ATI Fundamentals Exam NUR 325 Study Questions and Correct Answers
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Course
NUR 325
Institution
NUR 325
Patient is receiving tube feedings + medication through gastrostomy. Diarrhea has begun. When should the nurse intervene. Wash out feeding bag at each refilling throughout the day -replace every 24 hrs
Impending death. Noisy respiration from secretions in airway. Nurse actions? Elevate the head of...
ATI Fundamentals Exam NUR 325 Study
Questions and Correct Answers
Patient is receiving tube feedings + medication through gastrostomy. Diarrhea has
begun. When should the nurse intervene. ✅Wash out feeding bag at each refilling
throughout the day -replace every 24 hrs
Impending death. Noisy respiration from secretions in airway. Nurse actions?
✅Elevate the head of the bed
Good source of complete protein ✅Cheddar cheese
Nurse administering enoxaparin SubQ to patient. Nurse actions? ✅administer
medication with needle at 45 degree angle.
Documentation ✅Descriptive, objective information
Fluid overload. First action? ✅Evaluate electrolytes
Home oxygen therapy education ✅-check cord routinely for frays or tearing
-consider purchasing a generator
-observe for signs of hypoxia
tracheostomy education ✅use tracheostomy covers when outdoors
Postoperative patient-SCDs in use. Nurse action? ✅make sure two fingers fit under
sleeves
Client reports no known allergies, but developed a rash after taking a certain antibiotic.
✅Document exact medication bc they may be allergic to it.
Patient discharging. Medication reconciliation process? ✅compare prescriptions with
medications the client received during hospitalization
Transferring (patient non weight baring on one leg) from bed to chair. How should you
secure a safe environment? ✅assess the client for orthostatic hypotension
Seizure ✅Wrap blankets around all 4 sides of the bed.
Sign of pressure ulcer? ✅albumin level of 3 g/dL (<3.5 indicates protein deficiency)
, Priority information for patient with pneumonia ✅Breath sounds
Sign that catheter requires irrigation? ✅Bladder scan shows 525 ml of urine
Respiratory infection. Technique used during nasotracheal suctioning? ✅apply
intermittent suction when withdrawing catheter
Postmortem care ✅1. obtain death pronouncement from provider
2. remove tubes and indwelling lines
3. cleanse the body
4. ask family if they'd like to view the body
5. place name tag on body before transfer
4 oz. water = 120 ml ✅document half of ice chip volume to account for air
Remove IV catheter if: ✅Swelling and coolness observed at site
Patient refusing blood transfusion due to religious beliefs. ✅examine personal values
about the issue
New wrist restraint prescription ✅Pad wrists before applying restraints
Abnormal lung sounds ✅-Crackles: discontinuous sounds heard primarily during
inhalation and resulting from air bubbling through fluid or mucus in airways
-Friction Rub: scratching/ squeaking persisting throughout resp. cycle
-Rhonchi: dry, low-pitched, snore-like noises produced in throat or bronchial tube due to
partial obstruction
Nasal cannula ✅No more than 6 L/min
IV insertion-how to prevent infection? ✅thread the IV catheter so that the hub rests at
the insertion site
Initiate discharge planning during ✅the admission process
Fluid volume deficit ✅causes tachycardia-corrected once HR is normalized
DNR ✅Oxygen can provide comfort and is not resuscitative when the nurse delivers it
via nasal cannula
To auscultate pulmonary valve ✅second intercostal space at left sternal border
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