ATI RN
ATI RN Capstone Proctored Comprehensive Assessment A Questions
Extract:
Question 1 of 5
A nurse is inserting a short peripheral IV catheter for a client who requires IV fluids. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Select a site proximal to previous venipuncture sites. This is important to prevent complications such as phlebitis and infiltration. Choosing a site proximal to previous punctures allows for better vein integrity and minimizes the risk of injury. Options A and B are incorrect as they do not address potential complications or best practices for IV insertion. Option D is incorrect since using a larger gauge catheter can actually increase the risk of phlebitis. Option E, F, and G are not provided. In summary, selecting a site proximal to previous venipuncture sites is crucial for successful IV therapy and minimizing complications.
Question 2 of 5
A client on an acute mental health unit states to a nurse, 'Tie a bow. Row the boat. Now I know. Whoa! I see you, yo.' The nurse should document that the client is exhibiting which of the following speech alterations?
Correct Answer: C
Rationale: The correct answer is C: Clang association. Clang association refers to a speech pattern where words are chosen based on their sound rather than their meaning. In this case, the client's speech is characterized by rhyming and alliteration, such as "bow" and "row," indicating a connection based on sound rather than coherent meaning. Echolalia (
A) is the repetition of words spoken by others, which is not present here. Word salad (
B) is a jumble of unrelated words and phrases that do not make sense. Neologisms (
D) are made-up words, which are also not present in the client's speech.
Therefore, Clang association best describes the speech alteration exhibited by the client in this scenario.
Question 3 of 5
A nurse is assessing a 24-month-old toddler at a well-child checkup. Which of the following findings indicates to the nurse that the toddler has a developmental delay?
Correct Answer: D
Rationale: The correct answer is D. Referring to oneself by name at 24 months is a developmental milestone indicating self-awareness and language development. It shows understanding of personal identity.
Choices A, B, and C are typical gross motor skills for a 24-month-old. Falling when throwing a ball overhand is expected as motor skills are still developing. Going up stairs with two feet on each step is a common way toddlers climb stairs for safety. Running with a wide stance is normal at this age for balance and stability.
Question 4 of 5
A nurse is teaching a client who has major depressive disorder about what to expect when undergoing electroconvulsive therapy. Which of the following information should the nurse give the client?
Correct Answer: B
Rationale: The correct answer is B: You might feel a bit confused for a few hours after the procedure. This is correct because confusion is a common side effect of electroconvulsive therapy (ECT) due to the temporary disruption of brain function. Clients may experience memory loss, disorientation, and confusion post-procedure.
Choice A is incorrect as voice changes are not typically associated with ECT.
Choice C is incorrect as clients usually wake up shortly after the procedure, not 30 minutes later.
Choice D is incorrect as pulsations in the neck are not a common side effect of ECT.
Question 5 of 5
A nurse is teaching about leg and foot care to a client who has peripheral vascular disease of the lower extremities. Which of the following instructions should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: Use lamb's wool between toes that rub together. Lamb's wool helps prevent friction and skin breakdown between toes, which is important for clients with peripheral vascular disease to prevent ulcers. Wearing nylon socks (
A) can cause sweating and increase moisture, leading to skin irritation. Trimming toenails short and rounding the edges (
B) can increase the risk of ingrown toenails and cuts. Applying compression stockings that fit over the knees (
D) may not be suitable for clients with peripheral vascular disease as it can restrict blood flow.