Questions 38

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ATI NUR 104 Final Assessment Fundamentals Questions

Extract:

A nurse is prioritizing care for two clients at the start of the shift. The first client, who is 1 day postoperative following a partial bowel resection, requires a dressing change, total parenteral nutrition administration, and reports a pain level of 6 on a scale from 0 to 10. The second client, who has a newly inserted percutaneous gastrostomy tube, requires a tube feeding, dressing change, and daily weight. Which of the following nursing actions should the nurse plan to complete first?


Question 1 of 5

Administer pain medication to the first client

Correct Answer: A

Rationale: Administering pain medication to the postoperative client with a pain level of 6 is the priority to enhance comfort and recovery. Weighing, dressing changes, and vital signs are less urgent.

Extract:

A nurse is orienting a newly licensed nurse about documentation of a client's information in the electronic health record. Which of the following statements by the newly licensed nurse indicates understanding of the purpose of documentation?


Question 2 of 5

Documentation provides information for a client audit

Correct Answer: C

Rationale: Documentation communicates client care to the healthcare team, ensuring continuity. Audits, monitoring, and financial charges are secondary or incorrect.

Extract:

A nurse is teaching a newly licensed nurse about transcribing prescriptions. Which of the following examples should the nurse include in the instructions?


Question 3 of 5

Losartan 50.0 mg, PO, QD

Correct Answer: C

Rationale: Metformin 500 mg, 1 tablet, PO, daily is clear and avoids risky abbreviations. Losartan uses a trailing zero, qd is discouraged, and HS is less preferred than explicit terms.

Extract:

A nurse is completing a client's history and physical examination. Which of the following information should the nurse consider subjective data?


Question 4 of 5

Nausea

Correct Answer: A

Rationale: Nausea is subjective, reported by the client. Petechiae, blood pressure, and cyanosis are objective, observable, or measurable.

Extract:

A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses?


Question 5 of 5

Hemolysis

Correct Answer: B

Rationale: Diphenhydramine prevents urticaria (hives), a mild allergic reaction. Hemolysis, fever, and fluid overload require different management.

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