ATI RN CONCEPT -BASED LEVEL 3EXAM PREP|HIGH- YIELD
QUESTIONS, ANSWERS & REVIEW |CORRECT DETAILED
ANSWERS WITH RATIONALES COVERING THE MOST TESTED
QUESTIONS GUARANTEE A+ GRADE |ALREADY GRADED A+
A client who is being discharged today asks the nurse for supplies
for her wound dressing. Which of the following actions should the
nurse take to ensure quality, cost-effective care?
CORRECT ANSWER:
Provide enough supplies for 1 to 2 days.-Although wound care
supplies for home use are typically purchased by clients after
leaving the facility, it may be necessary to provide adequate supplies
for the immediate discharge period.
A nurse is administering baclofen for a client who has a spinal cord
injury. Which of the following should the nurse document as a
therapeutic outcome?
CORRECT ANSWER:
Decrease in flexor and extensor spasticity-
Baclofen decreases the frequency and severity of muscle spasms,
allowing for improved muscle function.
A nurse is providing postoperative instructions about complete
proteins to a client following a below-the-knee amputation. Which of
the following food choices indicates a need for additional
instruction?
CORRECT ANSWER:
Pinto beans-
Pinto beans are a plant protein; therefore, this food choice is an
incomplete protein.
,A community health nurse is asked to give a health education
program to a group of African-American men age 40 to 75.
Considering the health concerns of this group, which of the following
topics is most important to include in the program?
CORRECT ANSWER:
Prostate cancer screening-
The greatest risk for African-American males is death from prostate
cancer. Therefore, prostate cancer screening is the priority topic to
include.
A nurse is caring for an older adult client who has kidney failure. The
client tells the nurse that she has decided to stop hemodialysis
treatment. Which of the following actions by the nurse is appropriate
in regard to serving as the client's advocate?
CORRECT ANSWER:
Supporting the client's decision regarding treatment
-The nurse's role as client advocate is to support the client's decision
to discontinue treatment.
A nurse is caring for an older adult client. The client received 0.9%
sodium chloride 1 L over 4 hr instead of over 8 hr as prescribed.
Which of the following entries is the appropriate documentation of
this occurrence in the client's medical record?
CORRECT ANSWER:
0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable.- The
nurse should document the amount of fluid, how long it took to
infuse, and the client's physical status.
When planning care for a child who has increased intracranial
pressure (ICP), which of the following should the nurse include in the
child's plan of care?
CORRECT ANSWER:
,Maintain head in midline. -The child's head should be maintained in a
midline position to promote venous return and prevent an increase in
ICP.
Sleepy/Widening pulse pressure//decerebrate posturing.....
Sleepiness exhibited by the client is correct. Sleepiness or difficulty
arousing the client from sleep is an indication of increased ICP.//
Widening pulse pressure is correct. A widening pulse pressure
(increase in systolic with concurrent decrease in diastolic blood
pressure) is an indication of increased ICP.//
Decerebrate posturing is correct. Both decerebrate and decorticate
posturing indicate increased ICP.
A nurse is talking with a client who is beginning chemotherapy. She
tells the nurse that she is mourning the loss of her hair. Which of the
following actions should the nurse take first?
CORRECT ANSWER:
Discuss the importance of hair with the client.--The first action the
nurse should take using the nursing process is to assess the client.
By identifying the importance of hair to the client, the nurse can
acknowledge the importance of the expected loss to the client and
assist the client with anticipatory grieving.
an inability to manage finances.--
Clients who are in stage 4 have difficulty with tasks that require
planning and math skills, such as managing finances.
Fine and gross motor skill challenges-
Fine and gross motor skill challenges are manifestations of spastic
cerebral palsy.
Discontinue the infusion.--A report of pain and a red line extending
outward from the insertion site are manifestations of phlebitis and
indicates that the client is at the greatest risk from injury to the vein;
therefore, the first action the nurse should take is to discontinue the
infusion.
, A nurse is caring for a client who is scheduled to undergo
electroconvulsive therapy (ECT). The provider has explained the
procedure to the client. Which of the following statements made by
the client indicates a need for further teaching?
CORRECT ANSWER:
"This procedure can increase my risk for developing Parkinson's
disease."-
Developing Parkinson's disease is not an adverse effect of ECT;
therefore, this statement indicates a need for further teaching.
A nurse is caring for a client who has an ileostomy and is 4 weeks
postoperative. The client reports leakage and irritation around the
stoma. Which of the following is an appropriate intervention?
CORRECT ANSWER:
Instruct the client to use a skin barrier when refitting the pouch
system.-
The client should use a skin barrier to protect the skin from enzymes
and bile salts from gastrointestinal drainage at the stoma site.
A nurse is educating a client who is at 30 weeks of gestation
regarding a 3-hr oral glucose tolerance test. Which of the following
should the nurse include in her teaching?
CORRECT ANSWER:
Consume 150 g of carbohydrates daily for 3 days prior to the test.-
A carbohydrate load prior to the glucose tolerance test is necessary
for an accurate assessment.
A client with a diagnosis of depression is attending group therapy.
During the group meeting, the nurse asks each member to identify
one goal for the day. When it is the client's turn, she does not
respond. Which of the following should the nurse do before
repeating the request to the client?
