ATI Flashcards
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 explaining the various types of health care coverage clients might have to a group of nurses. Which of the following health care 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 manager is developing strategies to care for the increasing number of clients who have obesity. Which of the following should the nurse include in 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 postoperative complications related to obesity
a
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. Monitor evidence-based practice for clients who have specific diagnosis
b. Ensuring the 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 explaining the various levels of health care 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)
* remember tertiary care= intensive and subacute care*
a. Oncology treatment center
b. Burn center
c. Cardiac rehabilitation
d. Home health care
a, b, c
A nurse is caring for a group of clients on medical surgical unit. For which of the following client care needs should the nurse initiate a referral for social worker? (select all that 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 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 client who is postoperative following 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 medication’s effects? (select all that apply)
a. Provider
b. Certified nursing assistant
c. Pharmacist
d. Registered nurse
e. Respiratory therapist
a, c, d
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?
a. Social worker
b. Certified nursing assistant
c. Occupational therapist
d. Speech-language pathologist
d
A nurse is acquainting a group of newly licensed nurses with the roles of the various members of 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
everything except for determining the pain level
a, b, c, e
A nurse is caring for a client who has severe acute respiratory syndrome (SARS). The nurse knows that healthcare professionals are required to report communicable and infectious diseases. Which of the following illustrate the rationale for reporting? (select all that apply)
a. Planning and evaluating control and preventing strategies
b. Determining public health priorities
c. Ensuring proper medical treatment
d. Identifying endemic disease
e. Monitoring for common-source outbreaks
a, b, c, e
A nurse is caring for a client who has had a cough for 3 weeks and is beginning to cough up blood. The client has manifestation of which of the following conditions?
a. Allergic reaction
b. Ringworm
c. Systemic lupus erythematosus
d. Tuberculosis
d
A nurse is caring for a client who reports a severe sore throat, pain when swallowing, and swollen lymph nodes. The client is experiencing which of the following stages of infection?
a. Prodromal
b. Incubation
c. Convalescence
d. Illness
d
A charge nurse is reviewing with a newly hired nurse the difference in manifestations of localized versus a systemic infection. Which of the following are manifestations of a systemic infection?
a. Fever
b. Malaise
c. Edema
d. Pain or tenderness
e. Increase in pulse and respiratory rate
a, b, e
Systemic infection- fever, malaise, increased respiratory rate and pulse.
Localized infection- edema, pain or tenderness
A nurse is contributing to the plan of care for a client who is being admitted to the facility with a suspected diagnosis of pertussis. Which of the following interventions should the nurse include? (select all that apply)
a. Please the client in a room that has negative air pressure for at least six exchanges per hour
b. Wear a mask when providing care within 3 ft of the client
c. Place a surgical mask on the client if transportation to another department is unavoidable
d. Use sterile gloves when handling soiled linens
e. Wear a gown when performing care that might result in contamination from secretions
b, c, e
A nurse is caring for a client in the emergency department who has an oral body temperature of 38.3 C (101 F), pulse rate 114/min, and respiratory rate 22/min. The client is restless with warm skin. Which of the following interventions should the nurse take? (Select all that apply)
a. Obtain culture specimens before initiating antimicrobials
b. Restrict the clients oral fluid intake
c. Encourage the client to rest and limit activity
d. Allow the client to shiver to dispel excess heat
e. Assist the client with oral hygiene frequently
a, c, e
A nurse is instructing an assistive personnel (AP) about caring for a client who has low platelet count. Which of the following instructions is the priority for measuring vital signs for this client?
a. “Do not measure the client temperature rectally.”
b. “Count the client’s radial pulse for 30 seconds and multiply it by 2”
c. “Do not let the client know you are counting their respiration”
d. “Let the client rest for 5 minutes before you measure their blood pressure.”
a
A nurse is instructing a group of assistive personnel in measuring a client’s respiratory rate. Which of the following guidelines 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. Count and report any signs the client demonstrates
a, b, c
A nurse is measuring the blood pressure of a client who has a fractured femur. The blood pressure reading is 140/94 mm Hg, and the client denies any history of hypertension. Which of the following actions should the nurse take first?
a. Request a prescription for an antihypertensive medication
b. Ask the client if they are having pain
c. Request a prescription for an antianxiety medication
d. Return in 30 min to recheck the clients blood pressure
b
A nurse is performing an admission assessment on a client. The nurse determines the client’s radial pulse rate is 68/min and the simultaneous apical pulse rate is 84/min. What is the clients pulse deficit?
