ATI RN Capstone Proctored Comprehensive Assessment Exam A | Nurselytic

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ATI RN Capstone Proctored Comprehensive Assessment Exam A Questions

Extract:

Vital Signs
2000:
Temperature 36.7° C (98.1° F)
Heart rate 98/min
Respiratory rate 20/min
Blood pressure 128/84 mm Hg
Oxygen saturation 98% on room air
2100:
Temperature 37.5° C (99.5° F)
Heart rate 104/min
Respiratory rate 20/min
Blood pressure 132/84 mm Hg
Oxygen saturation 98% on room air
Nurses' Notes
2000:
Client is 38-year-old, G4 P3 at 38 weeks of gestation. Presents for evaluation of labor and spontaneous rupture of membranes (SROM). Client states, "My water broke a couple of hours ago and is a greenish color." Client also reports contractions began about 4 hr ago and have become consistently stronger and closer together.
Electronic fetal monitor applied. Small amount of thin green fluid noted on perineal pad. Contraction palpated, lasted 40 seconds, moderate in intensity. Fetal heart rate (FHR) 165/min. Vaginal examination performed: cervix 4 cm dilated, 70% effaced, 0 station, vertex presentation.
Client reports a history of chronic hypertension that has been well-controlled during this pregnancy. Also states Was diagnosed with gestational diabetes at 28 weeks of gestation.
2020:
Contractions occurring every 4 to 5 min, lasting 40 to 60
seconds. Small amount of bloody show noted when changing disposable pad on bed. Client rates contraction pain as a 5 on a scale of 0 to 10, breathing well through contractions. FHR 168/min, minimal variability. Client denies epigastric pain or



Question 1 of 5

A nurse in an antepartum unit is caring for a client. Which of the following actions should the nurse take?

Correct Answer: A,C,D,F,G

Rationale: The correct actions for the nurse to take are A, C, D, F, and G. Administering oxygen at 10L/min via a nonrebreather face mask is important for respiratory support. Initiating a bolus of IV fluid helps maintain adequate hydration and perfusion. Assisting the client to the left lateral position promotes optimal blood flow to the fetus. Notifying the provider of the client's condition ensures timely intervention. Lastly, preparing to administer an amnioinfusion may be necessary based on the client's condition. These actions prioritize the client's respiratory, circulatory, and fetal well-being. Other choices like requesting hydralazine or oxytocin may not be indicated without proper assessment and prescription.

Extract:


Question 2 of 5

Correct Answer:

Rationale:

Question 3 of 5

Correct Answer:

Rationale:

Question 4 of 5

Correct Answer:

Rationale:

Question 5 of 5

Correct Answer:

Rationale:

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