ATI_NUR 275 Competencies for Contemporary Nursing Practice
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Free ATI_NUR 275 Competencies for Contemporary Nursing Practice Questions
1. A charge nurse is providing an in-service to a group of nurses about benefits of an interprofessional team. Which of the following information should the nurse include?
- Increase in length of stay for client
- Decrease the number of visits to client by staff
- Efficiency in client-care services
- Decrease number of referrals needed for client
Explanation
C. Efficiency in client-care services
Interprofessional collaboration brings together multiple disciplines to coordinate care, decrease fragmentation, and streamline services. This teamwork enhances efficiency, reduces duplicate interventions, improves communication, and ensures that client needs are met more comprehensively and quickly. Efficient care supports better outcomes, faster recovery, and improved satisfaction.
Interprofessional collaboration brings together multiple disciplines to coordinate care, decrease fragmentation, and streamline services. This teamwork enhances efficiency, reduces duplicate interventions, improves communication, and ensures that client needs are met more comprehensively and quickly. Efficient care supports better outcomes, faster recovery, and improved satisfaction.
2. A nurse is reviewing laboratory values for a client who has systemic lupus erythematosus (SLE). Which of the following values should give the nurse the best indication of the client's renal function?
- Serum sodium
- Serum creatinine
- Urine-specific gravity
- Blood urea nitrogen (BUN)
Explanation
B. Serum creatinine
Serum creatinine is the most accurate indicator of renal function in clients with SLE. Creatinine is a byproduct of muscle metabolism cleared solely by the kidneys; therefore, rising levels reflect impaired glomerular filtration. Lupus nephritis is a serious complication of SLE and monitoring creatinine helps detect declining renal function early, guiding treatment decisions such as immunosuppressive therapy and protecting long-term kidney health.
Serum creatinine is the most accurate indicator of renal function in clients with SLE. Creatinine is a byproduct of muscle metabolism cleared solely by the kidneys; therefore, rising levels reflect impaired glomerular filtration. Lupus nephritis is a serious complication of SLE and monitoring creatinine helps detect declining renal function early, guiding treatment decisions such as immunosuppressive therapy and protecting long-term kidney health.
3. A nurse is assessing a client who has had staples removed from an abdominal wound postoperatively. The nurse notes separation of the wound edges with copious light-brown serous drainage. Which of the following actions should the nurse perform first?
- Check the client's vital signs.
- Obtain a culture and sensitivity of the wound drainage.
- Assess the client's pain level.
- Cover the wound with a moist, sterile gauze dressing.
Explanation
Cover the wound with a moist, sterile gauze dressing.
The client is showing signs of wound dehiscence, and the light-brown drainage may indicate possible evisceration (serosanguineous drainage can precede it). The priority is to protect the exposed tissues and prevent drying by immediately covering the wound with moist, sterile gauze. This action reduces the risk of further tissue damage and infection.
The client is showing signs of wound dehiscence, and the light-brown drainage may indicate possible evisceration (serosanguineous drainage can precede it). The priority is to protect the exposed tissues and prevent drying by immediately covering the wound with moist, sterile gauze. This action reduces the risk of further tissue damage and infection.
4. While performing an admission assessment for a client, the nurse notes that the client has varicose veins with ulcerations and lower extremity edema with a report of a feeling of heaviness. Which of the following nursing diagnoses should the nurse identify as being the priority in the client's care?
- Alteration in activity tolerance
- Impaired tissue perfusion
- Alteration in body image
- Impaired skin integrity
Explanation
B. Impaired tissue perfusion
This client has venous insufficiency signs: varicose veins, edema, heaviness, and ulcerations. These findings indicate compromised circulation, causing poor oxygen/nutrient delivery to tissues. Addressing perfusion first is essential because adequate blood flow is required for wound healing, prevention of infection, and maintenance of tissue viability. In nursing priority frameworks (ABCs & circulation), circulation comes first, making impaired tissue perfusion the priority diagnosis.
This client has venous insufficiency signs: varicose veins, edema, heaviness, and ulcerations. These findings indicate compromised circulation, causing poor oxygen/nutrient delivery to tissues. Addressing perfusion first is essential because adequate blood flow is required for wound healing, prevention of infection, and maintenance of tissue viability. In nursing priority frameworks (ABCs & circulation), circulation comes first, making impaired tissue perfusion the priority diagnosis.
5.
A nurse in an inpatient mental health facility is monitoring a client who has bipolar disorder.
Nurses' Notes
0800:
- Client pacing in their room. Did not sleep throughout the night according to report from previous RN. Refuses to eat breakfast. Attempts made to de-escalate client's anxiety by offering to take a walk and talk. Attempts to redirect client to other activities unsuccessful. Client refuses anti-anxiety medication.
0900:
- Client having argument with other clients in the dayroom. Begins to shout at other clients and staff members. Staff gathers for support. Attempts to redirect client are unsuccessful. Client refuses to leave the day room with staff members, refuses to take walk outdoors, refuses offer of anti-anxiety medication. Client shouts, "You people are always trying to drug me up!"
