how many gtt/min?
83 gtt/min
A nurse determines a client's radial pulse rate is 68/min and the simultaneous apical pulse rate is 84/min. What is the client's pulse deficit?
84 - 68 = 16
A nurse in a health clinic is caring for a 21-Year-Old client who tells the nurse that their last physical exam was in high school. Which of the following health screenings should the nurse expect the provider to perform for this client? A. Testicular examination B. Blood glucose C. Fecal occult blood D. Prostate-specific antigen
A
A nurse is delegating the ambulation of a client who had a knee arthroplasty 2 days ago to an AP. Which of the following information should the nurse share with the AP? (select all that apply.) A. The client's roommate ambulates independently B. The client ambulates wearing slippers over antiembolic stockings C. The client uses a front wheel walker when ambulating D. The client had pain medication 30 minutes ago E. The client is allergic to codeine F. The client ate 50% of breakfast this morning
B, C, D
A nurse is teaching an older adult client about medication self-administration. Which of the following instructions should the nurse include? (Select all that apply) A. Adjust dose to daily weight B. Place pills in daily pill holders. C. Set up a daily calendar with medication reminders. D. Ask a relative to assist as needed E. Request child-resistant caps on medication containers.
B, C, D
A nurse is caring for a client who has an oral temperature of 38.6 celcius ( 101.5 Fahrenheit) heart rate 114/min and respiratory rate 22/min. Which of the following interventions should the nurse take? (Select all that apply) A. Obtain culture specimens before initiating antimicrobials. B. Restric the client's oral fluid intake. C. Encourage the client to rest and limit activity. D. Allow the client to shiver to dispel excess heat
A, C, E
A nurse is assessing a client's thyroid as part of a comprehensive physical exam. Which of the following findings should the nurse expect? Select all that apply. A. Palpating the thyroid in the lower half of the neck. B. Visualizing the thyroid on inspection of the neck. C. Hearing a bruit when auscultating the thyroid. D. Feeling the thyroid when the client swallows. E. Finding symmetric extensions of the trachea on both sides of the midline.
A, D, & E
A nurse is examining a client's tonsils for size using a grading tool. Match the grade with the findings. A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4 1. The tonsils touch the uvula. 2. The tonsils are behind the soft structures supporting the palate. 3. The tonsils touch each other. 4. The tonsils are between the soft structures and the uvula.
A2, B4, C1, D3
A nurse is performing auditory screening for a client. Match the name of the test with the technique the nurse should use. 1. Rinne test (Air conduction) 2. Weber's test (Bone conductivity) 3. Whisper tests A. The nurse has the client occlude one ear and then tests the other ear to see if the client can hear sounds without seeing the nurse's mouth. B. The nurse places a vibrating tuning fork against the mastoid bone and asks the client to state when the sound can no longer be heard. C. The nurse places a vibrating tuning fork on the top of the head and asks the client if the sound is best in the left or right ear.
A3, B1, C2
A nurse is teaching clients about their medications. Match the following medication category to the corresponding nursing instructions. A. Immunosuppressant B. Antihypertensive C. Anticoagulant D. Anticholinergic 1. Change positions slowly. 2. Monitor for bruising 3. Monitor for an infection 4. Wear sunglasses when outside
A3, B1, C2, D4
This is the picture question. Match the number to the letter A. Monitor B. Blanket C. Defibrillator D. Baby with hat 1. Provide a warm environmental temperature, heated humidified oxygen, warming blanket, and/or warmed oral or IV fluids 2. Keep the head covered. 3. Provide continuous cardiac monitoring 4. Have emergency resuscitation equipment on standby
A3, B1, C4, D2
A nurse is examining a client's head and neck lymph nodes. Match the name of the lymph node with the location of the lymph node. A. Submental B. Postauricular nodes C. Anterior cervical nodes D. Tonsillar nodes E. Occipital nodes 1. Base of skull 2. Over the mastoid 3. Angle of the mandible 4. Under the chin 5. Along the sternocleidomastoid muscle
A4, B2, C5, D3, E1
A nurse is planning a presentation for a group of older adults about health promotion and disease prevention. Which of the following interventions should the nurse plan to include in the presentation? (Select all that apply) A. Human papilloma virus (HPV) immunization B. Pneumococcal immunization C. Yearly eye examination D. Peridodic mental health screening E. Annual fecal occult blood tests
B, C, D, & E
A nurse is assessing an adult client's internal ear canals with an otoscope as part of a head and neck examination. Which of the following actions should the nurse take? Select all that apply. A. Pull the auricle down and back. B. Insert the speculum slightly down and forward. C. Insert the speculum 2 to 2.5 cm (0.8 to 1 in). D. Make sure the speculum does not touch the ear canal. E. Use the light to visualize the tympanic membrane in a cone shape.
