ATI RN
ATI RN Capstone Proctored Comprehensive Assessment Exam A Questions
Extract:
Question 1 of 5
A nurse is planning assignments for the upcoming shift. Which of the following tasks should the nurse delegate to an assistive personnel?
Correct Answer: B,C,E
Rationale:
Correct Answer: B, C, E
Rationale:
1. Recording a client's intake after each meal can be delegated as it does not require specialized nursing skills.
2. Obtaining a client's vital signs at regular intervals is a routine task that can be safely delegated.
3. Transferring a client to physical therapy can be done by assistive personnel under supervision.
Incorrect
Choices:
A. Inserting an NG tube requires specialized nursing training and should not be delegated.
D. Instructing a client on the use of an incentive spirometer involves teaching and assessment, which should be done by a nurse.
Question 2 of 5
A nurse is speaking with a client during a counseling session who states, 'I feel like I am sliding off a cliff.' Which of the following responses should the nurse make?
Correct Answer: C
Rationale: The correct response is C: "You must be feeling very frightened right now." This acknowledges the client's emotions without making assumptions about the cause or offering unsolicited advice. It shows empathy and validates the client's feelings, which is essential in counseling.
Choice A is too vague and does not address the client's emotional state.
Choice B puts the client on the spot and may come off as confrontational.
Choice D is dismissive and invalidates the client's emotions by suggesting they simply think positively. By choosing option C, the nurse demonstrates active listening and creates a supportive environment for the client to express their feelings further.
Question 3 of 5
A nurse is admitting a client to the medical-surgical unit. The Patient Self-Determination Act requires the nurse to perform which of the following actions during the admission process?
Correct Answer: A
Rationale: The correct answer is A: Document in the client's medical record if the client has advance directives. This is in line with the Patient Self-Determination Act, which requires healthcare providers to inform patients of their right to make decisions about their own medical care, including the right to have advance directives. By documenting this information in the client's medical record, the nurse ensures that the client's wishes regarding their medical care are known and respected.
Choice B is incorrect because the act does not require the nurse to ensure the client has an attorney for end-of-life documents.
Choice C is incorrect because providing end-of-life education is not mandated by the act unless requested by the client.
Choice D is incorrect because the act does not require the nurse to provide a list of eligible individuals who can serve as a health care proxy.
Question 4 of 5
A nurse observes two assistive personnel (AP) discussing a client's information in the facility cafeteria. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Remind the AP about maintaining client confidentiality. The nurse should address the issue directly with the AP to reinforce the importance of maintaining client confidentiality. This action helps educate the AP on proper conduct and ensures compliance with privacy regulations.
Choices B, C, and D are incorrect because they do not address the immediate issue at hand and may escalate the situation unnecessarily. Notifying the client could breach confidentiality further, involving the ethics committee may be premature, and filing an incident report without addressing the behavior directly may not prevent future violations.
Question 5 of 5
In which order should the nurse perform the following steps for administering timolol eye drops? A. Administer the prescribed number of drops, B. Apply gentle pressure to the client's punctum, C. Tilt the client's head backward toward the ceiling, D. Pull the client's lower lid down with the nondominant hand, E. Verify the clarity and color of the eye drops.
Correct Answer: E,C,D,A,B
Rationale: The correct order for administering timolol eye drops is as follows:
E. Verify the clarity and color of the eye drops - This step ensures the correct medication is being used.
C. Tilt the client's head backward toward the ceiling - This position helps the drops enter the eye properly.
D. Pull the client's lower lid down with the nondominant hand - This helps create a pocket for the drops.
A. Administer the prescribed number of drops - The actual administration of the medication.
B. Apply gentle pressure to the client's punctum - This helps prevent systemic absorption of the medication.
The other choices are incorrect because they are not in the correct sequence for administering eye drops effectively.