0915:
- Client's anger continues to escalate. Staff escorts other clients out of the dayroom. Client picks up chair and throws it in the direction of RNs. Client restrained by staff members and taken to seclusion room.
Select the following 3 actions the nurse should take.
- Obtain a PRN prescription to restrain the client.
- Speak to the client in a calm, matter-of-fact manner.
- Allow the client to return to the dayroom following restraint removal.
- Offer the client food and liquids every 3 to 4 hr.
- Escort the client to the restroom every 1 to 2 hr.
- Measure the client’s vital signs every 1 to 2 hr.
Explanation
A. Obtain a PRN prescription to restrain the client.
When emergency restraints are used, the nurse must obtain a provider prescription as soon as possible. This ensures legal and ethical compliance and confirms that restraint use meets emergency safety criteria. Restraints are only for imminent danger, as seen when the client threw a chair. The order must outline length and monitoring requirements. Documentation of behavior leading to restraint and ongoing assessment is required to ensure safe, appropriate use.
B. Speak to the client in a calm, matter-of-fact manner.
Calm, consistent communication reduces escalation and helps re-establish control. Clients in manic or agitated states respond best to clear, brief, neutral language. After seclusion or restraint, the nurse continues structured, controlled interaction to maintain safety and rapport. This approach models emotional regulation and supports de-escalation once the crisis passes, reinforcing a therapeutic environment and protecting dignity.
F. Measure the client’s vital signs every 1 to 2 hr.
Following restraint use, frequent monitoring is mandatory to ensure client safety. Vital signs help detect physiologic distress, adverse medication effects, dehydration, or escalating agitation. Monitoring is part of required observation protocols and ensures rapid response to complications such as respiratory difficulty, circulatory impairment, or self-injury. Continuous documentation supports legal, ethical, and safety standards during restraint use.
When emergency restraints are used, the nurse must obtain a provider prescription as soon as possible. This ensures legal and ethical compliance and confirms that restraint use meets emergency safety criteria. Restraints are only for imminent danger, as seen when the client threw a chair. The order must outline length and monitoring requirements. Documentation of behavior leading to restraint and ongoing assessment is required to ensure safe, appropriate use.
B. Speak to the client in a calm, matter-of-fact manner.
Calm, consistent communication reduces escalation and helps re-establish control. Clients in manic or agitated states respond best to clear, brief, neutral language. After seclusion or restraint, the nurse continues structured, controlled interaction to maintain safety and rapport. This approach models emotional regulation and supports de-escalation once the crisis passes, reinforcing a therapeutic environment and protecting dignity.
F. Measure the client’s vital signs every 1 to 2 hr.
Following restraint use, frequent monitoring is mandatory to ensure client safety. Vital signs help detect physiologic distress, adverse medication effects, dehydration, or escalating agitation. Monitoring is part of required observation protocols and ensures rapid response to complications such as respiratory difficulty, circulatory impairment, or self-injury. Continuous documentation supports legal, ethical, and safety standards during restraint use.
6.
A nurse is caring for an adolescent.
Nurses' Notes
Adolescent presents with pain in right lower quadrant for past 2 days.
Vital Signs
- Temperature 38.6 °C (101.4°F)
- Respiratory rate 26/min
- Pulse rate 112/min
- BP 146/88 mm Hg
- SpO2 95%
Physical Examination
- Awake, alert, and oriented x4. Lung sounds clear bilaterally. Heart rate regular. Bowel sounds hypoactive in all 4 quadrants. Peripheral pulses palpable, 2+. Reports right lower quadrant pain rated as 9 on 0 to 10 pain scale. Adolescent states, "the pain seemed to go away for a while earlier today, but now it's back and really bad." Adolescent noted to grimace and guard abdomen during abdominal assessment. Vomited 480 mL green emesis during assessment and parent reports adolescent has not really eaten for the past 2 days due to nausea. Also reports 3 diarrhea stools and chills that began about 2 hr ago.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Potential Condition
- A. Gastrointestinal bleeding
- B. Ruptured appendix
- C. Intussusception
- D. Meckel diverticulum
Actions to Take
- A. Administer IV antibiotics.
- B. Initiate oxygen at 2 L/min via nasal cannula.
- C. Prepare client for a barium enema.
- D. Insert nasogastric tube.
Parameters to Monitor
- A. Oxygen saturation
- B. Urinary output
- C. White blood cell count
- D. Rectal bleeding
- E. Abdominal distention
-
Potential Condition: B. Ruptured appendix
Actions to Take: A. Administer IV antibiotics. & D. Insert nasogastric tube.
Parameters to Monitor: B. Urinary output & C. White blood cell count
Explanation
Potential Condition: B. Ruptured appendix
Actions to Take: A. Administer IV antibiotics. & D. Insert nasogastric tube.