B, D, & E
A nurse is collecting data from an older adult client as part of a comprehensive physical examination. Which of the following findings should the nurse expect as associated with aging? (Select all that apply) A. Skin thickening B. Decreased height C. Increased saliva productions D. Nail thickening E. Decreased bladder capacity
B, D, & E
A charge nurse is explaining the various stages of the lifespan to a group of newly licensed nurses. Which of the following examples should the charge nurse include as a developmental task for a young adult? A. Becoming actively involved in providing guidance to the next generation. B. Adjusting to major changes in roles and relationships due to losses. C. Devoting time to establishing an occupation. D. Finding oneself "sandwiched" between and being responsible for two generations.
C
A nurse is caring for a young adult at a college health clinic. Which of the following actions should the nurse take first? A. Give the client information about immunization against menegitis. B. Tell the client to have a TB skin test every 2 years. C. Determine the client's health risks. D. Teach the client about exercise recommendations.
C
A nurse is counseling a young adult who describes having difficulty dealing with several issues. Which of the following statements should the nurse identify as the priority to assess further? A. I have my own apartment now, but it's not easy living away from my guardians. B. It's been so stressful for me to even think about having my own family. C. I don't even know who I am yet, and now I'm supposed to know what to do. D. My partner is pregnant, and I don't think I have what it takes to be a good parent.
C
A nurse is preparing to administer diazepam to a client. Prior to administering the medication, which of the following actions is the nurse's priority? A. Teach the client about the purpose of the medication B. Give the medication at the prescribed administration time C. Identify the client's medication allergies. D. Document the client's anxiety level
C
A nurse is teaching a client who is lactating about taking medications. Which of the following instructions should the nurse include? A. Drink 8oz of milk with each dose of medication. B. Use sustained-release medications. C. Take medications right after breastfeeding D. Pump breast milk and freeze it prior to feeding
C
The nurse is reviewing the client's medical administration record and notes a perscription for docusate 100 mg PO once every day. The nurse should identify this as which of the following types of perscription? A. Single B. Stat C. Routine D. Now
C
A client who had a cerebrovascular accident has persistent problems with dysphagia. The nurse caring for the client should initiate a referral with which of the following members of the interprofessional care team? (select all that apply.) A. Social worker B. Certified nursing assistant C. Occupational therapist D. Speech language pathologist E. Physical therapist
C & D
A nurse in a provider's office is preparing to test a client's cranial nerve function. Which of the following directions should the nurse include when testing cranial nerve V? Select all that apply. A. "Close your eyes." B. "Tell me what you can taste." C. "Clench your teeth." D. "Raise your eyebrows." E. "Tell me when you feel a touch."