Answer: 84-68= 16/min
** the pulse deficit is the difference between the apical and radial pulse rates. it reflects the number of ineffective or nonperfusing heartbeats that do not transmit pulsations to peripheral pulse points. 84‐68 = 16
A nurse is caring for a client scheduled for abdominal surgery. The client reports being worried. Which of the following actions should the nurse take?
a. Offer information on a relaxation technique and ask the client if they are interested in trying it.
b. Request a social worker see the client to discuss mediation
c. Attempt to use biofeedback techniques with the client
d. Tell the client many people feel the same way before surgery and to think of something else
a
A nurse is assessing a client as part of an admission history. The client reports drinking an herbal tea every afternoon at work to relieve stress. Tea includes which of the following ingredients?
a. Chamomile
b. Ginseng
c. Ginger
d. Echinacea
a
A nurse is reviewing complementary and alternative therapies with a group of newly licensed nurses. Which of the following interventions are mind-body therapies (Select all that apply)
a. Art therapy
b. Acupressure
c. Yoga
d. Therapeutic touch
e. Biofeedback
a, c, e
A nurse is teaching a group of newly licensed nurses on complementary and alternative therapies they can incorporate into their practice without the need for specialized licensing or certification. Which of the following should the nurse encourage them to use?
a. Guided imagery
b. Massage therapy
c. Meditation
d. Music therapy
e. Therapeutic Touch
a, c, d
A nurse is planning to use healing intention with a client who is recovering from a lengthy illness. Which of the following is the priority action to take before attempting this particular mind-body intervention?
a. Tell the client the goal of the therapy is to promote healing
b. Ask whether the client is comfortable with using prayer
c. Encourage the client participate actively for best results
d. Instruct the client to relax during the therapy
b
A nurse prepares an injection of morphine to administer to a client who reports pain, then asks a second nurse to give the injection because another assigned client needs to use a bedpan. Which of the following actions should the second nurse take?
a. Offer to assist the client who needs the bedpan
b. Administer the injection the other nurse prepared
c. Prepare another syringe and administer the injection
d. Tell the client who needs the bedpan to wait while the nurse gives someone else medication
a
A nurse is reviewing a client’s prescribed medications at the beginning of the day shift. Which of the following 0900 medications can be given anytime between 0700 and 1100? (select all that apply)
a. A once-daily multivitamin
b. Eye drops prescribed every 3 hr
c. A blood pressure pill prescribed every 8 hrs
d. A blood pressure pill prescribed twice daily
e. A subcutaneous injection prescribed once weekly
a, e
A nurse orienting a newly licensed nurse is reviewing the procedure for taking a telephone prescription. Which of the following statements should the nurse identify as an indication that the newly licensed nurse understands the process?
a. “ A second nurse enters the prescription into the clients medical record.”
b. “Another nurse should listen to the phone call.”
c. “The provider can clarify the prescription when they sign the health record.”
d. “ I should omit the ‘read back’ if this is one-time prescription
b
A nurse educator is teaching newly licensed nurses about safe medication administration. Which of the following statements indicates understanding? (Select all that apply”
a. “ I will observe the adverse effects.”
b. “ I will monitor for therapeutic effects.”
c. “I will prescribe the appropriate dose.”
d. “ I will change the dose if adverse effects occur”
e. “ I will refuse to give medication if i believe it is unsafe.”
a, b, e
A nurse reviewing a client’s health record notes a new prescription for lisinopril 10mg PO once every day. The nurse should identify this as which of the following types of prescription?
a. Single
b. Stat
c. Routine
d. Now
c
a nurse is demonstrating how to insert an IV catheter. Which of the following statements by a nurse viewing the demonstration indicates understanding of the procedure?
