ATI_NUR 275 Competencies for Contemporary Nursing Practice
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Free ATI_NUR 275 Competencies for Contemporary Nursing Practice Questions
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?
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It decreases the client's level of anxiety.
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It facilitates the client's deep breathing.
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It enhances the client's ability to sleep.
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It reduces the client's blood pressure.
Explanation
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.
A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the following prescriptions should the nurse clarify?
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Serum cardiac enzyme levels
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MRI of the chest
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Low-sodium diet
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Physical therapy
Explanation
An MRI is contraindicated for clients with most permanent pacemakers because the strong magnetic field can interfere with pacemaker function, damage internal components, or dislodge the device leads. Any MRI order must be clarified before proceeding unless the pacemaker is specifically MRI-compatible and verified. The other orders are safe and appropriate: checking cardiac enzymes monitors cardiac injury, a low-sodium diet supports cardiovascular health, and physical therapy promotes safe mobility and recovery after surgery.
A nurse is teaching an older adult client who has diabetes mellitus about preventing the long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include?
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"Maintain stable blood glucose levels."
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"Have an eye examination once per year."
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"Wear compression stockings daily."
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"Examine your feet carefully every day."
Explanation
Maintaining stable blood glucose levels is the most important intervention to prevent long-term microvascular complications of diabetes, including retinopathy (damage to retinal blood vessels) and nephropathy (kidney damage). Consistent glycemic control slows progression of vascular injury by preventing glycation of blood vessels and limiting inflammatory damage to delicate capillaries in the eyes and kidneys. Research shows that maintaining an A1C within the recommended range significantly reduces the risk of blindness and chronic kidney disease in diabetic clients.
A nurse is caring for a client who has a T-4 spinal cord injury. Which of the following client findings should the nurse identify as an indication the client is at risk for experiencing autonomic dysreflexia?
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The client states having a severe headache.
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The client's blood pressure becomes elevated.
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The client's bladder becomes distended.
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The client states having nasal congestion.
Explanation
A distended bladder is a common trigger for autonomic dysreflexia (AD) in clients with spinal cord injuries at or above T-6. AD is a life-threatening medical emergency caused by a noxious stimulus below the level of injury that activates an exaggerated sympathetic response. Bladder distension accounts for most cases and must be relieved immediately (e.g., checking for catheter kinks or performing catheterization) to prevent severe hypertension, stroke, or death.
A nurse is caring for a client who has expressive aphasia following a cerebrovascular accident (CVA). Which of the following parameters should the nurse use first in order to assess the client's pain level?
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Pulse and blood pressure findings
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A self-report pain rating scale
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Behavioral indicators and effect
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Scheduled treatments and client illness
Explanation
A self-report pain scale is always the first and most reliable method to assess pain, even in clients with expressive aphasia, as long as they can understand and respond non-verbally. Tools such as numeric scales, picture charts, or communication boards allow the client to indicate pain level. Expressive aphasia affects verbal expression but not necessarily comprehension or ability to point, gesture, or use alternative communication methods, making self-report the priority.
pH 7.22
PaCO2 68 mm Hg
Base excess -2
PaO2 78 mm Hg
Saturation 80%
Bicarbonate 26 mEq/L
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Respiratory acidosis
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Metabolic alkalosis
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Metabolic acidosis
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Respiratory alkalosis
Explanation
The pH is low (7.22), indicating acidemia. PaCO2 is markedly elevated (68 mm Hg), which explains the acidemia and points to a primary respiratory cause. Bicarbonate (26 mEq/L) and base excess (−2) are near normal, showing little to no metabolic compensation. Therefore, the ABG is most consistent with acute respiratory acidosis (with hypoventilation and accompanying hypoxemia).
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.
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Obtain a PRN prescription to restrain the client.
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Speak to the client in a calm, matter-of-fact manner.
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Allow the client to return to the dayroom following restraint removal.
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Offer the client food and liquids every 3 to 4 hr.
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Escort the client to the restroom every 1 to 2 hr.
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Measure the client’s vital signs every 1 to 2 hr.
Explanation
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.
A nurse on an inpatient mental health unit attends a training session about nurse burnout. The nurse should identify that burnout is most common in nurses who have which of the following traits?
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Compassion fatigue
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Connects well with others
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High energy
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Consistent self-care
Explanation
Burnout is most common in nurses who experience compassion fatigue, which occurs when continuous emotional demands and exposure to suffering lead to emotional exhaustion, reduced empathy, and decreased ability to provide compassionate care. Mental health nursing involves intense emotional involvement, making nurses prone to burnout when coping resources and support are insufficient.
A nurse is caring for a client who is exhibiting increased agitation. The nurse offered toileting, lowered the lights in the client's room and closed door to client's room.
Admission Assessment
82-year-old client admitted with nondisplaced hip fracture awaiting surgery. History of mild dementia, and hypotension. The family is concerned about malnutrition and living alone. The client's daughter who is the power of attorney (POA) is currently out of state.
Vital Signs:
- Temperature 36.5° C (97.7° F)
- Heart rate 88/min
- Respiratory rate 16/min
- Blood pressure 98/64 mm/Hg
Medications: Donepezil (Aricept) q AM,
Vital Signs
2200:
- Temperature 37.7° C (99.9° F)
- Heart rate 110/min
- Respiratory rate 20/min
- Blood pressure 110/64 mm/Hg
Nurses' Notes
2200:
- Increasing agitation, and states, "I am getting out of this bed."
2215:
- Daughter who is POA was contacted and states, "They get more agitated at night, and this is when they falls. We don't know what to do. I am unable to come in as I am out of state."
2218:
- Provider contacted no new prescriptions received.
2220:
- Client remains agitated and repeats, "I am getting out of this bed and leaving this place."
The nurse states, "You may not climb out of bed" and applied a wrist restraint and raised all bedside rails.
Complete the following sentence by using the lists of options.
The nurse is at risk for ________ as evidenced by ________.
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False imprisonment; applying wrist restraints to the client
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Negligence; calling the daughter
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Assault; decreasing environmental stimuli
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Slander; closing the door
Explanation
False imprisonment occurs when a patient is unlawfully restrained or restricted without appropriate justification or a provider order. The client was alert, only agitated, and no new restraint order was obtained. Applying wrist restraints and preventing movement legally puts the nurse at risk for false imprisonment.
Blood pressure 102/66 mm Hg
Yellow-green drainage on the surgical incision
Straw-colored urine from an indwelling urinary catheter
Respiratory rate 18/min
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Blood pressure 102/66 mm Hg
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Yellow-green drainage on the surgical incision
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Straw-colored urine from an indwelling urinary catheter
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Respiratory rate 18/min
Explanation
Yellow-green drainage from a surgical incision 48 hours post-operation is an abnormal finding and indicates possible wound infection. Normal postoperative wound drainage is typically serous or serosanguineous. Purulent or foul-smelling drainage, especially yellow-green, suggests the presence of bacteria. Infection at the surgical site requires immediate provider notification for culture, antibiotic therapy, and wound management to prevent sepsis or wound dehiscence. The other findings are expected postoperative findings and do not require urgent intervention.
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