ATI_NUR 275 Competencies for Contemporary Nursing Practice
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Free ATI_NUR 275 Competencies for Contemporary Nursing Practice Questions
1. A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment?
- Alcohol use disorder
- Pacemaker
- Breast cancer survivor for 8 years
- 65-years of age
Explanation
A. Alcohol use disorder
Active substance use disorder, including alcohol use disorder, is a contraindication to kidney transplantation. Successful transplant requires strict lifelong adherence to immunosuppressive medications and follow-up care; substance misuse increases risk of nonadherence and poor outcomes. Clients must demonstrate sustained sobriety and rehabilitation before being considered candidates. Transplant programs typically require documentation of treatment participation and a period of abstinence prior to listing.
Active substance use disorder, including alcohol use disorder, is a contraindication to kidney transplantation. Successful transplant requires strict lifelong adherence to immunosuppressive medications and follow-up care; substance misuse increases risk of nonadherence and poor outcomes. Clients must demonstrate sustained sobriety and rehabilitation before being considered candidates. Transplant programs typically require documentation of treatment participation and a period of abstinence prior to listing.
2. A nurse is reviewing the serum laboratory findings for a client who has hypertension and is prescribed hydrochlorothiazide. Which of the following findings should the nurse report to the provider?
Potassium 2.3 mEq/L
Calcium 10 mg/dL
Sodium 136 mEq/L
Chloride 99 mEq/L
Potassium 2.3 mEq/L
Calcium 10 mg/dL
Sodium 136 mEq/L
Chloride 99 mEq/L
- Potassium 2.3 mEq/L
- Calcium 10 mg/dL
- Sodium 136 mEq/L
- Chloride 99 mEq/L
Explanation
Potassium 2.3 mEq/L
Hydrochlorothiazide is a thiazide diuretic that increases urinary excretion of potassium, placing clients at risk for hypokalemia. A potassium level of 2.3 mEq/L is dangerously low (normal 3.5–5.0 mEq/L) and requires immediate provider notification. Severe hypokalemia can result in life-threatening cardiac arrhythmias, muscle weakness, cramps, ileus, and respiratory depression. The nurse should anticipate potassium replacement and continuous cardiac monitoring. The other listed electrolyte values are within normal limits and do not require urgent intervention.
Hydrochlorothiazide is a thiazide diuretic that increases urinary excretion of potassium, placing clients at risk for hypokalemia. A potassium level of 2.3 mEq/L is dangerously low (normal 3.5–5.0 mEq/L) and requires immediate provider notification. Severe hypokalemia can result in life-threatening cardiac arrhythmias, muscle weakness, cramps, ileus, and respiratory depression. The nurse should anticipate potassium replacement and continuous cardiac monitoring. The other listed electrolyte values are within normal limits and do not require urgent intervention.
3. 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?
- Compassion fatigue
- Connects well with others
- High energy
- Consistent self-care
Explanation
A. Compassion fatigue
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.
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.
4. 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.
5. 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?
- "Maintain stable blood glucose levels."
- "Have an eye examination once per year."
- "Wear compression stockings daily."
- "Examine your feet carefully every day."
Explanation
A. "Maintain stable blood glucose levels."
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.
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.
6. A nurse is teaching a client who has type 1 diabetes mellitus about foot care. Which of the following statements by the client indicates an understanding of the teaching?
"I'll wear sandals in warm weather."
"I'll soak my feet in cool water every night before I go to bed."
"I'll put lotion between my toes after drying my feet."
"I'll check my feet every day for sores and bruises."
"I'll wear sandals in warm weather."
"I'll soak my feet in cool water every night before I go to bed."
"I'll put lotion between my toes after drying my feet."
"I'll check my feet every day for sores and bruises."
- "I'll wear sandals in warm weather."
- "I'll soak my feet in cool water every night before I go to bed."
- "I'll put lotion between my toes after drying my feet."
- "I'll check my feet every day for sores and bruises."
Explanation
"I'll check my feet every day for sores and bruises."
Daily foot inspection is the single most important self-care behavior to prevent ulcers and amputations in diabetes. Peripheral neuropathy reduces pain sensation, so cuts, blisters, or pressure areas can go unnoticed and rapidly become infected, especially with peripheral arterial disease. Inspect the entire foot—including heels, between toes, and soles—using a mirror or caregiver if needed. Report redness, swelling, warmth, drainage, cracks, calluses, or nail changes promptly. Best practices to support inspection include: wash and dry feet daily (pat dry, especially between toes), apply moisturizer to tops and bottoms (not between toes), trim nails straight across, wear clean, well-fitting shoes and cotton socks, never go barefoot or use heating pads, test bath water with elbow/thermometer, and maintain good glycemic control to promote wound healing and reduce infection risk.
Daily foot inspection is the single most important self-care behavior to prevent ulcers and amputations in diabetes. Peripheral neuropathy reduces pain sensation, so cuts, blisters, or pressure areas can go unnoticed and rapidly become infected, especially with peripheral arterial disease. Inspect the entire foot—including heels, between toes, and soles—using a mirror or caregiver if needed. Report redness, swelling, warmth, drainage, cracks, calluses, or nail changes promptly. Best practices to support inspection include: wash and dry feet daily (pat dry, especially between toes), apply moisturizer to tops and bottoms (not between toes), trim nails straight across, wear clean, well-fitting shoes and cotton socks, never go barefoot or use heating pads, test bath water with elbow/thermometer, and maintain good glycemic control to promote wound healing and reduce infection risk.
7.
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.
8. 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.
9. 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?
- Pulse and blood pressure findings
- A self-report pain rating scale
- Behavioral indicators and effect
- Scheduled treatments and client illness
Explanation
B. A self-report pain rating scale
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.
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.
10. 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.
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