ATI RN
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ATI Nursing 100 Day Exam 4 Fundamentals Questions
Extract:
Question
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1 of 5
A nursing instructor is observing a nursing student prepare and administer medications to adult clients. Which action by the nursing student requires intervention by the Instructor?
Correct Answer: B
Rationale: Buccal medications are placed between the cheek and gum to dissolve slowly not under the tongue which is for sublingual administration risking incorrect absorption. Injecting air into vials pouring 2 tsp (10 mL) of Robitussin and using a 1 mL syringe for heparin are correct techniques.
Question 2 of 5
The nurse is giving vancomycin to a client and must hold the dose until the results of the trough level are known. This term is associated with the point at which the:
Correct Answer: C
Rationale: Trough level refers to the lowest drug concentration in the blood before the next dose ensuring therapeutic levels without toxicity. It is not about half-life (related to elimination) toxicity or peak concentration which occurs shortly after administration.
Question 3 of 5
The nurse is assessing a client who exhibits positive Trousseau's and Chvostek's signs. What laboratory value would validate these clinical findings? A serum:
Correct Answer: D
Rationale: Low calcium (6.9 mg/dL below normal 8.5-10.2 mg/dL) causes neuromuscular excitability leading to Trousseau’s (arm spasm with cuff inflation) and Chvostek’s (facial twitching) signs. Normal potassium (3.5-5.0 mEq/L) phosphate (2.5-4.5 mg/dL) and magnesium (1.8-2.5 mEq/L) do not explain these findings.
Question 4 of 5
The nurse enters a client's room to find that his abdominal wound has eviscerated. Which intervention should the nurse implement first?
Correct Answer: D
Rationale: Applying a sterile saline dressing protects eviscerated abdominal contents by keeping them moist and preventing infection until surgical intervention. Reverse Trendelenburg may increase protrusion antibiotics are secondary and replacing organs risks damage and is not a nursing action.
Question 5 of 5
The nurse is administering an intramuscular injection to a 9 month old infant. What is the preferred injection site?
Correct Answer: D
Rationale: The vastus lateralis is the preferred IM site in infants due to its large muscle mass and low risk of nerve injury making it safe for injections. Gluteal maximus and ventral gluteal risk sciatic nerve damage and deltoid is underdeveloped in infants.