C & E
A nurse is performing a head and neck examination for an older adult client. Which of the following age-related findings should the nurse expect? Select all that apply. A. Reddened gums B. Lowered vocal pitch C. Tooth loss D. Glare intolerance E. Thickened eardrums
C, D, & E
A nurse is providing teaching for an older adult client who has lost 4.5kg (9.9 lb) since the last admission 6 months ago. Which of the following instructions should the nurse include in the teaching? (Select all that apply) A. Eat three large meals a day B. Eat your meals infront of the television C. Eat foods that are easy to eat, such as finger foods. D. Invite family members to eat meals with you. E. Exercise every day to increase appetite
C, D, & E
A charge nurse is explaining the various stages of the lifespan to a group of newly licensed nurses. Which of the following examples should the nurse include as a developmental task for middle adulthood? A. The client evaluates their behavior after a social interaction B. The client states they are learning to trust others C. The client wishes to find meaningful friendships D. The client expresses concerns about the next generation
D
A goal for a client who has difficulty with self-feeding due to rheumatoid arthritis is to use adaptive devices. The nurse caring for the client should initiate a referral to which of the following members of The interprofessional care team? A. Social worker B. Certified nursing assistant C. Registered dietitian D. Occupational therapist
D
A nurse administers the wrong medication to the client. Which of the following actions should the nurse take first? A. Report the error to the facility's risk manager B. Notify the provider C. Complete an incident report D. Check the client's vital signs
D
A nurse is counseling an older adult who describes having difficulty dealing with several issues. Which of the folloiwng problems verbalized by the client should the nurse identify as the priority? A. I spent my whole life dreaming about retirement, and now I wish I had my job back. B. It's been so stressful for me to have to depend on my child to help around the house. C. I just heard my friend Al died. That's the third one in 3 months. D. I keep forgetting which medications I have taken during the day.
D
As part of the admission process, a nurse at a long-term care facility is gathering a nutrition history for a client who has dementia. Which of the following components of the nutrition evaluation is the priority for the nurse to determine from the client's family? A. Body Mass Index B. Usual times for meals and snacks C. Favorite foods D. Difficulty swallowing
D
A nurse is teaching a newly licensed nurse about adverse effects of medications. Sort the adverse effects into extrapyramidal or anticholinergic reactions. A. Tremors B. Constipation C. Drooling D. Shuffling gait E. Dry mouth F. Photophobia
Extrapyramidal: A, C, D Anticholinergic: B, E, F
A nurse is teaching a class about physiological factors that can alter how a medication can affect infants and older adults. Sort the following physiological factors into either infants or older adults. A. High body water content B. High percentage of body fat C. Increased blood flow to skin D. Decreased total body water
Infants: A, C Older Adults: B, D
A nurse is instructing a newly licensed nurse about choosing a site to measure a client's temperature. Sort the following clients with the correct temperature site: Oral or Rectal. A. A client who breathes through the mouth B. A client who has a low platelet count C. A client who has facial trauma D. A client who has hemorrhoids
Oral: B, D Rectal: A, C
A charge nurse is signing client care to a RN and a PN. Understanding that an RN can perform each of the following tasks, match the tasks the nurse should assign to the RN or the PN. A. Creating a plan of care for a client who is recovering following a stroke B. Assessing a pressure injury on a client who is on bed rest C. Providing nasopharyngeal suctioning for a client who has pneumonia D. Teaching a client who has asthma to use a metered dose inhaler E. Administer enteral feeding to a client who has a nasogastric tube F. Inserting a urinary catheter for a client who has urinary retention
RN: A, B, D PN: C, E, F
The nurse is preparing to administer a medication to the client. What actions should the nurse take?
The nurse should avoid distractions during medication preparation because interruptions increase the risk of error. The nurse should prepare the medication for one client at a time, carefully check the label for the medication's name and concentration. Measure doses accurately and double-check dosage calculations with a colleague. Check the medication's expiration date. Follow the rights of medication administration consistently. Take the MAR to the client's bedside. The nurse should only give medications that the nurse has prepared. The nurse should not administer a medication prepared by someone else. The nurse should follow all laws and regulations for preparing and administering controlled substances. Keep the controlled substances in a secure area. Have another nurse witness the discarding of unused controlled substances.
A nurse is caring for a client who is taking cimetidine and imipramine. Knowing that cimetidine decreases the metabolism of imipramine, what are the potential effects of this combination?
