ATI FUNDAMENTALS PROCTORED EXAM
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VERSION 1
The skin barrier covering a client's intestinal fistula keeps falling off when she stands up to
ambulate. The nurse has reapplied it twice during the shift, but it remains intact only when the
client is supine in bed. The nurse telephoned the physical therapist about the difficulties
containing the drainage from the fistula, so the therapist didn't ambulate the client today. The
client sat in a chair during lunch w/an absorbent pad over the fistula. The client ate all the food
on her tray. The wound care nurse confirmed that she will see the client later today. The client
states she feels frustrated at not having physical therapy, but the nurse thinks the client
welcomed having a day to rest. Which of the following information should the nurse include in
the change-of-shift report? Select all that apply.
A. The physical therapist didn't ambulate the client today
B. The skin barrier's seal stays on in bed but loosens when the client stands.
C. The client seemed to welcome having a "day off" from physical therapy
D. The wound care nurse will see the client later today
E. The client ate all the food on her lunch tray
A, B, D
A nurse is receiving a provider's prescription by telephone for morphine for a client who is
reporting moderate to severe pain. Which of the following nursing actions are appropriate?
Select all that apply.
A. Repeat the details of the prescription back to the provider
B. Have another nurse listen to the telephone prescription
C. Obtain the prescriber's signature on the prescription within 24hrs
D. Decline the verbal prescription because it is not an emergency situation
E. Tell the charge nurse that the provider has prescribed morphine by telephone
A, B, C
A nurse is caring for an older adult client who lives alone & is to be discharged in 3 days. He
states that it is difficult to prepare adequate nutritious meals at home for just 1 person. To
which of the following members of the health care team should the nurse refer him?
A. Registered dietitian
B. Occupational therapist
,C. Physical therapist
D. Social worker
D. social worker
Rational: A social worker can make arrangements for a meal delivery service to provide
nutritious meals daily, or recommend a congregate meal site near the client's home
lOMoAR cPSD| 6457222
A goal for a client who has difficulty w/self-feeding due to rheumatoid arthritis is to use
adaptive devices. The nurse caring for the client should initiate a referral w/which of the
following members of the inter-professional care team?
A. Social worker
B. Certified nursing assistant
C. Registered dietitian
D. Occupational therapist
E. Registered dietitian
D. Occupational therapist
Rational: An occupational therapist can assist clients who have physical challenges to use
adaptive devices & strategies to help w/self-care activities
Can an RN delegate to the LPN to provide tracheostomy care to a client with pneumonia? Yes.
A nurse on a med-surg unit has received change-of-shift report & will care for 4 clients. Which
of the following client's needs may the nurse assign to a assistive personnel (AP)?
A. Feeding a client who was admitted 24 hrs ago w/aspiration pneumonia
B. Reinforcing teaching w/a client who is learning to walk using a quad cane
C. Reapplying a condom catheter for a client who has urinary incontinence
D. Applying a sterile dressing to a pressure ulcer
C. Reapplying a condom catheter for a client who has urinary incontinence
Rationale: The application of a condom catheter is a noninvasive, routine procedure that the
nurse may delegate to the AP
, A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP.
Which of the following information should the nurse share with the AP? Select All.
A. The roommate is up independently.
B. The client ambulates w/his slippers on over his antiembolic stockings
C. The client uses a front-wheeled walker when ambulating
D. The client had pain medication 30 min ago
E. The client is allergic to codeine
F. The client ate 50% of his breakfast this morning
B, C, D
lOMoAR cPSD| 6457222
An RN is making assignments for client care to a LPN at the beginning of the shift. Which of the
following assignments should the LPN question?
A. Assisting a client who is 24hr postop to use an incentive spirometer
B. Collecting a clean-catch urine specimen from a client who was admitted on the previous shift
C. Providing nasopharyngeal suctioning for a client who has pneumonia
D. Replacing the cartridge and tubing on a PCA pump
D. Replacing the cartridge and tubing on a PCA pump
Rationale: The RN is responsible for the PCA pump
A nurse is preparing an in-service program about delegation. Which of the following elements
should she identify when presenting the 5 rights of delegation? Select all.
A. Right client
B. Right supervision/evaluation
C. Right direction/communication
D. Right time
E. Right circumstances
B, C, E
Rational: A and D are rights of medication administration
A nurse manager of a med-surg unit is assigning care responsibilities for the oncoming shift. A
client is awaiting transfer back to the unit from the PACU following thoracic surgery. To which
staff member should the nurse assign to this client?
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