ATI RN
ATI Nur 104 Fundamentals Final Exam Questions
Extract:
Question 1 of 5
A nurse is planning to administer ceftriaxone IM to an adult client. Which of the following actions should the nurse plan to take?
Correct Answer: A
Rationale: Ceftriaxone requires Z-track to prevent tissue irritation. Ventrogluteal or vastus lateralis sites, 90° angle, and 1-1.5 inch needles are preferred.
Question 2 of 5
A nurse is teaching a class on health promotion and illness prevention. The nurse should include that which of the following is an example of secondary prevention?
Correct Answer: D
Rationale: Breast self-exams are secondary prevention, aiming for early detection. Support groups and foot care are tertiary, stress reduction is primary.
Question 3 of 5
A client receives a wrong medication. The nurse who made the medication error should take which of the following actions first?
Correct Answer: D
Rationale: Assessing the client ensures safety by identifying adverse effects. Notifying others and reporting follow.
Question 4 of 5
A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)
Correct Answer: A,B,D
Rationale: Furosemide (diuretic), Telmisartan (AR
B), and Duloxetine (antidepressant) can lower BP, increasing orthostatic hypotension risk. Atorvastatin and Clopidogrel don’t typically cause this.
Question 5 of 5
A nurse is preparing to administer medications to a client who states, 'I don't want to take those drugs.' Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Tell the client the physician wants him to take the medications: This response does not address the client’s concerns or autonomy. It is important to respect the client’s right to make decisions about their care, and simply telling them what the physician wants does not foster an open dialogue.Ask the client why he is refusing to take the medications: This is the most appropriate action. The nurse should assess the reason for the client's refusal to better understand the underlying concerns or misconceptions. This can help the nurse address any fears, misunderstandings, or barriers to medication adherence.Explain the purpose for the medications: While this is a good action, it is more effective after understanding why the client is refusing. Simply explaining the medication may not resolve the client's concerns if they have specific reasons for refusal.Document that the client refuses the medications: Documentation is important but should not be the first step. The nurse should first try to understand the client’s reasons for refusal and address them before documenting.