ATI RN
ATI RN Capstone Proctored Comprehensive Assessment Exam A Questions
Extract:
Question 1 of 5
A nurse is providing dietary teaching to the guardian of a preschooler who has celiac disease. Which of the following foods should the nurse recommend including in the preschooler's diet?
Correct Answer: C
Rationale: A corn tortilla with black beans. Corn tortillas are gluten-free, suitable for celiac disease. Rye, wheat, and barley contain gluten and must be avoided.
Question 2 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: Record a client's intake after each meal, obtain a client's vital signs every 4 hr, and transfer a client to physical therapy are within the scope of assistive personnel. Inserting an NG tube and instructing on an incentive spirometer require nursing judgment and cannot be delegated.
Question 3 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: C
Rationale: Post-procedure confusion is a common, temporary side effect of ECT. Pulsations, 30-minute awakening, or voice changes are not expected.
Extract:
Vital Signs
0830:
Temperature 35.1° C (95.2° F)
Heart rate 44/min
Respiratory rate 10/min
Blood pressure 84/45 mm Hg
Oxygen Saturation 90% on room air
Nurses' Notes
0800:
Client brought by ambulance to the ED with shallow breaths, slurred speech, confusion, and pupillary constriction. Minor abrasions noted on upper and lower extremities. Deep tendon reflexes (DTRs) 1+. Client vomited twice while in the care of emergency medical services. Family member fou the client lying on the sidewalk in front of the house. The client had not returned home last night, and the family member was going to see if the client's car was parked in the driveway.
Client's family member stated the client has had a change in their mood recently and was fired from their job for lack of attendance. The client came to live with the family member about 3 weeks ago after the client's partner divorced them, and they were without housing. The family member reports the client has been struggling for about a year with their back pain
Question 4 of 5
A nurse is caring for a client in the emergency department (ED).Exhibits: Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Correct Answer:
Rationale: Condition: Opioid intoxication (low vitals suggest opioid overdose). Actions: Obtain naloxone to reverse effects, prepare mechanical ventilation for respiratory depression. Parameters: Monitor pupillary reaction (miosis) and respiratory rate to assess treatment response.
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 5 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: Administer oxygen, initiate IV fluid bolus, assist to left lateral position, notify the provider, and prepare for amnioinfusion address fetal distress indicated by tachycardia and meconium-stained fluid. Hydralazine is not needed for normal BP, and oxytocin may worsen distress.