When analyzing cues, the nurse should identify that the client is at risk for imipramine toxicity. A medication that decreases the metabolism of another medication increases the blood level of that medication which can result in toxicity.
A nurse on a medical-surgical unit has received change-of-shift reports on five clients. Understanding that a PN can perform each of the following tasks, sort the tasks the nurse should assign to the AP or the PN. A. Assist with updating the plan of care for a client who is post-operative B. Reinforced teaching with a client who is learning to walk using a quad cane C. Reapply a condom catheter for a client who has urinary incontinence D. Apply a sterile dressing to a pressure injury E. Perform postmortem care for a client who has died
AP: C, E PN: A, B, D
A nurse at a health department is planning strategies related to heart disease. Which of the following activities should the nurse include as part of the primary prevention? A. Providing cholesterol screening. B. Teaching about a healthy diet. C. Providing information about antihypertensive medications. D. Developing a list of cardiac rehabilitiation programs.
B
A nurse at a provider's office is talking about routine screenings with a 45-year-old female client who has no specific family history of cancer or diabetes mellitus. Which of the following client statements indicates that the client understands how to proceed? A. I'll need a colonoscopy in 5 years. B. For now, I should continue to have a clinical breast exam each year. C. Because the doctor just did a pap smear, I'll come back next year for another one. D. I had my blood glucose test last year, so I won't need it again for 4 years.
B
A nurse is caring for a client who has a fractured femur and a blood pressure of 140/94 mm Hg. Which of the following actions should the nurse take first? A. Request a prescription for an antihypertesnive medications B. Ask the client if they are having pain. C. Instruct the client about a low-sodium diet D. Return in 30 min to recheck the client's blood pressure.
B
A nurse is counseling a middle adult client who describes having difficulty dealing with several issues. Which of the following client statements should the nurse identify as the priority to asses further? A. I am struggling to accept that my parents are aging and needs so much help. B. It's been so stressful for me to think about having intimate relationships. C. I know I should volunteer my time for a good cause, but maybe I'm just selfish. D. I love my grandchildren, but my child expects me to relive my parenting days.
B
A nurse is discussing the purpose of regulatory agencies during a staff meeting. Which of the following tasks should the nurse identify as the responsibility of State Licensing boards? A. Monitoring evidence-based practice for clients who have a specific diagnosis. B. Ensuring that Health Care Providers comply with regulations. C. Setting quality standards for accreditation of healthcare facilities. D. Determining whether medications are safe for administration to clients.
B
A nurse is instructing a young adult client about health promotion and illness prevention. Which of the of the following statements indicates understanding? A. I already had my immunizations as a child. So I'm protected in that area. B. It is important to schedule routine health care visits even if I am feeling well. C. I will just go to an urgent care center for my routine medical care. D. There's no reason to seek help if I am feeling stressed because it's just part of life.
B
A nurse manager is assigning care of a client who is being admitted from the PACU following thoracic surgery. The nurse manager should assign the client to which of the following staff members? A. Nursing supervisor B. Registered nurse (RN) C. Practical nurse (PN) D. Assistive personnel (AP)
B
A nurse in a provider's office is testing the cranial nerves during a head and neck examination. Which of the following cranial nerves are both sensory and motor? Select all that apply. A. Cranial Nerve II (Optic) B. Cranial Nerve V (Trigeminal) C. Cranial Nerve VII (Facial) D. Cranial Nerve VIII (Auditory) E. Cranial Nerve XI (Spinal Accessory)
B & C
A nurse is explaining the various types of HealthCare coverage clients might have to a group of nurses. Which of the following Healthcare financing mechanisms should the nurse include as federally funded? (select all that apply.) A. Preferred provider organization (PPO) B. Medicare C. Long-term care insurance D. Exclusive provider organization (EPO) E. Medicaid
B & E
A nurse is preparing to inspect the ears, nose, mouth, and throat of a client. Which of the following equipment does the nurse need? Select all that apply. A. Opthalmascope B. Tongue blade C. Penlight D. Gauze square E. Stethoscope
B, C, & D
A nurse is reviewing safety precautions with a group of young adults at a community health fair. Which of the following recommendations should the nurse include to address common health risks for this age group? (Select all that apply) A. Install bath rails and grab bars in bathrooms. B. Wear a helmet while skiing. C. Install a carbon monoxide detector. D. Secure firearms in a safe locations. E. Remove throw rugs from the home.
