ATI Fundamentals Proctored Exam AND Answers

1) A nurse is performing a Romberg's test during the physical assessment of a client. Which of the following techniques should the nurse use? ANS: Have the client stand with her arms at her side and her feet together.
2) A nurse is planning an deduction session for an older adult client who has just learned that she has type 2 diabetes mellitus. Which of the following strategies should the nurse plan to use with this client? ANS: Allow extra time for the client to respond to questions
3) A nurse is teaching an older client who is at risk for osteoporosis about beginning a program of regular physical activity. Which of the following types of activity should the nurse recommend? ANS: Walking briskly
4) A nurse is assessing an adult client who has been immobile for the past 3 weeks. The nurse should identify that which of the following findings requires further intervention?
ANS: Erythema on pressure points
5) A nurse is preparing to administer 0.5 mL of oral single-dose liquid medication to a client. Which of the following actions should the nurse take? ANS: Gently shake the container of medication prior to administration.
6) A nurse is responding to a call light and finds a client lying on the bathroom floor. Which of the following actions should the nurse take first? ANS: Check the client for injuries
7) A nurse is caring for a client who is expressing anger over his diagnosis of colorectal cancer. Which of the following actions should the nurse take? ANS: Reassure the client that this is an expected response to grief.
8) A nurse in a clinic is caring for a middle adult client who states, "The doctor says that, since I am at an average risk for colon cancer, I should have routine screening. What does that involve?" Which of the following responses should the nurse make? ANS: "You should have a fecal occult blood test every year."
9) A nurse is preparing to administer multiple medications to a client who has an enteral feeding tube. Which of the following actions should the nurse plan to take? ANS: Flush the tube with 15 mL of sterile water.
10) A nurse is caring for a client who has a prescription for wound irrigation. Which of the following actions should the nurse take? ANS: Cleanse the wound from the center outward.
11) A nurse is providing care to four clients. Which of the following situations requires the nurse the complete an incident report? ANS: A client who has an IV infusion pump receives an additional 250 mL of IV fluid.
12) A nurse is caring for a client receiving fluid through a peripheral IV catheter. Which of the following findings at the IV site should the nurse identify as infiltration? ANS: Skin blanching
13) A nurse is preparing a change-of-shift report. Which of the following tools or documents should the nurse use to communicate continuity of care? ANS: Situation, background, assessment, and recommendation (SBAR)
14) A nurse is admitting a client who has an abdominal wound with a large amount of purulent drainage. Which of the following types of transmission precautions should the nurse initiate? ANS: Contact precautions
15) A nurse is caring for a client who is having difficulty breathing. The client is lying in bed with a nasal cannula delivering oxygen. Which of the following interventions should the nurse take first? ANS: Assist the client to an upright position.
16) A nurse is reviewing a client's fluid and electrolyte status. Which of the following findings should the nurse report to the provider? ANS: Potassium 5.4 meq/L
17) A nurse is lifting a bedside cabinet to move it closer to a client who is sitting in a chair. To prevent self-injury, which of the following actions should the nurse take when lifting this object? ANS: Stand close to the cabinet when lifting it.
18) A nurse is reviewing a client's medication prescription, which reads, "digoxin 0.25 by mouth every day. "Which of the following components of the prescription should the nurse question? ANS: The dose