ATI 2

A competent adult client refuses a blood transfusion for religious reasons. Which actions should the nure take?

Which client should the nurse assess first?

Condition: Sepsis
Action:

Which findings indicates digoxin toxicity?

Which task can the RN delegate to an AP?

A client reports chest pain radiating to the left arm. What is the first action?

K+ level increases. What’s the nurse’s priority?

What intervention prevents infection? What treats infection?

Which finding indicates impending respiratory faailure?

Which are expected findings of a left-sided stroke?

Which lab requires immediate follow-up?

Condition: hypoglycemia
Actions:

Which finding indicates postpartum hemorrhage?

Which statement indicates therapeutic communication?

Which situations require airbourne precautions?

Which medication requires apical pulse assessment?

Which finding suggests upper GI bleeding?

Correct order?

Which finding indicates DKA?

Which indicates effective charge nurse behavior?

Which toy is appropiate for a toddler?

Which findings increase fall risk in an older adult?i

A client receiving IV potassium reports burning at the IV site. What is the nurse’s priority?

PE Risk/Action/OutcomeP

Which medication increases bleeding risk?P

A client states “I don’t want to live anymore” What is the nurse’s first action?PP

Contact precaution/ Droplet precaution/Airborne precaution

Which finding indicates acute kidney injury?P

Which findings indicate DVT?

Which task should the RN NOT delegate to a LPN?

Which symptom suggests bowel obstruction?

Hgb decreasing hourly; Which is the priority?

Which ABG indicates respiratory acidosis?

PPE removal order

Which finding indicates preeclampsia?

Which finding suggests increased intracranial pressure?

Anaphylaxis actions & outcome

Which lab confirms DM?

Which requires soap & water hand hygiene?

Which findings indicate hypovolemic shock?

Which client should be assigned to a new graduate RN?

Which medication requires monitoring for ototoxicity?

Oxygen Devices

Which finding indicates cirrhosis?

Which are subjective pain findings?

Which immunization is contraindicated in pregnancy?

Which position improves oxygenation?

Heart Failure Actions & Outcomes

Which situation requires MANDATORY REPORTING?

Which findings indicate hypocalcemia?

A postop client reports calf pain & warmth. What’s the nurse’s priority action?

Which finding indicates warsening heart failure?

Which medication should be held if the apical pulse is 52/min?

Hypovolemia Causes/Actions/Outcomes

Which client requires droplet precautions?

Which actions prevent medication errors?

A patient with a head injury becomes restless and confused. What is the priority action?

Delegation

Which findings indicate adequate oxygenation?

Which symptom is expected in hyperthyroidism?

BP lowers hourly. What is the priority?

Which finding requires immediate follow-up for an infant?

Which findings indicate hyperkalemia?

Which ABG reflects metabolic acidosis?

PPE Selection

Which assessment is appropiate for a LPN?

Which finding indicates fluid volume overload?

Which interventions prevent pressure injuries?

Which medication requires monitoring for nephrotoxicity?

Acute Ischemic Stroke Actions/Outcomes

Which diet is appripiate for acute pancreatitis?

Which actions support culturally competent care?

Which rhythm requires immediate intervention?

Urine output decreases hourly. Priority action?

Which client can legally give informed consent?

Which findings indicate COPD exacerbation?

Which finding indicates placental abruption?

Insulin Types

Which lab confirms infection?

Which actions are required during blood transfusion?

Which position helps reduce aspiration risk?

Sepsis Actions & outcomes

Which finding indicates mania?

Which is the best pain scale for a 4-years-old?

Which interventions are priority for a client with burns?

Which behavior demonstrates effective delegation?

A patient post-stroke is slurring speech and has right-sided weakness. What is priority?

A patient with shortness of breath has crackles in both lungs. What is the nurse’s first action?