ATI RN
ATI Capstone Exam 1 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Obtain a 12-lead ECG. A potassium level of 6.8 mEq/L is significantly elevated (normal range is 3.5-5.0 mEq/L) and can lead to serious cardiac complications, such as arrhythmias.
Therefore, obtaining an ECG is crucial to assess the client's cardiac status.
Choice B (salt substitute) is incorrect as it can further elevate potassium levels.
Choice C (citrus juices and bananas) is incorrect as these are high-potassium foods that should be avoided.
Choice D (serum sodium level) is irrelevant to the client's elevated potassium level.
Question 2 of 5
A nurse enters a client’s room and finds him on the floor in the clonic phase of a tonic-clonic seizure. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct action is to place a pillow under the client's head. This helps to protect the client's head from injury during the seizure. It is important to maintain a patent airway and prevent head injury. Inserting a padded tongue blade (choice
B) could cause injury or obstruct the airway. Applying a face mask for oxygen (choice
C) may not be necessary at this point and can be done after the seizure stops. Gently restraining the client's extremities (choice
D) can cause further injury. It is crucial to prioritize safety and comfort during a seizure.
Question 3 of 5
A nurse is preparing to administer 40 mg of furosemide IV. Available is furosemide 10 mg/mL. How many mL should the nurse administer per dose?
Correct Answer: 4
Rationale:
Correct Answer: A nurse should administer 4 mL of furosemide per dose.
To calculate this, divide the total dose (40 mg) by the concentration (10 mg/mL). 40 mg ÷ 10 mg/mL = 4 mL. This ensures the correct dosage is administered.
Choice B: Incorrect. This choice does not follow the correct calculation method and does not provide the accurate dosage.
Choice C: Incorrect. This choice does not consider the concentration of the medication and does not provide the correct amount to administer.
Choice D: Incorrect. This choice does not involve the necessary division of the total dose by the concentration, resulting in an incorrect answer.
Choice E: Incorrect. This choice does not show a clear calculation method or consideration of the medication concentration.
Choice F: Incorrect. This choice lacks any calculation or explanation, making it an insufficient answer.
Choice G: Incorrect. This choice does not provide any reasoning or calculation to support the amount to administer, making it an inadequate
Question 4 of 5
A community health nurse is developing a pamphlet about breast self-examination (BSE) for a local health fair. Which of the following instructions should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: Breasts can be examined in the shower with soapy hands. This instruction is important because warm water and soap help to make the examination more comfortable and easier to detect any abnormalities. By examining the breasts in the shower, the individual can incorporate BSE into their routine without it feeling like a separate task. This method also allows for better coverage and thorough examination of the entire breast tissue.
Choice A is incorrect because using the palm of the hand in a circular motion may not be as effective in detecting lumps compared to using the fingertips.
Choice B is incorrect as breast dimpling or discharge are not normal signs of aging, and should be reported to a healthcare provider.
Choice D is incorrect as performing BSE at specific times in the menstrual cycle is not necessary.
Question 5 of 5
A nurse is triaging clients following a mass casualty event. Which of the following clients should the nurse assess first?
Correct Answer: B
Rationale: The correct answer is B. The client with severe respiratory stridor and a deviated trachea should be assessed first as this indicates a compromised airway, which is a life-threatening emergency. Immediate intervention is crucial to prevent respiratory arrest. Clients with airway issues should always be the top priority in triage.
Other choices are incorrect because:
A: Small circular partial-thickness burn of the left calf is not immediately life-threatening and can be addressed after addressing more critical conditions.
C: Splinted open fracture of the left medial malleolus, while serious, does not present an immediate threat to the client's life compared to compromised airway.
D: Massive head injury and seizures are also serious, but in this scenario, the client with compromised airway takes precedence as airway issues can lead to rapid deterioration.