A nurse is performing a focused assessment on a client with a history of chronic obstructive pulmonary disease (COPD). What finding should the nurse expect?

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ATI Capstone Fundamentals Assessment Proctored Questions

Question 1 of 5

A nurse is performing a focused assessment on a client with a history of chronic obstructive pulmonary disease (COPD). What finding should the nurse expect?

Correct Answer: B

Rationale: The correct answer is B: Flushed skin. Flushed skin is a common finding in clients with COPD who are experiencing dyspnea. Increased breath sounds (choice A) are not typically associated with COPD; they may indicate conditions like pneumonia. Nasal flaring (choice C) is more commonly seen in respiratory distress in pediatric patients. Decreased respiratory rate (choice D) is not a typical finding in COPD and could indicate respiratory depression.

Question 2 of 5

A nurse is caring for a client who is receiving continuous enteral feedings. What finding indicates intolerance to the feeding?

Correct Answer: B

Rationale: Nausea is a common sign of intolerance to enteral feedings and should be addressed promptly. Weight gain is not typically associated with intolerance to enteral feedings; instead, it may indicate other issues such as fluid retention. Constipation is also not a direct indicator of intolerance to enteral feedings. While an elevated heart rate can occur for various reasons, it is less specific to enteral feeding intolerance compared to nausea.

Question 3 of 5

A nurse is caring for a client who reports pain and burning around the peripheral IV site. What is the nurse's priority action?

Correct Answer: B

Rationale: The correct answer is B: Discontinue the IV line. When a client reports pain and burning around the peripheral IV site, it indicates possible phlebitis, which is inflammation of the vein. The priority action is to discontinue the IV line to prevent further complications such as infection or thrombosis. Applying a warm compress (Choice A) may worsen the inflammation. Increasing the IV flow rate (Choice C) can exacerbate the symptoms and elevate the risk of complications. Elevating the limb (Choice D) may provide comfort, but it does not address the underlying issue of phlebitis. Therefore, the priority action is to discontinue the IV line.

Question 4 of 5

A nurse is preparing to transfer a client from a bed to a chair. The client can bear partial weight and has upper body strength. What device should the nurse use?

Correct Answer: D

Rationale: A stand-assist lift is the correct choice in this scenario. This device is suitable for clients who can bear partial weight and have upper body strength, as it allows them to actively participate in the transfer process. A mechanical lift is typically used for clients who are non-weight bearing or have limited mobility. A gait belt is used for providing support and stability during walking or transferring short distances. A slide board is used for transferring clients who are unable to bear weight and need assistance moving from one surface to another.

Question 5 of 5

A healthcare professional is reviewing a client's medical history and identifies an increased risk for infections. What risk factor should the healthcare professional include?

Correct Answer: D

Rationale: The correct answer is D: Chronic conditions. Chronic conditions, such as diabetes or immune suppression, can compromise the immune system, making individuals more susceptible to infections. Frequent handwashing (Choice A) is actually a protective measure against infections. Increased mobility (Choice B) and high blood pressure (Choice C) are not directly associated with an increased risk for infections.

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