ATI RN
ATI NUR 104 Final Assessment Fundamentals Questions
Extract:
A nurse is administering several medications via a client's gastrostomy tube. At which of the following times should the nurse instill 15 to 30 mL of warm water? (Select all that apply.)
Question 1 of 5
Prior to administering each medication
Correct Answer: A,D,E
Rationale: Instilling water before and after each medication and after multiple medications ensures proper delivery and prevents clogging. Aspirating contents and slow flow do not require water instillation.
Extract:
A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation?
Question 2 of 5
The client has not been taking the medication properly
Correct Answer: C
Rationale:
Tolerance, requiring higher doses for the same effect, explains the need for increased morphine. Addiction involves compulsive use, not dose increase, and other options are unrelated.
Extract:
A nurse is administering several medications via a client's gastrostomy tube. At which of the following times should the nurse instill 15 to 30 mL of warm water? (Select all that apply.)
Question 3 of 5
Prior to administering each medication
Correct Answer: A,D,E
Rationale: Instilling water before and after each medication and after multiple medications ensures proper delivery and prevents clogging. Aspirating contents and slow flow do not require water instillation.
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 receiving a provider's prescription for a client via telephone. Which of the following actions should the nurse take to ensure the accuracy of the telephone prescription? (Select all that apply.)
Question 5 of 5
Question any part of the order that is unclear or inappropriate
Correct Answer: A,D,E
Rationale: Questioning unclear orders, repeating the order back, and obtaining the provider’s signature within a specified timeframe (typically 24 hr) ensure accuracy. Transcribing is necessary but not sufficient alone, and recorded messages are not standard.