ATI RN
ATI RN Fundamentals 2019 with NGN - Exam 2 Questions
Extract:
Question 1 of 5
A nurse is assessing the visual acuity of a client who wears glasses using a Snellen chart. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The client should be positioned 6.1 m (20 feet) away from the chart, not 3.3 m (10 feet). The nurse should document the smallest line the client can read on the chart, not the largest line. The nurse should instruct the client to begin the assessment with one eye covered, not both eyes open. The nurse should begin by testing the client while they are wearing glasses because this is how the client normally sees.
Question 2 of 5
A nurse is preparing to administer an intramuscular injection. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: A 23-gauge needle is appropriate, but aspirating for blood ensures the needle is not in a blood vessel, which is critical for IM injections. Rapid injection causes discomfort. The site should be cleansed with alcohol, not soap and water.
Question 3 of 5
A nurse is assessing a client who is receiving a blood transfusion. The nurse notes lung crackles, hypoxia, and distended neck veins. Which of the following actions should the nurse take? (Select all that apply.)
Correct Answer: A,B,D,E
Rationale: Stopping the transfusion, placing the client in high-Fowler's position, obtaining a diuretic prescription, and administering oxygen manage transfusion-associated circulatory overload (TACO). Epinephrine is for anaphylaxis, not TACO.
Question 4 of 5
A nurse is preparing to administer insulin to a client with diabetes mellitus. Which of the following actions should the nurse take to ensure safe administration?
Correct Answer: C
Rationale: Shaking the insulin vial can denature the insulin; it should be gently rolled if needed. A 25-gauge needle is appropriate, but the key safety step is verifying the insulin type and dose with another nurse to prevent medication errors. Insulin is typically administered in subcutaneous sites like the abdomen or thigh, not the deltoid muscle.
Question 5 of 5
A nurse is caring for a client who is receiving enteral feedings via an NG tube. Which of the following actions should the nurse take prior to administering the formula?
Correct Answer: B
Rationale: Checking gastric residual volume ensures tolerance of feedings and prevents aspiration. Water sips are not necessary, flushing with sterile saline is not standard, and deep breathing/coughing is unrelated to NG feeding administration.