Parameters to Monitor: B. Urinary output & C. White blood cell count
The adolescent's symptoms — severe right lower quadrant pain, guarding, fever, tachycardia, diarrhea, green emesis, pain that "went away then returned," and chills — are consistent with ruptured appendix with peritonitis. Pain that temporarily subsides suggests perforation. IV antibiotics and gastric decompression with an NG tube help treat infection and prevent aspiration. Monitoring urinary output assesses perfusion and kidney function, while WBC count reflects infection severity and response to treatment.
Actions to Take: A. Administer IV antibiotics. & D. Insert nasogastric tube.
Parameters to Monitor: B. Urinary output & C. White blood cell count
The adolescent's symptoms — severe right lower quadrant pain, guarding, fever, tachycardia, diarrhea, green emesis, pain that "went away then returned," and chills — are consistent with ruptured appendix with peritonitis. Pain that temporarily subsides suggests perforation. IV antibiotics and gastric decompression with an NG tube help treat infection and prevent aspiration. Monitoring urinary output assesses perfusion and kidney function, while WBC count reflects infection severity and response to treatment.
7. A nurse is providing teaching to a client who is postoperative following coronary artery bypass graft (CABG) surgery and is receiving opioid medications to manage discomfort. Aside from managing pain, which of the following desired effects of medications should the nurse identify as most important for the client's recovery?
- It decreases the client's level of anxiety.
- It facilitates the client's deep breathing.
- It enhances the client's ability to sleep.
- It reduces the client's blood pressure.
Explanation
B. "It facilitates the client's deep breathing."
Following CABG surgery, maintaining adequate ventilation and preventing pulmonary complications such as atelectasis, pneumonia, and hypoxemia is critical. Effective pain control allows the client to take deep breaths, cough, and participate in pulmonary hygiene (e.g., incentive spirometry). Without adequate analgesia, the client may splint their chest to avoid pain, resulting in shallow breathing and ineffective lung expansion, significantly increasing postoperative respiratory risk.
Following CABG surgery, maintaining adequate ventilation and preventing pulmonary complications such as atelectasis, pneumonia, and hypoxemia is critical. Effective pain control allows the client to take deep breaths, cough, and participate in pulmonary hygiene (e.g., incentive spirometry). Without adequate analgesia, the client may splint their chest to avoid pain, resulting in shallow breathing and ineffective lung expansion, significantly increasing postoperative respiratory risk.
8. A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first?
- Notify the provider who inserted the PICC line.
- Remove the PICC line.
- Apply a cold pack to the client's upper arm.
- Measure the circumference of both upper arms.
Explanation
D. Measure the circumference of both upper arms.
Swelling above a PICC insertion site can indicate thrombosis or catheter-related complication. The nurse’s first action is to assess the extent of swelling by measuring and comparing arm circumferences. This establishes a baseline and determines severity before notifying the provider. Objective data collection is essential for accurate evaluation and guiding further interventions, such as imaging, anticoagulants, or catheter management.
Swelling above a PICC insertion site can indicate thrombosis or catheter-related complication. The nurse’s first action is to assess the extent of swelling by measuring and comparing arm circumferences. This establishes a baseline and determines severity before notifying the provider. Objective data collection is essential for accurate evaluation and guiding further interventions, such as imaging, anticoagulants, or catheter management.
9. A nurse is observing the closed chest drainage system of a client who is 24 hr post thoracotomy. The nurse notes slow, steady bubbling in the suction control chamber. Which of the following actions should the nurse take?
- Check the tubing connections for leaks.
- Check the suction control outlet on the wall.
- Continue to monitor the client's respiratory status.
- Clamp the chest tube.
Explanation
C. Continue to monitor the client's respiratory status.
Slow, steady bubbling in the suction control chamber is an expected finding in a chest drainage system when suction is applied. This indicates the system is functioning properly to remove air and fluid from the pleural space. Since the bubbling is occurring where it should be, the priority action is to continue monitoring the client's respiratory status and overall chest tube function, ensuring adequate lung expansion and ventilation.
Slow, steady bubbling in the suction control chamber is an expected finding in a chest drainage system when suction is applied. This indicates the system is functioning properly to remove air and fluid from the pleural space. Since the bubbling is occurring where it should be, the priority action is to continue monitoring the client's respiratory status and overall chest tube function, ensuring adequate lung expansion and ventilation.
10. A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?
- Stridor
- Cheyne-Stokes respirations
- Apneustic respirations
- Kussmaul respirations
Explanation
B. Cheyne-Stokes respirations
Cheyne-Stokes respirations are characterized by a cyclical pattern of progressively deep, rapid breathing followed by periods of apnea. This pattern often occurs in clients who are unconscious and may indicate severe neurologic injury, increased intracranial pressure, or end-of-life changes. Recognizing this pattern allows the nurse to notify the provider, monitor neurologic status, and support respiratory needs appropriately.
Cheyne-Stokes respirations are characterized by a cyclical pattern of progressively deep, rapid breathing followed by periods of apnea. This pattern often occurs in clients who are unconscious and may indicate severe neurologic injury, increased intracranial pressure, or end-of-life changes. Recognizing this pattern allows the nurse to notify the provider, monitor neurologic status, and support respiratory needs appropriately.
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