RN VATI Fundamentals 2019 Assessment Final Exam Questions and
Answers 100% Correct | Updated
Question 1
A nurse is preparing to mix short-acting and intermediate-acting insulin in one syringe to
administer to a client who has type 1 diabetes mellitus. Identify the correct sequence of steps the
nurse should follow.
A) 1, 2, 3, 4, 5
B) 2, 3, 5, 4, 1
C) 3, 2, 4, 5, 1
D) 2, 3, 4, 1, 5
E) 3, 2, 4, 5
Correct Answer: E) 3, 2, 4, 5
Rationale: The correct sequence prevents contaminating the short-acting insulin with the
intermediate-acting insulin. The nurse first injects air into the intermediate vial (cloudy),
then injects air into the short-acting vial (clear), then withdraws the short-acting insulin
("clear before cloudy"), and finally withdraws the intermediate-acting insulin.
Question 2
A nurse is assessing a client who wears partial dentures and reports mouth pain. Which of the
following actions should the nurse take?
A) Advise the client to keep the dentures in at all times to get used to them.
B) Advise the client to rinse their mouth and dentures after each meal.
C) Recommend that the client soak their dentures in bleach overnight.
D) Instruct the client to use a hard-bristled brush to clean the dentures.
E) Tell the client to see their dentist in one month if the pain persists.
Correct Answer: B) Advise the client to rinse their mouth and dentures after each meal.
Rationale: Rinsing the mouth and dentures after meals helps to remove food particles that
can cause irritation, inflammation, and pain. It also promotes good oral hygiene, which is
essential for comfort and preventing infection. Dentures should be removed for several
hours daily, never cleaned with bleach, and brushed with a soft brush.
Question 3
A nurse is planning care for a client who has dysphagia and is at risk for aspiration. Which of the
following referrals should the nurse make?
A) Physical therapist
B) Occupational therapist
C) Social worker
D) Speech-language pathologist
E) Respiratory therapist
Correct Answer: D) Speech-language pathologist
Rationale: A speech-language pathologist is the professional who assesses swallowing
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function, recommends appropriate diet consistency (e.g., thickened liquids), and teaches
compensatory strategies to reduce the risk of aspiration. This referral is essential for the
safety of a client with dysphagia.
Question 4
A nurse is planning care for a client following a thoracentesis. Which of the following
interventions should the nurse include?
A) Position the client on the unaffected side.
B) Maintain the head of the bed at 45°.
C) Measure the client's abdominal girth at the level of the umbilicus.
D) Leave the puncture site open to air.
E) Encourage the client to cough vigorously every hour.
Correct Answer: A) Position the client on the unaffected side.
Rationale: After a thoracentesis, the client is often positioned on the unaffected side for a
period. This position helps to keep the puncture site compressed and can facilitate the
expansion of the affected lung. An upright position (e.g., HOB at 30°) is also used to ease
breathing, but positioning on the unaffected side is a key post-procedure intervention.
Question 5
A nurse is planning teaching for a client who has a new diagnosis of type 2 diabetes mellitus.
Which of the following actions should the nurse take prior to beginning the teaching? (Select all
that apply.)
A) Establish the client's learning needs.
B) Determine the client's literacy level.
C) Evaluate the client's readiness for learning.
D) Identify the client's learning style.
E) Provide the client with a detailed pamphlet.
Correct Answer: A, B, C, D
Rationale: Before initiating any client education, the nurse must first perform an
assessment of the learner. This includes identifying what the client needs to know (A), their
ability to understand the information (B), their willingness and motivation to learn at that
moment (C), and how they learn best (D). This assessment allows the nurse to tailor the
teaching plan to the individual client, making it more effective.
Question 6
A nurse is preparing to notify the provider about a change in a client's status using the SBAR
communication tool. Which information should the nurse plan to include in the "background"
portion?
A) "The client is reporting chest pain."
B) "I am requesting that you come and assess the client."
C) "The client has a history of coronary artery disease."
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D) "The client's vital signs are..."
