ATI RN
ATI RN Capstone Proctored Comprehensive Assessment Exam A Questions
Extract:
Question 1 of 5
A nurse in a pediatric clinic is assessing a toddler at a well-child checkup. After reviewing the child's current medical record, which of the following interventions should the nurse expect the provider to prescribe?
Correct Answer: D
Rationale: The correct answer is D: Iron supplementation.
Toddlers often require iron supplementation as they are at risk for iron deficiency anemia due to rapid growth and dietary habits. The provider may prescribe this based on the child's medical record. Antibiotic therapy (
A) is not typically prescribed for a well-child checkup unless there is an active infection. Protective environment (
B) is a general concept for preventing infections and not a specific intervention for a toddler. Blood transfusion (
C) is a serious intervention usually reserved for severe cases of anemia, not typically indicated in a routine well-child checkup.
Question 2 of 5
A nurse is caring for a client who has a three-chamber chest tube system. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Ensure 2 cm (0.8 in) of water is in the water seal chamber. This is important to create a seal that prevents air from entering the pleural space. If the water level is too high or too low, it can affect the functioning of the chest tube system.
Choice B is incorrect as checking tubing patency every 2 hours is not necessary unless there are signs of blockage or decreased drainage.
Choice C is incorrect as the drainage system should be kept below the level of the client's chest to facilitate drainage by gravity.
Choice D is incorrect as the collection chamber should be emptied as needed based on the amount of drainage, not on a fixed time schedule.
Question 3 of 5
A nurse is assessing a child who is postoperative following a tonsillectomy. Which of the following findings should the nurse identify as the priority?
Correct Answer: D
Rationale: The correct answer is D: Frequent swallowing. This is the priority finding as it could indicate bleeding after tonsillectomy, which is a potential complication requiring immediate attention. Dark brown emesis (choice
B) could also indicate bleeding but is less specific. Sore throat (choice
A) is expected post-operatively. Blood-tinged mucus (choice
C) can be common after tonsillectomy.
Therefore, the priority is to assess for signs of bleeding, which is most indicative by frequent swallowing.
Question 4 of 5
A nurse is observing an assistive personnel (AP) measure blood pressures from the right arms of a group of clients. The nurse should instruct the AP to measure the blood pressure in the left arm of which of the following clients?
Correct Answer: C
Rationale: The correct answer is C: A client who has a right peripherally inserted central catheter (PIC
C). The reason for measuring blood pressure in the left arm of this client is to avoid potential damage to the PICC line in the right arm. Blood pressure measurements on the side with a PICC line should be avoided to prevent disruption of the line, which could lead to complications such as dislodgement, infection, or leakage of medication into the surrounding tissues.
Choice A (a client with an arteriovenous shunt in the left lower forearm) is incorrect because the shunt is not in the arm where blood pressure is being measured.
Choice B (a client with a right hemisphere stroke) is irrelevant to the location of the blood pressure measurement.
Choice D (a client who had blood drawn from the right antecubital area 1 hr ago) is also incorrect as recent blood draw does not impact the choice of arm for blood pressure measurement.
Question 5 of 5
A nurse is caring for a client who is at 32 weeks of gestation and has deep-vein thrombosis. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Measure and record the client's leg circumferences daily. This is essential in monitoring for changes in swelling, which can indicate worsening deep-vein thrombosis. This action helps in early detection of complications. Option B is incorrect as it can increase the risk of thrombus dislodgement. Option C is irrelevant as monitoring RBCs does not directly address the client's condition. Option D is contraindicated in pregnancy due to the risk of fetal harm.