ATI SEMINAR PRETEST
1. A nurse is collecting data from a client who is having repeated episodes of
emesis. Which of the following findings is the priority for the nurse to
report to the provider!
a. Urine output 40 mL/hr
b. Rapid capillary refill
c. Pulse rate 68/min
d. Decreased level of consciousness
2. A nurse is contributing to the plan of care for an older adult client who has
impaired vision and lower extremity weakness due to diabetes
mellitus. Which or the following Interventions is the nurse's priority?
a. Reinforce teaching about diabetes mellitus management.
b. Recommend a referral for physical therapy.
c. Ensure the client's call light is within reach
d. Identify the location or food on a plate using clock numbers as a
reference
3. A nurse is assigned to provide care for a group of clients. Which of the
following actions should the nurse plan to complete first?
a. Reinforce teaching about a low-sodium diet with a client who has
hypotension
b. Administer an antidiarrheal medication for a client who has had multiple
watery stools.
c. Record the meal intake for a client who has dementia.
d. Observe a client who has rheumatoid arthritis perform active range-ormotion exercises.
4. A nurse is collecting data from clients following a mass casualty event.
Which of the following clients should the nurse recommend for priority
treatment?
a. A client who is in cardiac arrest
b. A client who has an open femur fracture
c. A Client who has a large penetrating Toot wound
d. A client who has multiple abrasions
5. A nurse is caring for a client who is receiving enteral nutrition. The nurse
should plan to monitor the client for which of the following early
indications or aspiration? Select all that apply.)
a. Restlessness
b. Behavioral changes
c. Peripheral cyanosis
d. Tachypnea
e. Pulmonary abscess formation
6. A nurse is caring for a client immediately following lumbar puncture. Which
of the following actions should the nurse plan to take first?
a. Remind the client analgesia may be prescribed for headache.
b. Place the bed flat with a pillow under the client's head.
c. Offer the client a choice of beverages to drink.
d. Review the purpose or spinal fluid testing with the client
7. A nurse is caring for a female client who is prescribed an indwelling urinary
catheter. Which of the following actions should the nurse take first?
a. Perform a routine cleansing of the perineal area
b. Place the client in a dorsal recumbent position
c. Set up a sterile field with catheterization supplies.
d. Determine if the client has any physical limitations
8. A nurse is contributing to the plan of care for a client who has left-sided
weakness due to a stroke. Which of the following interventions should the nurse
identify as the priority?
a. Determining whether the client is able to feed himself
b. Supporting role changes among the client's family members
c. Encouraging the client's efforts to begin a new hobby
d. Providing the client with information about a stroke support group
9. A nurse in a provider's office has completed preliminary screening of four clients.
Which of the following clients should the nurse recommend first treatment?
a. A client who has a 5 cm (2 in) long laceration on the arm
b. A client who has audible inspiratory stridor
c. A client who reports dysuria
d. A client who reports a headache of 5 on a 0 to 10 scale
10. A nurse at a long-term care facility discovers a wastebasket fire in the room of
two residents. Identify the sequence of actions the nurse should follow.
a. Assist the residents out of the room to the end of the hallway
b. Activate the fire alarm
c. Close the door to the client's room
d. Activate an appropriate fire extinguisher
e. Put out the base of the fire using a side-to-side motion
11. A nurse is preparing to collect physical assessment data from clients following a natural
disaster in the community. The nurse should first collect data from clients in which of the
following triage categories?
a. Emergent
b. Minor
c. Expectant
d. Urgent
12. A nurse is preparing to collect physical assessment data from an older adult client who
has acute confusion. Which of the following assessments should the nurse perform first?
a. Auscultate lung sounds
b. Check skin turgor
c. Measure body temperature
d. Obtain blood pressure
13. A nurse enters a client's room and finds the client lying on the floor at the
bedside. The client states, "I fell because no one would help me to the bathroom,
but I think I can get up okay." Which of the following actions by the nurse is
appropriate?
a. Report the client's fall to the facility administer
b. Place an incident report in the client's medical record
c. Obtain a wheelchair and assist the client back to bed
d. Push the client's call button and request assistance
14. A nurse is preparing to administer medications to a client who begins having a
seizure. Which of the following actions should the nurse take first?
a. Turn the client on her side
b. Administer an anticonvulsant medication
c. Document the time the seizure began
d. Provide verbal reassurance for the client
15. A nurse is preparing to administer a cleansing enema to a client. Which of the
following actions should the nurse plan to take?
a. Assist the client into the right Sims' position
b. Lubricate 1.3 to 2.5 cm of the enema tubing
c. Hold the enema bag 45 cm above the client to initiate fluid flow
d. Insert the tubing into the client's rectum toward the umbilicus
e. Fill the enema bag with 750 mL of warmed solution
16. A nurse is caring for a client who reports a latex allergy and is scheduled for
surgery the following day. When implementing latex allergy precautions. Which of
the following tasks should the nurse assign to an assistive personnel (AP)?
