ATI COMPREHENSIVE: All Q&A
1. A nurse is performing tracheostomy care for a client who is postop following a
laryngectomy. Which of the following actions take when suctioning the client’s airway?
a. Apply suction for 10 seconds
2. A nurse is preparing to administer a long acting insulin to a client who has DM. Which of
the following actions should the nurse take first?
a. Check the correct dose with another licensed nurse
3. A nurse is caring for an older adult client in the PACU following gen anesthesia. Which of
the following should the nurse report to the provider?
a. Audible stridor
4. A nurse is planning an educational session for staff nurses about working with parents
whose terminally ill children are candidates for donating their organs. Which of the
following information should the nurse plan to include?
a. The family can have the child in an open casket without fearing that the organ
donation might disfigure the child’s body.
5. Math 0.6mL
6. A nurse manager is planning to make changes to the current scheduling system on the
unit. To facilitate the staff’s acceptance of this change, which of the following actions
should the nurse manager take first?
a. Provide information about scheduling issues to the staff
7. A nurse is assessing a client who is receiving a blood transfusion. Which of the following
findings should indicate to the nurse that the client is having a hemolytic transfusion
reaction?
a. Low back pain
8. A nurse is assessing a client who has macular degeneration. Which of the following
findings should the nurse expect?
a. Decreased central vision
9. A nurse who is working in a long-term care facility is assessing an adult client. Which of
the following findings places the client at risk for development of a pressure injury?
a. Recent weight loss
10. A nurse is teaching about TPN and IV lipid emulsion with a client who has an extensive
burn injury. Which of the following information should the nurse include?
a. “you will receive finger sticks for blood glucose testing.”
11. A nurse is caring for a client who has dehydration secondary to nausea and vomiting.
The nurse should identify which of the following findings as an indication of fluid volume
deficit?
a. Orthostatic hypotension
12. A nurse is caring for a client who is in labor at 39 weeks of gestation. During the second
stage of labor, the nurse observes early decelerations on the monitor tracing. Which of
the following actions should the nurse take?
a. Continue observing the fetal heart rate
, 13. A nurse is caring for a client who requires physical therapy following discharge. Which of
the following actions should the nurse take?
a. Involve the client in the selection of a physical therapy provider
14. A nurse is assessing a client who has sickle cell anemia. The nurse should identify which
of the following findings as a manifestation of vaso-occlusive crisis?
a. Hematuria
15. A nurse is teaching a group of guardians about child safety measures. Which of the
following statements by a guardian indicates an understanding of the teaching?
a. I should have my child avoid sun exposure between 10am and 2pm
16. A nurse is caring for four clients at the beginning of a shift. After receiving change of
shift report, which of the following clients should the nurse attend to first?
a. A client who is confused and has been attempting to get out of bed.
17. A nurse is assessing a client who has been taking lithium carbonate for the past month
to treat bipolar disorder. Which of the following assessment findings should the nurse
identify as the priority?
a. Confusion
18. A nurse manager is on a planning committee to develop an emergency preparedness
plan. The nurse should recommend that which of the following actions takes place first
when implementing an emergency preparedness plan?
a. Notify the incident commander
19. A nurse is planning care for a client who is receiving hemodialysis via an established AV
fistula in the right arm. Which of the following interventions should the nurse include in
the client’s plan of care?
a. Auscultate the affected extremity for a bruit
20. A nurse receives a request from a client to review the information in his medical record.
Which of the following responses should the nurse give?
a. There is a protocol for reviewing your medical record, and I can initiate the
process
21. A nurse is assessing a client who has OSA. For which of the following complications
should the nurse monitor?
a. Hypertension
22. Math heparin 0.5
23. A nurse in an ED is assessing a client who reports taking MDMA. Which of the following
should the nurse expect?
a. Diaphoresis
24. A nurse is caring for a client who has a terminal illness and requests no lifesaving
measure if a cardiac arrests occurs. Which of the following statements should the nurse
make?
a. I will provide you with information about medical treatment to include in your
living will
25. A nurse is administering cyclophosphamide orally to a school-aged child who has
neuroblastoma. Which of the following actions should nurse take when administering
this medication?