E) "The client was admitted yesterday."
Correct Answer: C) "The client has a history of coronary artery disease."
Rationale: The "Background" component of SBAR provides the relevant context for the
current situation. This includes the client's admitting diagnosis, pertinent medical history
(such as a history of heart disease), and a brief summary of their treatment to date. The
current problem (A) is the Situation. The request (B) is the Recommendation. Vital signs
(D) are part of the Assessment.
Question 7
A nurse is providing discharge teaching to a client who has a new prescription for home oxygen
therapy utilizing a compressed oxygen system. Which statement by the client indicates an
understanding of the teaching?
A) "I can use petroleum jelly to soothe my dry nose."
B) "I will store oxygen tanks in an upright position."
C) "My family members can smoke as long as they are 6 feet away from the tank."
D) "I will wear clothing made of wool or synthetic materials to stay warm."
E) "I will increase the oxygen flow rate if I feel short of breath."
Correct Answer: B) "I will store oxygen tanks in an upright position."
Rationale: Compressed oxygen tanks are under high pressure and must be stored securely
in an upright position in an approved holder or cart to prevent them from falling and being
damaged, which could cause a dangerous release of pressure. Petroleum jelly is flammable
(A), smoking is not allowed near oxygen (C), and synthetic/wool clothing can create static
electricity (D). The flow rate should not be changed without a provider's order (E).
Question 8
A nurse is caring for a client who has terminal cancer. The client begins to cry and says, "I am so
afraid of dying." Which of the following responses should the nurse make?
A) "Don't worry, we will give you medication to keep you comfortable."
B) "Let's talk about something more positive to get your mind off of it."
C) "It must be a very difficult time for you."
D) "You should talk to your family about how you are feeling."
E) "Would you like me to call the hospital chaplain?"
Correct Answer: C) "It must be a very difficult time for you."
Rationale: This response is an example of the therapeutic communication technique of
showing empathy. It validates the client's feelings and acknowledges the difficulty of their
situation without offering false reassurance or dismissing their concerns. It creates an open,
non-judgmental space for the client to express their fears.
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Question 9
A nurse is assessing a client's coping skills. Which of the following should the nurse identify as
an internal stressor?
A) A recent job loss.
B) A death in the family.
C) Fear of medical test results.
D) A change in financial status.
E) A noisy hospital environment.
Correct Answer: C) Fear of medical test results.
Rationale: Stressors can be classified as internal or external. External stressors are events
and situations that happen outside the person, such as a job loss or a death in the family.
Internal stressors are self-generated and originate from within the person, such as their
thoughts, beliefs, expectations, and fears. The fear of test results is an internal
psychological stressor.
Question 10
A nurse is performing postmortem care for an older adult client who has just died. Which of the
following actions should the nurse take?
A) Leave the client's dentures out of their mouth.
B) Place the client in a supine position with the head of the bed flat.
C) Gently close the client's eyelids.
D) Remove all tubes and lines immediately after death is pronounced.
E) The family should be asked to perform all postmortem care.
Correct Answer: C) Gently close the client's eyelids.
Rationale: As part of preparing the body for viewing by the family, the nurse should create
a respectful and natural appearance. This includes gently closing the eyelids and placing
dentures in the mouth to maintain the shape of the face. The head of the bed should be
slightly elevated to prevent pooling of blood in the face. Correction: Let's look at the provided
answer "Identify the client using two identifiers." This seems unusual for postmortem care itself
but may be a first step. Let's re-evaluate. Before any procedure, including postmortem care,
verifying the correct client is a safety standard.
Correct Answer (Revised): Identify the client using two identifiers.
Rationale: The principles of patient safety and proper identification apply to all procedures,
including those performed after death. Before beginning postmortem care, the nurse must
confirm the identity of the deceased client using two identifiers (e.g., name and medical
record number) to ensure that care is being performed on the correct individual.