a. Reviewing a pamphlet about latex exposure with the client's family
b. Documenting the presence of a latex allergy on the preoperative checklist
c. Replacing the client's IV site dressing with non-latex tape
d. Placing a latex-free cart outside the client's door
17. A nurse is collecting data from a client who is 4 days postoperative following
abdominal surgery. The client reports feeling his incision "pop", and the nurse
sees the client's organs protruding through the abdominal wall. Which of the
following actions should the nurse take? Select all that apply.
a. Monitor the client for manifestations of shock
b. Have an assistive personnel hold dry towels over the wound
c. Assist the client to lie down
d. Retrieve the sterile hydrogen peroxide from the supply room
e. Instruct the client to bend his knees
18. A nurse is preparing to collect data from an adult client after receiving change-ofshift report. Which of the following client issues should the nurse address first?
a. The client requests pain medication for joint pain due to arthritis
b. The client has obesity and refuses the prescribed diet
c. The client has orthostatic hypotension
d. The client has repeated episodes of stress incontinence
19. A nurse is providing instructions for a client who has urinary frequency and is
scheduled for a bladder ultrasound the following day. Which of the following
information should the nurse include?
a. "You will receive a cleansing enema early tomorrow morning."
b. "You may be asked to drink water before the test."
c. "You will be given intravenous contrast by the radiologist."
d. "You may experience a short-term dysuria following the procedure.”
20. A nurse is caring for a client who has orthopnea and is confused. The nurse is preparing
to apply restraints to prevent the client from removing the oxygen device. Which of the
following images indicates an action the nurse should plan to take?
21. A nurse is caring for a client who is receiving enteral nutrition. The nurse should plan to
monitor the client for which of the following early indications of aspriation?
a. Restlessness
b. Behavioral changes
c. Peripheral cyanosis
d. Tachypnea
e. Pulmonary abscess formation
22. A nurse is reviewing the plan of care for several clients at the beginning of the
shift. Which of the following tasks should the nurse plan to delegate to an
assistive personnel (AP)? Select all that apply.
a. Reviewing pre-printed instructions with a client regarding diet
b. Feeding a client who had a stroke 2 years ago
c. Performing a bed bath for a client who is paraplegic
d. Comparing a client's peripheral pulses
e. Determining whether a client has rebound tenderness
23. A nurse is caring for an older client who is agitated and attempting to pull out of
the peripheral IV catheter. Which of the following actions should the nurse take
first?
a. Put a thumbless mitten device on the hand opposite of the IV site
b. Place a stockinette dressing over the client's IV site
c. Apply bilateral restraints on the client's wrists
d. Request an antianxiety medication from the provider
24. A nurse is assisting with the admission of a client who is postoperative following
laparoscopic abdominal surgery. Which of the following assessments should the
nurse identify as the priority?
a. Observe the client's breathing pattern
b. Auscultate bowel sounds
c. Determine the client's ability to void
d. Check incision site for indications of infection
25. A nurse is caring for an older adult client who is receiving hospice care. Which of
the following actions should be the nurse's priority?
a. Encourage the family to give the client permission to die
b. Contact the client's spiritual care provider
c. Ensure the client's pain is controlled
d. Support the client's family during the grieving process
26. A nurse at a long-term care facility is talking with a group of clients at breakfast.
One client reports not having a bowel movement the previous day. Which of the
following actions should the nurse take first?
a. Administer a laxative medication
b. Request a prescription to check for impaction
c. Offer to help the client to the toilet after mealtimes
d. Provide the client with a glycerin suppository
27. A nurse is taking with an older adult client during a home visit. Which of the
following statements by the client should the nurse identify as the priority?
a. "I can't sleep as well at night as during the day."
b. "I can't afford to buy many fresh fruits and vegetables."
c. "I don't know if my smoke alarms work."
d. "I don't get along well with most of my family."
28. A nurse is contributing to the plan of care for an older adult client who has
impaired vision and lower extremity weakness due to diabetes mellitus. Which of
the following interventions is the nurse's priority?
a. Reinforce teaching about diabetes mellitus management
b. Recommend a referral for physical therapy
c. Ensure the client's call light is within reach
d. Identify the location of food on a plate using clock numbers as a reference
29. A nurse is reinforcing teaching with a client who reports having leg cramps due to
hypokalemia. The nurse should recommend 1 cup servings of which of the following
foods for this client?
a. Fresh avocado
b. Air-popped popcorn
c. Canned apricots
d. Raw green lettuce
e. Brazil nuts
30. A nurse collects nutritional data from a client and determines that the client is
underweight and needs to increase daily caloric intake. Which of the following
actions should the nurse take first?
a.
b.
c.
d.
Recommend a referral for a dietary consult.
Create a menu plan based on the client's preferences
Set a goal with the client for weight gain
Instruct the client to record daily caloric intake