ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. What steps are NOT included in preparing a sterile field?
- A. Do not turn away from the sterile field
- B. Obtain PAPR mask
- C. Prepare the client before setting up the sterile field
- D. Cover the sterile field once it is set up
Correct answer: B
Rationale:
2. The nurse is caring for 4 clients. Which of these clients will the nurse see first?
- A. A client with sudden and increasing pain in his fractured arm
- B. A client being discharged in 2 hours and needs to be taught how to use his crutches
- C. A client with RA and a scheduled pain medication
- D. A client with a fractured ankle who would like a glass of water
Correct answer: A
Rationale:
3. What observation by the nurse indicates the need for further teaching to unlicensed assistive personnel (UAP) on assisting with ambulation?
- A. The UAP puts shoes on the client
- B. The UAP removes floor rugs and loose objects from the path
- C. The UAP walks to the side and slightly in front of the client
- D. The UAP uses a transfer (gait) belt
Correct answer: C
Rationale: Choice C is the correct answer because the UAP should walk slightly behind or to the side of the client, not in front, to provide proper support during ambulation. Choices A, B, and D are not indicative of incorrect technique or the need for further teaching. Putting shoes on the client, removing floor rugs and loose objects, and using a transfer (gait) belt are all appropriate actions when assisting with ambulation.
4. What device would be best to use for a client who is immobile?
- A. Standing assist device
- B. A mechanical lift
- C. Transfer board
- D. Gait belt
Correct answer: B
Rationale: A mechanical lift is the most suitable device for a client who is immobile as it provides safe and efficient assistance in moving the individual. A standing assist device is used for support during standing activities, not for transferring an immobile client. A transfer board is helpful for assisting a client in sliding from one surface to another but may not be the best option for someone who is completely immobile. A gait belt is used for providing support and stability during walking or transferring, which may not be effective for a client who is immobile and requires more comprehensive assistance.
5. The nurses assess the client's pain prior to completing a dressing change. The client says his current pain is 5/10, but he has pain of 10/10 when his dressing is changed. What is the priority intervention for this client?
- A. Offer the client protein with meals to promote healing
- B. Remove the old dressing with clean gloves
- C. Teach the client about nonpharmacological pain control methods
- D. Check medication administration record (MAR)for as needed orders (PRN)
Correct answer: C
Rationale:
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