B, C, & D
A nurse is collecting data to evaluate the middle adult's psychosocial development. The nurse should expect middle adults to demonstrate which of the following developmental tasks? (Select all that apply) A. Develop an acceptance of diminished strength and increased dependence on others. B. Spend time focusing on improving job performance. C. Welcome opportunities to be creative and productive. D. Commit to finding friendship and companionship. E. Become involved with community issues and activities.
B, C, & E
A nurse is preparing an in-service program about delegation. Which of the following are components of the five rights of delegation? (select all that apply.) A. Right place B. Right supervision and evaluation C. Right direction and communication D. Right documentation E. Right circumstances
B, C, & E
A nurse is preparing the discharge summary for a client who has had knee arthroplasty and is going home. Which of the following information about the client should the nurse include discharge summary? (Select all that apply) A. Advance directives status B. Follow-Up Care C. Instructions for diet and medications D. Most recent vital sign data E. Contact information for the home health care agency.
B, C, & E
A nurse is caring for a client who asks what their Snellen eye test results mean. The client's visual acuity is 20/30. Which of the following responses should the nurse make? A. "Your eyes see at 20 feet what visually unimpaired eyes see at 30 feet." B. "Your right eye can see the chart clearly at 20 feet, and your left eye can see the chart clearly at 30 feet." C. "Your eyes see at 30 feet what visually unimpaired eyes see at 20 feet." D. "Your left eye can see the chart clearly at 20 feet, and your right eye can see the chart clearly at 30 feet."
A
A nurse is performing an admission assessment for an older adult client. After gathering the assessment data and performing the review of systems, which of the folloiwng actions is a priority for the nurse? A. Orient the client to their room B. Conduct a client care conference C. Review medical perscriptions D. Develop a plan of care
A
A nurse manager is developing strategies to care for the increasing number of clients who have obesity. Which of the following actions should the nurse include as a primary health care strategy? A. Collaborating with providers to perform obesity screenings during routine office visits. B. Ensuring the availability of specialized beds in rehabilitation centers for clients who have obesity. C. Providing specialized intraoperative training in surgical treatments for obesity. D. Educating acute care nurses about post-operative complications related to obesity
A
A nurse is explaining the various levels of healthcare services to a group of newly licensed nurses. Which of the following examples of care or care settings should the nurse classify as tertiary care? ( select all that apply.) A. Intensive Care Unit B. Oncology Treatment Center C. Burn Center D. Cardiac Rehabilitation E. Home Health Care
A, B, & C
A nurse is caring for a group of clients on a medical surgical unit. For which of the following client care needs should the nurse initiate a referral for a social worker? ( select all the apply.) A. A client who has terminal cancer requests hospice care in the home. B. A client asks about Community Resources available for older adults C. A client states, " I would like to have my child baptized before surgery." D. A client requests an electric wheelchair for use after discharge. E. A client states, "I do not understand how to use a nebulizer."
A, B, & D
A nurse is discussing restorative healthcare with a newly licensed nurse. Which of the following examples should the nurse include in the teaching? (select all that apply.) A. Home Health Care B. Rehabilitation Facilities C. Diagnostic Centers D. Skilled nursing facilities E. Oncology centers
A, B, & D
A nurse is instructing an assistive personnel how to measure a client's respiratory rate. Which of the following statements should the nurse include? (Select all that apply) A. Place the client in semi-Fowler's position B. Have the client rest an arm across the abdomen C. Observe one full respiratory cycle before counting the rate D. Count the rate for 30 sec if it is irregular E. Inform the client you are counting their respiratory rate
A, B, C
A nurse in a clinic is planning health promotion and disease prevention strategies for a client who has multiple risk factors for cardiovascular disease. Which of the following interventions should the nurse include? (Select all that apply) A. Help the client see the benefits of their actions. B. Identify the client's support systems. C. Suggest and recommend community resources. D. Device and set goals for the client. E. Teach stress management strategies.
