ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B Questions
Question 1 of 5
A nurse is caring for a toddler diagnosed with respiratory syncytial virus (RSV). Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Using a designated stethoscope is the correct action when caring for a toddler diagnosed with RSV. This measure helps prevent the spread of infection to other clients by reducing the risk of contamination. Wearing an N95 respirator mask is not necessary for routine care of a toddler with RSV unless performing aerosol-generating procedures. Removing the disposable gown after leaving the toddler's room is important for infection control but not specific to RSV care. Placing the toddler in a room with negative air pressure is not a standard practice for managing RSV in toddlers.
Question 2 of 5
A client who is 2 hours postpartum reports heavy bleeding and passing large clots. What is the nurse's priority action?
Correct Answer: A
Rationale: The correct answer is A: Perform fundal massage. Fundal massage promotes uterine contractions, which is the initial action to reduce postpartum hemorrhage caused by uterine atony. Checking vital signs (choice
C) is important but not the priority when active bleeding is present. Administering oxytocin IV (choice
B) may be needed but is not the priority action. Encouraging the client to void (choice
D) does not address the underlying issue of postpartum hemorrhage and should not be the priority.
Question 3 of 5
A nurse is teaching a client with newly diagnosed hypertension about lifestyle changes. Which of the following recommendations should the nurse make?
Correct Answer: B
Rationale: The correct answer is B: 'Exercise for at least 30 minutes most days of the week.' Regular exercise, especially aerobic activity, is known to help lower blood pressure and should be included in lifestyle changes for managing hypertension.
Choice A is incorrect because the recommended sodium intake for individuals with hypertension is usually lower than 3,000 mg per day.
Choice C is incorrect as it is advisable to limit alcohol intake to one drink per day for women and two drinks per day for men.
Choice D is incorrect because increasing fluid intake to 3 liters per day may not be necessary and could be harmful in some cases, depending on the individual's health status.
Question 4 of 5
The nurse instructs the patient about incentive spirometry as part of preoperative teaching. Which phase of the nursing process does this illustrate?
Correct Answer: C
Rationale: Instructing a patient about incentive spirometry falls under the implementation phase of the nursing process. During this phase, nursing interventions are put into action. Assessment (choice
A) involves collecting data about the patient's condition, planning (choice
B) involves setting goals and creating a care plan, and evaluation (choice
D) involves assessing the outcomes of nursing interventions.
Therefore, the correct answer is C, as it reflects the active teaching and intervention part of the process.
Question 5 of 5
A nurse is caring for a client with deep vein thrombosis (DVT). Which of the following interventions should the nurse include in the plan of care?
Correct Answer: D
Rationale: The correct answer is to elevate the affected leg while in bed. Elevating the leg helps reduce swelling and promotes venous return, aiding in the management of DVT. Positioning the affected leg below the heart can worsen the condition by increasing the risk of clot dislodgment. Massaging the affected extremity can also dislodge the clot and should be avoided. Cold compresses are not recommended as they can cause vasoconstriction, potentially worsening the condition.
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