Question 11
A nurse has administered 5 mL of medication to a client via NG tube, then used 30 mL of water
to flush the tube both before and after the instillation. The nurse should document which of the
Answers 100% Correct | Updated
Question 1
A nurse is preparing to mix short-acting and intermediate-acting insulin in one syringe to
administer to a client who has type 1 diabetes mellitus. Identify the correct sequence of steps the
nurse should follow.
A) 1, 2, 3, 4, 5
B) 2, 3, 5, 4, 1
C) 3, 2, 4, 5, 1
D) 2, 3, 4, 1, 5
E) 3, 2, 4, 5
Correct Answer: E) 3, 2, 4, 5
Rationale: The correct sequence prevents contaminating the short-acting insulin with the
intermediate-acting insulin. The nurse first injects air into the intermediate vial (cloudy),
then injects air into the short-acting vial (clear), then withdraws the short-acting insulin
("clear before cloudy"), and finally withdraws the intermediate-acting insulin.
Question 2
A nurse is assessing a client who wears partial dentures and reports mouth pain. Which of the
following actions should the nurse take?
A) Advise the client to keep the dentures in at all times to get used to them.
B) Advise the client to rinse their mouth and dentures after each meal.
C) Recommend that the client soak their dentures in bleach overnight.
D) Instruct the client to use a hard-bristled brush to clean the dentures.
E) Tell the client to see their dentist in one month if the pain persists.
Correct Answer: B) Advise the client to rinse their mouth and dentures after each meal.
Rationale: Rinsing the mouth and dentures after meals helps to remove food particles that
can cause irritation, inflammation, and pain. It also promotes good oral hygiene, which is
essential for comfort and preventing infection. Dentures should be removed for several
hours daily, never cleaned with bleach, and brushed with a soft brush.
Question 3
A nurse is planning care for a client who has dysphagia and is at risk for aspiration. Which of the
following referrals should the nurse make?
A) Physical therapist
B) Occupational therapist
C) Social worker
D) Speech-language pathologist
E) Respiratory therapist
Correct Answer: D) Speech-language pathologist
Rationale: A speech-language pathologist is the professional who assesses swallowing
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function, recommends appropriate diet consistency (e.g., thickened liquids), and teaches
compensatory strategies to reduce the risk of aspiration. This referral is essential for the
safety of a client with dysphagia.
Question 4
A nurse is planning care for a client following a thoracentesis. Which of the following
interventions should the nurse include?
A) Position the client on the unaffected side.
B) Maintain the head of the bed at 45°.
C) Measure the client's abdominal girth at the level of the umbilicus.
D) Leave the puncture site open to air.
E) Encourage the client to cough vigorously every hour.
Correct Answer: A) Position the client on the unaffected side.
Rationale: After a thoracentesis, the client is often positioned on the unaffected side for a
period. This position helps to keep the puncture site compressed and can facilitate the
expansion of the affected lung. An upright position (e.g., HOB at 30°) is also used to ease
breathing, but positioning on the unaffected side is a key post-procedure intervention.
Question 5
A nurse is planning teaching for a client who has a new diagnosis of type 2 diabetes mellitus.
Which of the following actions should the nurse take prior to beginning the teaching? (Select all
that apply.)
A) Establish the client's learning needs.
B) Determine the client's literacy level.
C) Evaluate the client's readiness for learning.
D) Identify the client's learning style.
E) Provide the client with a detailed pamphlet.
Correct Answer: A, B, C, D
Rationale: Before initiating any client education, the nurse must first perform an
assessment of the learner. This includes identifying what the client needs to know (A), their
ability to understand the information (B), their willingness and motivation to learn at that
moment (C), and how they learn best (D). This assessment allows the nurse to tailor the
teaching plan to the individual client, making it more effective.
Question 6
A nurse is preparing to notify the provider about a change in a client's status using the SBAR
communication tool. Which information should the nurse plan to include in the "background"
portion?
A) "The client is reporting chest pain."
B) "I am requesting that you come and assess the client."
C) "The client has a history of coronary artery disease."
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D) "The client's vital signs are..."
E) "The client was admitted yesterday."