A, B, C, & E
A nurse is acquainting a group of newly licensed nurses with the roles of the various members of the healthcare team they will encounter on a medical-surgical unit. When providing examples of the types of tasks certified nursing assistants (CNAs) can perform, which of the following client activities should the nurse include? (select all that apply.) A. Bathing B. Ambulating C. Toileting D. Determining pain level E. Measuring vital signs
A, B, C, & E
A nurse is caring for a client who had a stroke and is scheduled for transfer to a rehabilitation center. Which of the following tasks are the responsibility of the nurse at the transferring facility? (Select all that apply) A. Ensure that the client has possession of their valuables. B. Confirm that the rehabilitiation center has a room available at the time of transfer. C. Assess how the client tolerates the transfer. D. Give a verabal transfer report via telephone. E. Complete a transfer form for the receiving facility.
A, B, D, & E
A nurse is teaching a client who has a new prescription for oxybutynin about managing the medication's anticholinergic effects. Which of the following instructions should the nurse include? (Select all that apply) A. Take sips of water frequently. B. Wear sunglasses when outdoors in sunlight C. Use a soft toothbrush when brushing teeth D. Take the medication with an antacid E. Urinate prior to taking the medication
A, B, E
A client who was post-operative following knee arthroplasty is concerned about the adverse effects of the medication prescribed for pain management. Which of the following members of the interprofessional care team can assist the client in understanding the medications effects? (select all that apply.) A. Provider B. Certified nursing assistant C. Pharmacist D. Registered nurse E. Respiratory therapist
A, C, & D
A nurse is reviewing CDC immunization recommendations with a young adult client. Which of the following vaccines should the nurse recommend as routine, rather than catch-up, during young adulthood? (Select all that apply) A. Influenza B. Measles, Mumps, Rubella C. Pertussis D. Tetanus E. Polio
A, C, & D
A nurse is collecting history and physical examination data from a middle adult. The nurse should expect to find decreases in which of the following physiologic functions? (Select all that apply) A. Metabolism B. Ability to hear low-pitched sounds C. Gastric secretions D. Far vision E. Glomerular filtration
A, C, & E
A nurse is talking with an older adult client about improving nutritional status. Which of the folloiwng interventions should the nurse recommend? (Select all that apply) A. Increase protein intake to increase muscle mass. B. Decrease fluid intake to prevent urinary incontinence. C. Increase calcium intake to prevent osteoporosis. D. Limit sodium intake to prevent edema E. Increase fiber intake to prevent constipation.
A, C, D, & E
A nurse is caring for a client who takes several medications. The client states, "I fast for several days each week to control my weight" The nurse should instruct the client that fasting increases the risk for medication toxcity due to what physiological factor?
When taking actions, the nurse should instruct inadequate nutrition, such as from intermittent fasting, can decrease the level of plasma albumin, which decreases the protein-binding response of medications. This causes an increase in level of medication and increases the risk for medication toxicity.
A nurse is teaching a client who is in the first trimester of pregnancy about medications. What instructions should the nurse include in the teaching?
When taking actions, the nurse should instruct that pregnancy is a contraindication for live-virus vaccines, including rubella, due to possible teratogenic effects. Most medications, including over-the-counter, are potentially harmful to the fetus. The client should avoid any medications unless prescribed by the provider. Nutritional supplements that include iron are prescribed during pregnancy to support the health of the mother and the fetus. Providers can prescribe medications to treat nausea and other discomforts of pregnancy.