CORRECT ANSWER:
QUESTIONS, ANSWERS & REVIEW |CORRECT DETAILED
ANSWERS WITH RATIONALES COVERING THE MOST TESTED
QUESTIONS GUARANTEE A+ GRADE |ALREADY GRADED A+
A client who is being discharged today asks the nurse for supplies
for her wound dressing. Which of the following actions should the
nurse take to ensure quality, cost-effective care?
CORRECT ANSWER:
Provide enough supplies for 1 to 2 days.-Although wound care
supplies for home use are typically purchased by clients after
leaving the facility, it may be necessary to provide adequate supplies
for the immediate discharge period.
A nurse is administering baclofen for a client who has a spinal cord
injury. Which of the following should the nurse document as a
therapeutic outcome?
CORRECT ANSWER:
Decrease in flexor and extensor spasticity-
Baclofen decreases the frequency and severity of muscle spasms,
allowing for improved muscle function.
A nurse is providing postoperative instructions about complete
proteins to a client following a below-the-knee amputation. Which of
the following food choices indicates a need for additional
instruction?
CORRECT ANSWER:
Pinto beans-
Pinto beans are a plant protein; therefore, this food choice is an
incomplete protein.
,A community health nurse is asked to give a health education
program to a group of African-American men age 40 to 75.
Considering the health concerns of this group, which of the following
topics is most important to include in the program?
CORRECT ANSWER:
Prostate cancer screening-
The greatest risk for African-American males is death from prostate
cancer. Therefore, prostate cancer screening is the priority topic to
include.
A nurse is caring for an older adult client who has kidney failure. The
client tells the nurse that she has decided to stop hemodialysis
treatment. Which of the following actions by the nurse is appropriate
in regard to serving as the client's advocate?
CORRECT ANSWER:
Supporting the client's decision regarding treatment
-The nurse's role as client advocate is to support the client's decision
to discontinue treatment.
A nurse is caring for an older adult client. The client received 0.9%
sodium chloride 1 L over 4 hr instead of over 8 hr as prescribed.
Which of the following entries is the appropriate documentation of
this occurrence in the client's medical record?
CORRECT ANSWER:
0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable.- The
nurse should document the amount of fluid, how long it took to
infuse, and the client's physical status.
When planning care for a child who has increased intracranial
pressure (ICP), which of the following should the nurse include in the
child's plan of care?
CORRECT ANSWER:
,Maintain head in midline. -The child's head should be maintained in a
midline position to promote venous return and prevent an increase in
ICP.
Sleepy/Widening pulse pressure//decerebrate posturing.....
Sleepiness exhibited by the client is correct. Sleepiness or difficulty
arousing the client from sleep is an indication of increased ICP.//
Widening pulse pressure is correct. A widening pulse pressure
(increase in systolic with concurrent decrease in diastolic blood
pressure) is an indication of increased ICP.//
Decerebrate posturing is correct. Both decerebrate and decorticate
posturing indicate increased ICP.
A nurse is talking with a client who is beginning chemotherapy. She
tells the nurse that she is mourning the loss of her hair. Which of the
following actions should the nurse take first?
CORRECT ANSWER:
Discuss the importance of hair with the client.--The first action the
nurse should take using the nursing process is to assess the client.
By identifying the importance of hair to the client, the nurse can
acknowledge the importance of the expected loss to the client and
assist the client with anticipatory grieving.
an inability to manage finances.--
Clients who are in stage 4 have difficulty with tasks that require
planning and math skills, such as managing finances.
Fine and gross motor skill challenges-
Fine and gross motor skill challenges are manifestations of spastic
cerebral palsy.
Discontinue the infusion.--A report of pain and a red line extending
outward from the insertion site are manifestations of phlebitis and
indicates that the client is at the greatest risk from injury to the vein;
therefore, the first action the nurse should take is to discontinue the
infusion.
, A nurse is caring for a client who is scheduled to undergo
electroconvulsive therapy (ECT). The provider has explained the
procedure to the client. Which of the following statements made by
the client indicates a need for further teaching?
CORRECT ANSWER:
"This procedure can increase my risk for developing Parkinson's
disease."-
Developing Parkinson's disease is not an adverse effect of ECT;
therefore, this statement indicates a need for further teaching.
A nurse is caring for a client who has an ileostomy and is 4 weeks
postoperative. The client reports leakage and irritation around the
stoma. Which of the following is an appropriate intervention?
CORRECT ANSWER:
Instruct the client to use a skin barrier when refitting the pouch
system.-
The client should use a skin barrier to protect the skin from enzymes
and bile salts from gastrointestinal drainage at the stoma site.
A nurse is educating a client who is at 30 weeks of gestation
regarding a 3-hr oral glucose tolerance test. Which of the following
should the nurse include in her teaching?
CORRECT ANSWER:
Consume 150 g of carbohydrates daily for 3 days prior to the test.-
A carbohydrate load prior to the glucose tolerance test is necessary
for an accurate assessment.
A client with a diagnosis of depression is attending group therapy.
During the group meeting, the nurse asks each member to identify
one goal for the day. When it is the client's turn, she does not
respond. Which of the following should the nurse do before
repeating the request to the client?
CORRECT ANSWER:
