ATI Fundamental Retake #2 Level 2, Corrected 2022

1) A nurse is caring for a client who has a tracheostomy which of the following actions should the nurse take? A) Cotton tip applicator to clean the inside of the cannula B) Soak the outer cannula in warm soapy tap water C) Cleanse the skin around the stoma with normal saline D) Secure the tracheostomy ties to allow one finger to fit snuggly underneath 2) A nurse is planning care for client who is scheduled for an intravenous pyelogram. Which of the following actions is appropriate for the nurse to include? A) Ensure the client is free of metal objects B) Administer 240 ml (8oz) oral contrast before the procedure C) Monitor the client for pain in the suprapubic region D) Assist the client with a bowel cleansing 3) A nurse is testing a client for conduction deafness by performing the Weber’s tests. which of the following actions should the nurse take when performing the test? A) Move a vibrating tuning fork in front of the clients canals one after the other B) Place the base of the vibrating tuning fork on the top of the client’s head C) Place the base of a vibrating tuning fork on the client’s mastoid process D) Count how many seconds a client can hear a tuning fork after it has been struck 4) A nurse is planning care for a client who has a new prescription for parental nutrition in 20% dextrose and fat emulsion. Which of the following is the appropriate action to indicate in the plan of care? A) Prepare the client for a central venous line B) Change the PN infusion bag every 48 hours C) Administer the PN and fat emulsion separately D) Obtain a random blood glucose daily *5) A nurse is teaching a group of newly licensed nurses about the Braden scale. Which of the following responses by a newly licensed nurse indicates understanding in the teaching? A) Each element has a range 1 to 5 points B) The higher the score the higher the pressure ulcer risk C) The client’s age is part of the measurement D) The scale measures six elements *6) A nurse is providing care for a client who is to undergo a total laryngectomy. Which of the following interventions is the nurse’s priority? A) Determine the client’s reading ability B) Review the use of an artificial larynx C) With the client schedule a support session D) For the client explain the techniques of esophageal speech 7) A nurse is caring for a client who reports that she has insomnia. Which of the following interventions is appropriate for the nurse to recommend? A) Eat a light carbohydrate snack before bedtime B) Exercise 1 hour before bedtime C) Drink a cup of hot cocoa before bedtime D) Take a 30 min nap daily 8) A nurse in an emergency department is assessing a client who reports a right lower quadrant pain, nausea and vomiting for the past 48 hours? Which of the following actions should the nurse take first? A) Offer pain medication B) Palpate the abdomen C) Auscultate bowel sounds D) Administer an antiemetic 9) A nurse is teaching a client how to self-administer daily low dose heparin injections. Which of the following factors is most likely to increase the client’s motivation to learn? A) The client’s belief that his needs will be met through education B) The nurse explaining the need for education to the client C) The client seeking family approval by agreeing to a teaching plan D) The nurse’s empathy about the client having to self-inject 10) A nurse is caring for a client who has restraints to each extremity. Which of the following assessment should the nurse perform first? A) Elimination needs B) Comfort level C) Peripheral pulses D) Skin integrity 11) A charge nurse is monitoring the documentation of the medication by a newly licensed nurse. The charge nurse should intervene if the newly licensed nurse uses which of the following abbreviations? A) OJ for orange juice B) SQ for subcutaneous C) SS for sliding scale D) BRP for bathroom privileges 12) A nurse is caring for a client who has tuberculosis. Which of the following precautions should the nurse plan to implement? A) Contact B) Droplet C) Airborne D) Protection 13) A nurse is caring for a client receiving continuous enteral feedings through an NG tube. Which of the following is an unexpected finding? A) Diarrhea one time in a 24-hour period B) A weight gain of 0.9 (2lb) in 2 days C) A gastric residual of 300 mL at the end of the shift D) A blood glucose level of 110 14) A nurse is preparing a sterile field to assist with nurturing a client’s laceration. Which of the following actions should the nurse plan to take? A) Pour the sterile solution with the bottle held 20 cm (8 in) above the sterile bowl B) Hold the bottle of sterile solution so that the label is facing the palm of the hand C) Place the lid of the sterile solution bottle face down on the sterile drape D) Apply sterile gloves before opening the bottle of sterile solution 15) A nurse is preparing to administer several medications to a client via NG tube to a client who is receiving continuous enteral feeding. Which of the following actions should the nurse take first? A) Dilute each crushed medication with sterile water B) Mix the medications together in a single syringe C) Combine the medications with the formula D) Flush the NG tube with 5 mL of sterile water prior to administration