a. Maintain hydration with liberal fluid intake
1. A nurse is performing tracheostomy care for a client who is postop following a
laryngectomy. Which of the following actions take when suctioning the client’s airway?
a. Apply suction for 10 seconds
2. A nurse is preparing to administer a long acting insulin to a client who has DM. Which of
the following actions should the nurse take first?
a. Check the correct dose with another licensed nurse
3. A nurse is caring for an older adult client in the PACU following gen anesthesia. Which of
the following should the nurse report to the provider?
a. Audible stridor
4. A nurse is planning an educational session for staff nurses about working with parents
whose terminally ill children are candidates for donating their organs. Which of the
following information should the nurse plan to include?
a. The family can have the child in an open casket without fearing that the organ
donation might disfigure the child’s body.
5. Math 0.6mL
6. A nurse manager is planning to make changes to the current scheduling system on the
unit. To facilitate the staff’s acceptance of this change, which of the following actions
should the nurse manager take first?
a. Provide information about scheduling issues to the staff
7. A nurse is assessing a client who is receiving a blood transfusion. Which of the following
findings should indicate to the nurse that the client is having a hemolytic transfusion
reaction?
a. Low back pain
8. A nurse is assessing a client who has macular degeneration. Which of the following
findings should the nurse expect?
a. Decreased central vision
9. A nurse who is working in a long-term care facility is assessing an adult client. Which of
the following findings places the client at risk for development of a pressure injury?
a. Recent weight loss
10. A nurse is teaching about TPN and IV lipid emulsion with a client who has an extensive
burn injury. Which of the following information should the nurse include?
a. “you will receive finger sticks for blood glucose testing.”
11. A nurse is caring for a client who has dehydration secondary to nausea and vomiting.
The nurse should identify which of the following findings as an indication of fluid volume
deficit?
a. Orthostatic hypotension
12. A nurse is caring for a client who is in labor at 39 weeks of gestation. During the second
stage of labor, the nurse observes early decelerations on the monitor tracing. Which of
the following actions should the nurse take?
a. Continue observing the fetal heart rate
, 13. A nurse is caring for a client who requires physical therapy following discharge. Which of
the following actions should the nurse take?
a. Involve the client in the selection of a physical therapy provider
14. A nurse is assessing a client who has sickle cell anemia. The nurse should identify which
of the following findings as a manifestation of vaso-occlusive crisis?
a. Hematuria
15. A nurse is teaching a group of guardians about child safety measures. Which of the
following statements by a guardian indicates an understanding of the teaching?
a. I should have my child avoid sun exposure between 10am and 2pm
16. A nurse is caring for four clients at the beginning of a shift. After receiving change of
shift report, which of the following clients should the nurse attend to first?
a. A client who is confused and has been attempting to get out of bed.
17. A nurse is assessing a client who has been taking lithium carbonate for the past month
to treat bipolar disorder. Which of the following assessment findings should the nurse
identify as the priority?
a. Confusion
18. A nurse manager is on a planning committee to develop an emergency preparedness
plan. The nurse should recommend that which of the following actions takes place first
when implementing an emergency preparedness plan?
a. Notify the incident commander
19. A nurse is planning care for a client who is receiving hemodialysis via an established AV
fistula in the right arm. Which of the following interventions should the nurse include in
the client’s plan of care?
a. Auscultate the affected extremity for a bruit
20. A nurse receives a request from a client to review the information in his medical record.
Which of the following responses should the nurse give?
a. There is a protocol for reviewing your medical record, and I can initiate the
process
21. A nurse is assessing a client who has OSA. For which of the following complications
should the nurse monitor?
a. Hypertension
22. Math heparin 0.5
23. A nurse in an ED is assessing a client who reports taking MDMA. Which of the following
should the nurse expect?
a. Diaphoresis
24. A nurse is caring for a client who has a terminal illness and requests no lifesaving
measure if a cardiac arrests occurs. Which of the following statements should the nurse
make?
a. I will provide you with information about medical treatment to include in your
living will
25. A nurse is administering cyclophosphamide orally to a school-aged child who has
neuroblastoma. Which of the following actions should nurse take when administering
this medication?
a. Maintain hydration with liberal fluid intake
