ATI RN
ATI Nursing 100 Day Exam 4 Fundamentals Questions
Extract:
Question 1 of 5
The nurse is to administer a volume of 2 mL intramuscularly (IM) to a 150-pound client. Assuming that there are no skin problems which is the preferred site for the injection?
Correct Answer: C
Rationale: The ventrogluteal site is preferred for IM injections in adults due to its safety (avoids sciatic nerve) and vascularity accommodating 2 mL comfortably. Deltoid is less suitable for larger volumes dorsogluteal risks nerve injury and vastus lateralis is preferred in infants.
Question 2 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.
Question 3 of 5
An adult client is to receive ear drops four times a day to treat an inner ear infection. What is the correct nursing procedure to follow when administering this type of medication?
Correct Answer: C
Rationale: Pulling the auricle up and back straightens the ear canal in adults for effective ear drop administration ensuring medication reaches the inner ear. Down and back is for children pulling the earlobe post-instillation is unnecessary and microwaving risks burns.
Question 4 of 5
A client has a serum potassium level of 6.3 mEq/L. The nurse recognizes that the highest priority intervention(s) for this client are to:
Correct Answer: C,E
Rationale: Hyperkalemia (6.3 mEq/L above normal 3.5-5.0 mEq/L) risks cardiac dysrhythmias and neuromuscular issues requiring immediate assessment for muscle weakness/flaccid paralysis and cardiac monitoring to detect life-threatening arrhythmias. Diluting potassium or encouraging potassium-rich foods worsens hyperkalemia and intake/output monitoring is secondary.
Question 5 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.