ATI RN
ATI N103N103 Fundamentals Final Exam Questions
Extract:
Question 1 of 5
A nurse is preparing to administer oral medications to a client. According to the Joint Commission which are acceptable client identifiers? (Select all that apply.)
Correct Answer: A,D
Rationale: The Joint Commission identifies the client’s full name and date of birth as acceptable identifiers due to their uniqueness. Photograph identification (
B) is not standard and room number (
C) is unreliable as it may change.
Question 2 of 5
A nurse is caring for a client who has a Jackson-Pratt (JP) drain in place after surgery for an abdominal wound. The nurse should understand that the JP drain was placed for which purpose?
Correct Answer: D
Rationale: The primary purpose of a Jackson-Pratt (JP) drain is to prevent fluid from accumulating in the wound, including blood and lymphatic fluid, which reduces the risk of infection and promotes healing. It is not used for medication administration, does not eliminate the need for dressings, and while it may help manage bleeding, its main role is fluid removal.
Question 3 of 5
A nurse received a prescription to administer a medication NOW to a client. Which action should the nurse take?
Correct Answer: A
Rationale: A NOW order requires prompt administration within 90 minutes, ensuring timely treatment without the urgency of a STAT order. Scheduled, interval, or symptom-based administration does not apply.
Question 4 of 5
A nurse is preparing to assess a client. Which action should the nurse take to check cranial nerve VI?
Correct Answer: C
Rationale: Cranial nerve VI (abducens) controls the lateral rectus muscle enabling lateral eye movement. Asking the client to look outward assesses this function. Visual acuity (
A) whispering (
B) and smiling (
D) assess cranial nerves II VIII and VII respectively.
Question 5 of 5
Which clinical manifestation is most reflective of an early response to hypoxia?
Correct Answer: A
Rationale: Restlessness is an early sign of hypoxia as the brain responds to low oxygen levels with agitation. Cyanosis, apnea, and bradycardia are later signs, occurring after prolonged oxygen deprivation.