ATI RN
ATI N103N103 Fundamentals Final Exam Questions
Extract:
Question 1 of 5
A nurse is monitoring the urinary output of a client who had a colon resection. Which 24-hour output total indicates oliguria?
Correct Answer: A
Rationale: Oliguria is defined as <400-500 mL urine output per 24 hours. 380 mL (
A) meets this criterion while 550 mL (
B) 600 mL (
C) and 720 mL (
D) are above the threshold.
Question 2 of 5
A nurse is teaching a client who has left-sided weakness after a stroke on how to use a cane. What instructions should the nurse include?
Correct Answer: A
Rationale: Holding the cane on the right side supports the weaker left leg, enhancing balance. Advancing the strong leg with the cane, removing the rubber tip, or placing the cane too far ahead reduces stability.
Question 3 of 5
A nurse is caring for a client who is preoperative. The nurse signs as a witness on the client's consent form. The nurse's signature on the consent form indicates which of the following?
Correct Answer: D
Rationale: The nurse’s signature as a witness confirms the client is competent and voluntarily signing the consent form, ensuring informed consent. It does not record necessity, assess mental illness, or indicate the nurse explained risks.
Question 4 of 5
A nurse is assessing a client's wound and notes there is slough present. What would be an appropriate intervention for this wound?
Correct Answer: C
Rationale: Debridement is the most appropriate intervention for a wound with slough, as it removes necrotic tissue to promote a clean wound bed and facilitate healing. Covering or leaving the wound alone risks infection and delayed healing, while cleaning alone is insufficient to remove slough.
Question 5 of 5
A nurse is preparing an educational program about client confidentiality. The nurse should explain that nurses may share a client's protected health information with which individuals?
Correct Answer: C
Rationale: Health care team members involved in the client’s care can access protected health information under HIPAA to ensure safe treatment. Sharing with family, administrators, or clergy requires client consent or a specific need, which is not automatic.