Correct Answer: C) "The client has a history of coronary artery disease."
Rationale: The "Background" component of SBAR provides the relevant context for the
current situation. This includes the client's admitting diagnosis, pertinent medical history
(such as a history of heart disease), and a brief summary of their treatment to date. The
current problem (A) is the Situation. The request (B) is the Recommendation. Vital signs
(D) are part of the Assessment.
Question 7
A nurse is providing discharge teaching to a client who has a new prescription for home oxygen
therapy utilizing a compressed oxygen system. Which statement by the client indicates an
understanding of the teaching?
A) "I can use petroleum jelly to soothe my dry nose."
B) "I will store oxygen tanks in an upright position."
C) "My family members can smoke as long as they are 6 feet away from the tank."
D) "I will wear clothing made of wool or synthetic materials to stay warm."
E) "I will increase the oxygen flow rate if I feel short of breath."
Correct Answer: B) "I will store oxygen tanks in an upright position."
Rationale: Compressed oxygen tanks are under high pressure and must be stored securely
in an upright position in an approved holder or cart to prevent them from falling and being
damaged, which could cause a dangerous release of pressure. Petroleum jelly is flammable
(A), smoking is not allowed near oxygen (C), and synthetic/wool clothing can create static
electricity (D). The flow rate should not be changed without a provider's order (E).
Question 8
A nurse is caring for a client who has terminal cancer. The client begins to cry and says, "I am so
afraid of dying." Which of the following responses should the nurse make?
A) "Don't worry, we will give you medication to keep you comfortable."
B) "Let's talk about something more positive to get your mind off of it."
C) "It must be a very difficult time for you."
D) "You should talk to your family about how you are feeling."
E) "Would you like me to call the hospital chaplain?"
Correct Answer: C) "It must be a very difficult time for you."
Rationale: This response is an example of the therapeutic communication technique of
showing empathy. It validates the client's feelings and acknowledges the difficulty of their
situation without offering false reassurance or dismissing their concerns. It creates an open,
non-judgmental space for the client to express their fears.
, [Type here]
Question 9
A nurse is assessing a client's coping skills. Which of the following should the nurse identify as
an internal stressor?
A) A recent job loss.
B) A death in the family.
C) Fear of medical test results.
D) A change in financial status.
E) A noisy hospital environment.
Correct Answer: C) Fear of medical test results.
Rationale: Stressors can be classified as internal or external. External stressors are events
and situations that happen outside the person, such as a job loss or a death in the family.
Internal stressors are self-generated and originate from within the person, such as their
thoughts, beliefs, expectations, and fears. The fear of test results is an internal
psychological stressor.
Question 10
A nurse is performing postmortem care for an older adult client who has just died. Which of the
following actions should the nurse take?
A) Leave the client's dentures out of their mouth.
B) Place the client in a supine position with the head of the bed flat.
C) Gently close the client's eyelids.
D) Remove all tubes and lines immediately after death is pronounced.
E) The family should be asked to perform all postmortem care.
Correct Answer: C) Gently close the client's eyelids.
Rationale: As part of preparing the body for viewing by the family, the nurse should create
a respectful and natural appearance. This includes gently closing the eyelids and placing
dentures in the mouth to maintain the shape of the face. The head of the bed should be
slightly elevated to prevent pooling of blood in the face. Correction: Let's look at the provided
answer "Identify the client using two identifiers." This seems unusual for postmortem care itself
but may be a first step. Let's re-evaluate. Before any procedure, including postmortem care,
verifying the correct client is a safety standard.
Correct Answer (Revised): Identify the client using two identifiers.
Rationale: The principles of patient safety and proper identification apply to all procedures,
including those performed after death. Before beginning postmortem care, the nurse must
confirm the identity of the deceased client using two identifiers (e.g., name and medical
record number) to ensure that care is being performed on the correct individual.
Question 11
A nurse has administered 5 mL of medication to a client via NG tube, then used 30 mL of water
to flush the tube both before and after the instillation. The nurse should document which of the
