a nurse is preparing to administer medications to a client who has a nasogastric ng tube which of the following actions should the nurse take first
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Nursing Elites

ATI RN

ATI Comprehensive Exit Exam 2023 With NGN

1. A nurse is preparing to administer medications to a client who has a nasogastric (NG) tube. Which of the following actions should the nurse take first?

Correct answer: A

Rationale: The correct first action for the nurse to take when preparing to administer medications to a client with a nasogastric (NG) tube is to check for tube placement. This step is crucial to ensure that the NG tube is correctly positioned in the stomach and not in the respiratory tract, reducing the risk of aspiration. Flushing the NG tube with 0.9% sodium chloride, administering the medications as a bolus, or dissolving the medications in sterile water should only be done after confirming the proper placement of the NG tube. Therefore, options B, C, and D are incorrect as they precede the essential step of verifying tube placement.

2. A nurse is planning care for a client who has dehydration. Which of the following interventions should the nurse include?

Correct answer: D

Rationale: The correct intervention for a client with dehydration is to administer 0.45% sodium chloride IV. This solution helps correct fluid imbalance by providing the necessary electrolytes. Restricting fluid intake (Choice A) is not appropriate for dehydration as the client needs adequate fluids to rehydrate. Providing a high-protein diet (Choice B) is not directly related to correcting dehydration. Encouraging the client to ambulate frequently (Choice C) is beneficial for overall health but does not address the issue of dehydration directly.

3. What is the priority nursing action for a patient with respiratory distress?

Correct answer: A

Rationale: The priority nursing action for a patient with respiratory distress is to administer oxygen. Oxygen therapy is crucial in improving oxygenation levels and relieving respiratory distress, making it the top priority intervention. Repositioning the patient, administering bronchodilators, or providing chest physiotherapy may be necessary interventions depending on the underlying cause, but ensuring adequate oxygen supply should take precedence in addressing respiratory distress.

4. A client is being discharged two days after a mastectomy. Which of the following instructions should the nurse include?

Correct answer: B

Rationale: The correct answer is to instruct the client to avoid lifting heavy objects for at least 6 weeks after a mastectomy. This is important to prevent complications and promote proper healing. Choice A is incorrect because tight-fitting bras can increase the risk of lymphedema and discomfort. Choice C is incorrect as sleeping on the affected side can cause discomfort and interfere with healing. Choice D is incorrect as initiating arm exercises too soon after surgery can strain the surgical site and hinder recovery.

5. A nurse is providing teaching to a client who has a new prescription for digoxin. Which of the following instructions should the nurse include?

Correct answer: B

Rationale: The correct answer is B: 'Contact your provider if you experience visual changes.' Visual changes, such as blurred or yellow vision, can indicate digoxin toxicity and should be reported immediately to the healthcare provider for further evaluation and management. Choice A is incorrect because digoxin can be taken with antacids. Choice C is incorrect because increasing potassium intake can lead to hyperkalemia when taking digoxin. Choice D is incorrect because increased urination is not a common side effect of digoxin.

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