ATI Nursing Fundamentals Set
1. A nurse is preparing to transfer a client from an acute care facility to a long-term care facility. Which of
the following information should the nurse plan to include in the transfer report? Why?
A) Discontinued medications
B) resolved health conditions
C) frequency of vital signs
D) completed nursing interventions: B) resolved health conditions ;the nurse should report both unresolved and
resolved health conditions to promote continuity of care.
2. A nurse is repositioning a client who has quadriplegia and is in the supine position. Which of the following
actions should the nurse take to prevent client musculoskeletal injury?
Why?
A) support the clients head on a pillow that maintains cervical flex ions
B) position the clients shoulders off the pillow for internal rotation.
C) place the client's arms at their sides to keep their elbows extended
D) internally rotate the client's hips by using a trochanter roll: D) internally rotate the client's hips by using a
trochanter roll; the nurse should place trochanter rolls at the proximal end of each of the clients legs to maintain a neural
or internal rotation of the client's hips and to prevent external rotation of the hips, which can cause injury when the
client is supine.
3. A nurse is caring for a client who is postop and is experiencing Nashua and vomiting. The nurse should
identify which of the following findings as indications that the client has fluid volume deficit? select all that
apply.
A) full bounding pulse
B) cool extremities
C) moist crackles in the lungs
D) orthostatic hypotension
E) flat neck veins: B) Cool extremities
D) orthostatic hypotension
E) Flat neck veins
A and C indicate fluid volume excess, nurse should expect a weak peripheral pulse in a client with fluid volume deficit,
the nurse should expect clear lungs in a client w volume deficit.
4. What can the nurse delegate to Assistant Personnel?
A) apply thromboembolic stockings.
B) monitor the circulation in all four extremities
C) record the condition of the client's skin
, ATI Nursing Fundamentals Set
D) reinforce teaching about performing ROM exercises: A) apply thromboem- bolic stockings
5. A nurse is contributing to the plan of care for a client who has a positive throat culture for streptococci.
Which of the following interventions should the nurse recommended to be included in the plan of care?
A) place the client in a room with another client who has pharyngitis
B) ensure that the client wears a surgical mask during transportation through- out the facility
C) limit the client's visitations to 30 minutes
D) provide the client a room with negative-pressure airflow of six air ex- changed per hour.: B) ensure that the
client wears a surgical mask during trans- portation throughout the facility ; S. Pharyngitis requires droplet precautions.
Staff should make every attempt to limit the clients movements outside of the room.
6. A nurse is preparing to administer o2 to a client who has heart failure and is having sever difficulty breathing.
Which of the following o2 delivery equipment should the nurse elect to provide the highest concentration of o2 to
the client?
A) nasal cannula
B) simple face mask
C) Venturi mask
D) nonrebreather mask: D) nonrebreather mask ; provides the highest % of o2 concentration without intubation
and mechanical ventilation
7. A nurse is planning to perform wound irrigation for a client who has a large abdominal wound. Which of the
following actions should the nurse plan to take?
A) administer an analgesic 30 minutes before starting the procedure
B) hold the syringe 5cm (2in) above the upper end of the wound
C) place the irrigation solution in a basin of cool water
D) perform the wound irrigation with a 10-mL syringe with an angiocatheter.-
A) administer an analgesic 30 minutes before starting the procedure; the nurse should administer an analgesic to promote pa
control, which allows the client to move more easily and be positioned to facilitate the irrigation.
8. A nurse is reinforcing preposition teaching with a client about how to turn, cough, and deep breathe. Which of
the following statements by the client indicate an understanding of the teaching?
A) "this can help prevent nausea"
B) "this can help prevent pneumonia"
C) "i should do this q4h"
D) "i should do this to keep my heart from beating too fast": B) "this can help prevent pneumonia" ; it reduces
the risk of respiratory complication such ad
1. A nurse is preparing to transfer a client from an acute care facility to a long-term care facility. Which of
the following information should the nurse plan to include in the transfer report? Why?
A) Discontinued medications
B) resolved health conditions
C) frequency of vital signs
D) completed nursing interventions: B) resolved health conditions ;the nurse should report both unresolved and
resolved health conditions to promote continuity of care.
2. A nurse is repositioning a client who has quadriplegia and is in the supine position. Which of the following
actions should the nurse take to prevent client musculoskeletal injury?
Why?
A) support the clients head on a pillow that maintains cervical flex ions
B) position the clients shoulders off the pillow for internal rotation.
C) place the client's arms at their sides to keep their elbows extended
D) internally rotate the client's hips by using a trochanter roll: D) internally rotate the client's hips by using a
trochanter roll; the nurse should place trochanter rolls at the proximal end of each of the clients legs to maintain a neural
or internal rotation of the client's hips and to prevent external rotation of the hips, which can cause injury when the
client is supine.
3. A nurse is caring for a client who is postop and is experiencing Nashua and vomiting. The nurse should
identify which of the following findings as indications that the client has fluid volume deficit? select all that
apply.
A) full bounding pulse
B) cool extremities
C) moist crackles in the lungs
D) orthostatic hypotension
E) flat neck veins: B) Cool extremities
D) orthostatic hypotension
E) Flat neck veins
A and C indicate fluid volume excess, nurse should expect a weak peripheral pulse in a client with fluid volume deficit,
the nurse should expect clear lungs in a client w volume deficit.
4. What can the nurse delegate to Assistant Personnel?
A) apply thromboembolic stockings.
B) monitor the circulation in all four extremities
C) record the condition of the client's skin
, ATI Nursing Fundamentals Set
D) reinforce teaching about performing ROM exercises: A) apply thromboem- bolic stockings
5. A nurse is contributing to the plan of care for a client who has a positive throat culture for streptococci.
Which of the following interventions should the nurse recommended to be included in the plan of care?
A) place the client in a room with another client who has pharyngitis
B) ensure that the client wears a surgical mask during transportation through- out the facility
C) limit the client's visitations to 30 minutes
D) provide the client a room with negative-pressure airflow of six air ex- changed per hour.: B) ensure that the
client wears a surgical mask during trans- portation throughout the facility ; S. Pharyngitis requires droplet precautions.
Staff should make every attempt to limit the clients movements outside of the room.
6. A nurse is preparing to administer o2 to a client who has heart failure and is having sever difficulty breathing.
Which of the following o2 delivery equipment should the nurse elect to provide the highest concentration of o2 to
the client?
A) nasal cannula
B) simple face mask
C) Venturi mask
D) nonrebreather mask: D) nonrebreather mask ; provides the highest % of o2 concentration without intubation
and mechanical ventilation
7. A nurse is planning to perform wound irrigation for a client who has a large abdominal wound. Which of the
following actions should the nurse plan to take?
A) administer an analgesic 30 minutes before starting the procedure
B) hold the syringe 5cm (2in) above the upper end of the wound
C) place the irrigation solution in a basin of cool water
D) perform the wound irrigation with a 10-mL syringe with an angiocatheter.-
A) administer an analgesic 30 minutes before starting the procedure; the nurse should administer an analgesic to promote pa
control, which allows the client to move more easily and be positioned to facilitate the irrigation.
8. A nurse is reinforcing preposition teaching with a client about how to turn, cough, and deep breathe. Which of
the following statements by the client indicate an understanding of the teaching?
A) "this can help prevent nausea"
B) "this can help prevent pneumonia"
C) "i should do this q4h"
D) "i should do this to keep my heart from beating too fast": B) "this can help prevent pneumonia" ; it reduces
the risk of respiratory complication such ad
