ATI Fundamentals Proctored Exam Study Guide

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A nurse receives report about a client who has 0.9% sodium chloride infusing IV at 125

mL/hr. When the nurse performs the initial assessment, he notes that the client has

received only 80 mL over the last 2 hrs. Which of the following actions should the nurse

take first?

✓ Check the IV tubing for obstruction

A nurse is planning care for a client who has fluid overload. Which of the following

actions should the nurse plan to take first?

✓ Evaluate electrolytes

A nurse is planning to initiate IV therapy for an older adult client who requires IV fluids.

Which of the following actions should the nurse take?

✓ Insert the IV catheter without using a tourniquet

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A nurse is caring for a client who has a heart murmur. The nurse is preparing to

auscultate the pulmonary valve. Over which of the following locations should the nurse

place the bell of the stethoscope?

✓ Second intercostal space at the left sternal boarder

A nurse is caring for a client who has a terminal illness and is approaching death. The

client's respirations are noisy from secretions in her airway and she is short of breath.

Which of the following actions should the nurse take?

✓ Elevate the head of the client's bed 

A nurse is caring for a client who has a terminal diagnosis and whose health is declining.

The client requests information about advance directives. Which of the following

responses should the nurse make?

✓ "We can talk about advance directives, and I can also give you some

brochures about them."

A nurse is assessing a client who reports increased pain following physical therapy.

Which of the following questions should the nurse ask when assessing the quality of the

client's pain?

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✓ "Is your pain sharp or dull?"

A nurse is giving a change-of-shift report about a client he admitted earlier that day who

has pneumonia. Which of the following pieces of information is the priority for the nurse

to provide?

✓ Breath sounds

A nurse is reviewing the medical records of a client who has a pressure ulcer. Which of

the following findings should the nurse expect?

✓ Albumin level of 3g/dL

A nurse is completing an admission assessment of an older adult client. Which of the

following findings should the nurse identify as a potential indication of abuse?

✓ Bruises on the arms in various stages of healing 

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A nurse is caring for a client who is postoperative and has signs of hemorrhagic shock.

When the nurse notifies the surgeon, he directs her to continue to measure the client's

vitals every 15 minute and call him back in 1 hour. From a legal perspective, which of the

following actions should the nurse take next?

✓ Notify the nursing manager

A nurse is caring for a client who is receiving parenteral fluid therapy via a peripheral IV

catheter. After which of the following observations should the nurse remove the IV

catheter?

✓ Swelling and coolness are observed at the IV site

A client who is non-ambulatory notifies the nurse that his trash can is on fire. After the

nurse confirms the fire, which of the following actions should the nurse take next?

✓ Evacuate the client

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A nurse in a provider's office is obtaining the health and medication history of a client

who has a respiratory infection. The client tells the nurse that she is not aware of any

allergies, but that she did develop a rash the last time she was taking an antibiotic. Which

of the following information should the nurse give to the client?

✓ "We need to document the exact medication you were taking because you

might be allergic to it."

A home health nurse who has attended a training session for the therapeutic use of

aromatherapy with essential oils is planning to use this modality with some of her clients.

For which of the following clients should the nurse consult the provider before using this

complementary therapy?

✓ A client who has asthma

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