ATI RN
ATI Nsg 131 Fundamentals Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a client who requests prescription pain medication. Which of the following actions should the nurse perform first?
Correct Answer: A
Rationale: The correct answer is A: Determine the location of the pain. This is the first step because assessing the location of pain is crucial in understanding the client's condition and choosing the appropriate medication. Identifying the source of pain helps in selecting the most effective treatment. Repositioning the client (
B) or administering medication (
C) should only be done after the nurse assesses the pain location. Reviewing the effects of the pain medication (
D) is important but not the first step. Other choices are not relevant to the initial assessment of the client's pain.
Question 2 of 5
A nurse accidentally sticks her hand with a syringe needle after administering an IM injection to a client. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct action for the nurse to take first is to wash the area of the puncture thoroughly with soap and water. This is important to reduce the risk of infection and minimize any potential harm caused by the needle stick injury. Washing the area helps to remove any contaminants and reduce the chances of infection. Going to employee health services or reporting the incident can be done after washing the area to address any further necessary actions. Completing an incident report and reporting to the charge nurse are important steps but should follow immediate washing of the puncture site to prioritize the nurse's health and safety.
Question 3 of 5
When reviewing the admitting prescriptions for a client, the nurse notes that the dose of one medication is three times the usual dose of this medication. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct action for the nurse to take is to contact the provider to question the dosage (
D). This is because administering a medication at three times the usual dose could pose serious risks to the client's health and safety. By contacting the provider, the nurse can clarify if the dosage was intended and if there was any error in prescribing.
Choice A is incorrect because confirming with the pharmacy does not address the potential harm of the high dosage.
Choice B is incorrect as the nurse should not administer a potentially unsafe dose without clarification.
Choice C is also incorrect as asking another nurse to verify does not address the issue at the source.
In summary, contacting the provider (
D) is the best course of action to ensure the client's safety and prevent any medication errors.
Question 4 of 5
A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: The correct answer is D: Check the client's vital signs. The first action the nurse should take is to assess the client's vital signs to monitor for any potential adverse effects of the medication. Nifedipine is a calcium channel blocker that can cause hypotension and other cardiovascular effects. By checking the vital signs first, the nurse can promptly identify any signs of distress and take immediate action to ensure the client's safety. This step is crucial in prioritizing the client's well-being and addressing any potential harm caused by the medication error.
Summary:
A: Filling out an occurrence form can be done later but is not the immediate priority.
B: Administering the medication to the correct client is not appropriate as it may cause harm.
C: Notifying the client's provider is important but not as urgent as assessing the client's vital signs.
D: Checking the client's vital signs is the first and most critical step to ensure client safety.
Question 5 of 5
A nurse is assessing a client who has had diarrhea for several days. Which of the following findings should the nurse expect?
Correct Answer: A
Rationale: The correct answer is A: Dehydration. Diarrhea can lead to fluid and electrolyte loss, causing dehydration. The nurse should expect signs such as increased thirst, dry mouth, decreased urine output, and low blood pressure. Rigid abdomen (
B) is more indicative of a surgical emergency like peritonitis. Decreased bowel sounds (
C) may occur in diarrhea but are not as concerning as dehydration. Hypothermia (
D) is not a typical finding in diarrhea.