A. “I will thread the needle all the way into the vein until the hub rests against the insertion site after I see a flashback of blood.”
B. “I will insert the needle into the client’s skin at an angle of 10 to 30 degrees with the bevel up.”
C.“I will apply pressure approximately 1.2 inches below the insertion site prior to removing the needle.”
D.“I will choose a vein in the antecubital fossa for Iv insertion due to its size and easily accessible location.”
B
a nurse is collecting data from a client who is receiving IV therapy and reports pain in his arm, chills, and “not feeling well.” The nurse notes warmth, edema, induration, and red streaking on the client’s arm close to the IV insertion site. Which of the following actions should the nurse plan to take first?
A. obtain a specimen for culture.
B. apply a warm compress.
C. administer analgesics.
D. Discontinue the infusion.
D
During new employee orientation, a nurse is explaining how to prevent IV infections. Which of the following statements by an orientee indicates understanding of the preventive strategies?
A. “I will leave the IV catheter in place after the client completes the course of IV antibiotics.”
B. “as long as I am working with the same client, I can use the same IV catheter for my second insertion attempt.”
C.“If my client needs to use the restroom, it would be safer to disconnect his IV infusion as long as I clean the injection part thoroughly with an antiseptic swab.”
D.“I will replace any IV catheter when I suspect contamination during insertion.”
D
a nurse on the Iv team is conducting an in‐service education program about the complications of Iv therapy. Which of the following statements by an attendee indicates an understanding of the manifestations of infiltration? (select all that apply.)
a. “the temperature around the Iv site is cooler.”
b. “the rate of the infusion increases.”
c. “the skin at the Iv site is red.”
d. “the Iv dressing is damp.”
e. “the tissue around the venipuncture site is swollen.”
a, d, e
a nurse is caring for a client receiving dextrose 5% in 0.9% sodium chloride Iv at 120 mL/hr. Which of the following statements by the client should alert the nurse to suspect fluid overload? (select all that apply.)
a. “I feel lightheaded.”
b. “I feel as though my heart is racing.”
c. “I feel a little short of breath.”
d. “the nurse technician told me that my blood pressure was 150 over 90.”
e. “I think my ankles are less swollen”
b, c, d
A nurse is collecting data from a client who takes haloperidol to treat schizophrenia. Which of the following findings should the nurse document as extrapyramidal symptoms (EPS)? (select all that apply.)
A. orthostatic hypotension B. Tremors c. Acute dystonia d. decreased level of consciousness e. Restlessness
b, c, e
*extrapyramidal symptoms= tremors, acute dystonia, restlessness
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 nurse is reviewing a client’s medications. They include cimetidine and imipramine. Knowing that cimetidine decreases the metabolism of imipramine, the nurse should identify that this combination is likely to result in which of the following effects?
a. decreased therapeutic effects of cimetidine
b. Increased risk of imipramine toxicity
c. decreased risk of adverse effects of cimetidine
d. Increased therapeutic effects of imipramine
b
A nurse in an outpatient clinic is caring for a client who has a new prescription for an antihypertensive medication. Which of the following instructions should the nurse give the client?
a. “Get up and change positions slowly.”
b. “Avoid eating aged cheese and smoked meat.”
c. “report any usual bruising or bleeding to the doctor immediately.”
d. “eat the same amount of foods that contain vitamin K every day.”
a
A nurse in an outpatient surgical center is admitting a client for a laparoscopic procedure. the client has a prescription for a preoperative diazepam. Prior to administering the medication, which of the following actions is the nurse’s priority?
A. teaching the client about the purpose of the medication
B. Giving the medication at the administration time the provider prescribed
C. Identifying the client’s medication allergies
D. documenting the client’s anxiety level nurse
C
