ATI RN
ATI RN Capstone Proctored Comprehensive Assessment Exam A Questions
Extract:
Question 1 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: A client who has a right peripherally inserted central catheter. Measuring blood pressure on the same side as a PICC can damage the catheter. The shunt is in the lower forearm, stroke or recent blood draw do not contraindicate right-arm measurement.
Question 2 of 5
A nurse is monitoring a client who is receiving a transfusion of packed RBCs. The client reports chills, headache, low-back pain, and a feeling of 'tightness' in their chest. The nurse should identify that the client has developed which of the following types of transfusion reactions?
Correct Answer: B
Rationale: Acute hemolytic. This reaction occurs when the client receives incompatible blood, leading to red blood cell destruction. Symptoms include chills, headache, low-back pain, chest tightness, hypotension, and fever. Allergic reactions typically involve itching and rash. Bacterial reactions involve fever and sepsis. Febrile nonhemolytic reactions lack low-back pain and chest tightness.
Question 3 of 5
A nurse is caring for a client who is 12 hr postoperative following a below-the-knee amputation. Which of the following interventions should the nurse implement?
Correct Answer: C
Rationale: Using an overbed trapeze promotes mobility and prevents pressure injuries. Turning every 2 hours, not 4, is needed, air mattresses are not specific, and bandages are rewrapped every 4–6 hours in a figure-eight pattern.
Question 4 of 5
A nurse is evaluating the progress of a school-age child who takes methylphenidate. Which of the following findings indicates the effectiveness of the medication?
Correct Answer: A
Rationale: Decreased impulsiveness. Methylphenidate treats ADHD by improving impulse control. Abdominal pain resolution, increased appetite, or urine output are not indicators of effectiveness.
Question 5 of 5
A nurse is assessing a client who has a sliding hiatal hernia. Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: Heartburn is common due to acid reflux from the hernia. Breathlessness, cramping, or constipation are not typical symptoms.