ATI RN Concept-Based Assessment Level 1 Practice A (Latest 2023/ 2024) Questions and Verified Answers with Rationales| 100% Correct| Grade A

ATI RN Concept-Based Assessment Level 1

Practice A (Latest 2023/ 2024) Questions and

Verified Answers| 100% Correct| Grade A

Q: A nurse is searching electronic databases for clinical research about behavioral indicators of

pain in an infant. Which of the following online sources should the nurse select to research this

infant care issue?

1. Cumulative Index to Nursing and Allied Health Literature (CINAHL)

2. The Nursing Minimum Data Set

3. The Omaha System

4. The Nursing Interventions Classification (NIC)

Answer:

Cumulative Index to Nursing and Allied Health Literature (CINAHL)

Rationale: The nurse should select the Cumulative Index to Nursing and Allied Health

Literature (CINAHL) to locate clinical research about health-related client care issues. CINAHL

is a cumulative index that the nurse can search electronically to locate reliable data related to the

specific topic being researched.

Q: A nurse is caring for a client who has dysphagia following a stroke. Which of the following

actions should the nurse take to facilitate safe swallowing and decrease the risk of aspiration?

1. Delay the client's meal-time if he is fatigued.

2. Instruct the client to tilt his head to the side when swallowing.

3. Assist the client with fluid intake by inserting it into the client's mouth with a syringe.

4. Encourage the client to focus on a television program during meal time.

Answer:

Delay the client's meal-time if he is fatigued.

Rationale: To facilitate safe swallowing and decrease the risk of aspiration, the nurse should

encourage the client to rest prior to meal-time. If the client is fatigued, the nurse should delay the

meal-time and give the client time to rest.

Q: A nurse in a long term care facility is performing a fall risk assessment on a newly admitted

client using the Timed Up and Go (TUG) test. The client reports using a tripod cane for

ambulation. Which of the following actions should the nurse take when using this test?

1. Observe the client ambulating a distance of 3 m (10 feet) during the TUG test.

2. Instruct the client to perform the TUG test without the use of the cane.

3. Assist the client to stand up from the chair when starting the TUG test.

4. Advise the client to use the arms of the chair to stand when starting the TUG test.

Answer:

Observe the client ambulating a distance of 3 m (10 feet) during the TUG test.

Rationale:The nurse should mark a spot 3 m (10 feet) away from the client's sitting location.

The nurse should instruct the client to stand, ambulate to the marked spot, turn, ambulate back to

the chair, and sit down. The nurse should observe the client's ability to perform the test and use a

stopwatch to time the client. The nurse should identify that the client is at increased risk of falls

if it takes longer than 14 seconds to complete the test.

Q: A nurse in an emergency is caring for an infant who requires emergency surgery. The infant

is accompanied by his 16-year-old mother and his maternal grandfather. Which of the following

actions should the nurse take when assisting with informed consent?

1. Witness consent obtained from the infant's mother.

2. Inform the family that informed consent is not needed due to emergency surgery.

3. Notify the maternal grandfather that he is required to give informed consent.

4. Request that a court-appointed representative provide informed consent.

Answer:

Witness consent obtained from the infant's mother.

Rationale: The nurse should assist in obtaining informed consent from the infant's mother by

witnessing her signature. Statutory guidelines indicate that a minor, even if unemancipated, can

provide consent for her infant. Unemancipated minors can also legally provide informed consent

for STI treatment, substance use treatment, and care related to pregnancy in some states.

Q: A nurse is planning care to prevent a catheter-related blood stream infection for a client who

is receiving IV fluid therapy. Which of the following interventions should the nurse include in

the plan?

1. Change bags of IV solution every 72 hr.

2. Perform hand hygiene before touching the IV tubing.

3. Use hydrogen peroxide to cleanse the IV insertion site.

4. Assess the IV insertion site every 12 hr for redness.

Answer:

Perform hand hygiene before touching the IV tubing.

Rationale: The nurse should perform thorough hand hygiene before touching any part of the

infusion system or the client to reduce the risk of catheter-related blood stream infections.

Q: A nurse is caring for an adolescent client who is in critical condition following a motor

vehicle crash in which he was the passenger. The clients parents shouts at the nurse, asking why

her son is dying instead of the driver. Which of the following actions should the nurse take to

provide emotional support to the patient?

1. Encourage the parent to speak with the family of the driver of the car.

2. Inform the parent that anger is a natural response when dealing with loss.

3. Ask the parent to leave and come back later after she has calmed down.

4. Contact a clergy member to come and speak with the parent.

Answer:

Inform the parent that anger is a natural response when dealing with loss.

Rationale: The nurse should identify that the parent is in the anger stage of grief. The nurse

should assist the parent to understand that anger is a natural response to loss and encourage her

to talk about her feelings.

Q: A nurse is teaching about advice directives with an older adult client who has a terminal

illness. Which of the following statements should the nurse make?

1. "Having advance directives means that you don't want to receive CPR."

2. "Your next of kin can amend your advance directives for you if you are unconscious."

3. "Advance directives are verbal or written instructions."

4. "Your advance directives can designate a friend to make your health care decisions."

Answer:

"Your advance directives can designate a friend to make your health care decisions."

Rationale: The nurse should inform the client that he may include a health care proxy or durable

power of attorney for health care as part of his advance directives. This form designates a person

of the client's choosing to make health care decisions for him if he becomes unable to do so for

himself. This may be a relative, personal friend, or anyone the client designates. The nurse

should ensure that this form is witnessed or notarized according to state law.

Q: A nurse is teaching a client who has rheumatoid arthritis about chronic pain management.

Which of the following statements by the client indicates an understanding of the teaching?

1. "I should stop participating in my bowling league."

2. "I should take a cool shower in the morning to relieve stiffness."

3. "I should decrease my intake of foods containing purine."

4. "I should use a warm paraffin dip for my hands and feet."

Answer:

"I should use a warm paraffin dip for my hands and feet."

Rationale: The nurse should instruct the client to dip her hands and feet in warm paraffin to

alleviate pain and stiffness. The client can more easily perform hand and finger exercises

following the treatment.

Q: A nurse is caring for a child who has contact dermatitis due to poison ivy. The parent asks

the nurse how to prevent further reactions. Which of the following responses should the nurse

make?

1. "Rinse your child's skin with hot water within 30 min of contact with the poison ivy plant."

2. "Wash your child's exposed clothing with hot water and detergent."

3. "Scrub your child's exposed skin with warm water and antibacterial soap."

4. "Don't allow your child to have contact with other children who have poison ivy."

Answer:

"Wash your child's exposed clothing with hot water and detergent."

Rationale: The nurse should instruct the parent to wash the child's clothing in hot water and

detergent after exposure to the poison ivy plant. This will remove the oil, urushiol, which causes

the skin reaction.