ATI FUNDAMENTAL 2023 RETAKE

A nurse in a mental health clinic is caring for an older adult client who has depression and has stopped taking their medication. The client tells the nurse, "I want to die now that my partner is gone." Which of the following responses should the nurse make?

"Have you thought about harming yourself?"

A nurse is preparing to provide tracheostomy care for a client. Which of the following action should the nurse plan to take?

Wear clean gloves while cleaning the inner cannula.

Nurse is caring for a client who has severe rheumatoid arthritis in her hands and is unable to feed herself. For which of the following healthcare team members should the nurse request a referral from the provider?

Occupational therapist

A nurse is caring for a postoperative client who has an IV PCA delivering opioids. The client rates the pain as 2 on a scale of 0 to 10 and has not pressed the button to deliver a bolus dose in over 2 hours. Which of the following action should the nurse take?

Instruct the client to push the button more frequently.

The nurse is prioritizing care for a client. Which of the following procedures should the nurse perform first?

Endotracheal suctioning.

The nurse manager overhears a nurse telling a client, "I will administer your medication by injection if you don't swallow your pills." The nurse manager should identify that the nurse is committing which of the following torts?

Assault

The nurse is preparing to administer several medications via an NG tube to a client who is receiving continuous to feeding. Which of the following action should the nurse take?

Dilute each crushed medication with warm water.

A nurse he's preparing to provide postmortem care for a client. Which of the following action should the nurse plan to take?

Turn the overhead lights to a bright setting.

A nurse is obtaining a health history from a client. The nurse should recognize which of the following data as placing the client a higher risk for osteoporosis?

The client has a sedentary lifestyle.

A nurse is caring for a client who is postoperative and is in bedrest. Which of the following action should the nurse take to decrease the clients risk of developing a pressure injury?

Ensure the client's heels are not touching the mattress.

A nurse is preparing to teach a female client about osteoporosis prevention. Which of the following recommendations should the nurse make for this client?

"Walk for 30 minutes 3 to 5 times each week."

The nurse is planning care for a client who has a prescription for extremity restraints for both wrists. Which of the following action should the nurse include in the plan of care?

-Pad bony prominence before applying to restrains.

-Ensure the client's bed is in the lowest position.

-Assess skin temperature and color before applying the restraints.

Nurses assessing a client who is receiving a blood transfusion. The nurse notes, lung crackles, hypoxia, and distended neck veins. Which of the following action should the nurse take?

-Obtain a prescription for diuretic.

-Administer oxygen to the client.

-Stop the transfusion.

-Place the client in high-Fowler's position.

A nurse is preparing to reposition a client who has lower back injury. Which of the following action should the nurse take?

Flex the clients knees.

A nurse is providing discharge, teaching about safety considerations to an older client who lives at home. The client has heart failure and has a new prescription for hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching?

"I will leave a light on in my bathroom my name."

A nurse is admitting a client who is at risk for falls to a medical surgical unit. Which of the following action should the nurse take?

Provide the client with a night light.

A nurse is obtaining a health history from a client. Which of the following factors places the client at risk for cardiovascular disease?

Metabolic syndrome.

A nurse is caring for a client who has a terminal illness. The client states, "I am not giving up. I want as much treatment as possible." Which of the following responses should the nurse make?

"I will contact your provider to discuss your options."

A nurse is preparing to administer packed RBCs to a client who has low hemoglobin level. Which of the following action should the nurse take prior to the start of the infusion?

Check the blood products compatibility with the client's blood type.

A nurse in an emergency department is caring for a client who is unconscious and require surgery. There is no one available to give consent for the treatment. Which of the following action should the nurse take?

Prepare the client for surgery

A nurse is teaching a client how to self administer help heparin. Which of the following instruction should the nurse include in the teaching?

Expel air bubble before injecting medication.

A nurse is planning to change a clients tracheostomy ties. Which of the following action should the nurse take?

All

A nurse is preparing to perform an Anthropometric assessment on a client. Which of the following client data should the nurse include?

Weight.

A nurse is teaching an older adult client about reducing the risk for osteoporosis. Which of the following statements by the client indicates an understanding of the teaching?

"I will walk three times per week."

A nurse is reviewing a medication prescription that reads "morphine 5 mg IV bolus for pain." Which of the following components should the nurse clarify with the provider?

Time.

A nurse is providing teaching to a client about reducing the adverse effects of immobility. Which of the following statements by the client indicates an understanding of the teaching?

"I will perform ankle and knee exercises every hour."

A nurse is caring for a client who has dysphagia when assisting the client during breakfast. Which of the following actions by the client indicates the nurse should intervene?

The client drinks their thickened juice with a straw.

A nurse is caring for a client who reports frequent headaches and believes balance is achieved through the concept of Yin and yang. Which of the following food should a nurse expect the client to choose to treat their headache?

Honey.

A home health nurse is assessing the home environment of an older adult who has osteoporosis. For which of the following findings should the nurse intervene?

There's an area rug covering a tile floor.

A nurse is assessing a client who has left sided weakness following a stroke. Which of the following findings is in the nurses priority?

The client coughs frequently while eating.

A nurse is caring for a client who has a colostomy. Which of the following action should the nurse take?

Ensure the pouch is 0.32 cm larger than the stoma.

A nurse is assessing a client who has respecters for developing heart disease. Which of the following factors does the nurse recognize as modifiable risk factor?

Physical inactivity.

A nurse is caring for a client who has left lower lobe atelectasis. In which of the following positions should the nurse place the client for postural drainage?

Side- lying with the right side of the chest elevated.

A nurse is teaching a client about reducing the risk for osteoporosis. Which of the following statements by the client indicates an understanding of possible anaphylaxis?

A sharp decrease in blood pressure.

A nurse is planning care for a client who is immobile. Which of the following actions should the nurse include in the plan of care?

Use trochanter rolls besides the client's legs.

The nurse is reviewing a complementary therapies approved by the provider with a client who has hypertension. Which of the following supplements should the nurse discuss with the client?

Garlic

A nurse identifies a small fire in a client;s room. After moving the client to safety, which of the following is the next action the nurse should take?

Activate the facility's fire alarm.

A nurse is planning to administer insulin to a client who has type 1 DM, what action should the nurse perform first?

Verify the dose of insulin with another nurse once it is prepared.

The nurse is caring for a client who has pneumonia. The nurse is providing discharge teaching for the client and their caregiver. Which of the following information should the nurse include?

-The steroid dose will decrease each day.

-Adjust the oxygen flow rate as needed to ease breathing.

-Steroid medication should be taken in the morning.

-Ensure the oxygen delivery system is at least 8 feet from any heat source.

A nurse is caring for a client. The nurse is reviewing the clients medical record, which of the following finding places the client a high risk for heart disease?

-Family history.

-Fasting glucose level.

-History of hyperlipidemia.

-History of hypertension

-Cholesterol level.

A nurse is preparing to administer medication to a client for the first time. Which of the following action should the nurse take to help ensure safe medication administration?

Read the medication label twice prior to administration.