ATI RN
ATI Nursing 100 Day Exam 4 Fundamentals Questions
Extract:
Question 1 of 5
A nurse is caring for a client being treated for hypernatremia. Which of the following are appropriate nursing interventions? (Select all that apply)
Correct Answer: B,D,E
Rationale: Restricting sodium reduces hypernatremia by lowering sodium intake monitoring vital signs detects fluid balance changes such as blood pressure or pulse alterations and tracking intake/output assesses fluid status to ensure proper hydration. Encouraging potassium-rich foods is unrelated to sodium levels and decreasing water intake worsens hypernatremia by concentrating sodium further risking dehydration and complications like seizures.
Question 2 of 5
It is most critical for the nurse to use a filtered needle when preparing a parenteral medication that:
Correct Answer: A
Rationale: A filtered needle prevents glass particles from an ampule (broken to access medication) entering the syringe reducing risks of tissue damage or embolism. Mixing medications reconstitution or clear solutions do not inherently produce particles requiring filtration.
Question 3 of 5
The nurse is caring for a client who is at high risk for development of pressure injury. The client is able to move independently but has been placed on bedrest. The client has experienced two episodes of urinary incontinence. Which intervention(s) should the nurse include in the care plan?
Correct Answer: A,D,E
Rationale: Shifting weight every 15 minutes reduces pressure on bony prominences moisture barrier cream protects against incontinence-related skin breakdown and a specialty mattress distributes pressure to prevent ulcers. Raising the bed at 45 degrees increases shear and massaging prominences risks tissue damage.
Question 4 of 5
A client has a serum potassium level of 6.3 mEq/L. The nurse recognizes that the highest priority intervention(s) for this client are to:
Correct Answer: C,E
Rationale: Hyperkalemia (6.3 mEq/L above normal 3.5-5.0 mEq/L) risks cardiac dysrhythmias and neuromuscular issues requiring immediate assessment for muscle weakness/flaccid paralysis and cardiac monitoring to detect life-threatening arrhythmias. Diluting potassium or encouraging potassium-rich foods worsens hyperkalemia and intake/output monitoring is secondary.
Question 5 of 5
The nurse understands that the rationale(s) for clients receiving intravenous (IV) therapy is/are to:
Correct Answer: A,D,E
Rationale: IV therapy compensates for fluid/electrolyte losses (e.g. vomiting) corrects imbalances (e.g. hyponatremia) and expands volume in dehydration or hypovolemia. Increasing urine specific gravity indicates concentrated urine not an IV goal and moving fluid to unavailable areas (e.g. cerebrospinal fluid) is not achieved by IV therapy.