ATI RN
ATI RN Capstone Proctored Comprehensive Assessment A Questions
Extract:
Question 1 of 5
A nurse is teaching the parents of a school-age child who has sickle cell anemia about managing the disease at home. Which of the following instructions should the nurse include?
Correct Answer: A
Rationale:
Correct Answer: A - Report sudden, persistent headaches
Rationale: Sudden, persistent headaches in a child with sickle cell anemia could indicate a serious complication such as a stroke. Immediate medical attention is crucial to prevent further complications. Reporting symptoms promptly can lead to timely interventions and prevent life-threatening situations.
Summary of Incorrect
Choices:
B: Restricting fluid intake during times of stress is not recommended for children with sickle cell anemia as adequate hydration helps prevent dehydration and complications.
C: Applying cold compresses to painful areas may provide temporary relief, but it does not address the underlying cause of pain in sickle cell anemia.
D: Meningococcal immunizations are important for children with sickle cell anemia to prevent infections, so avoiding them is not recommended.
Question 2 of 5
A nurse is reviewing a client’s laboratory results prior to administering medications. Which of the following findings should the nurse report to the provider?
Correct Answer: C
Rationale: The correct answer is C: SpO2 88%. This finding indicates low oxygen saturation levels, which can be life-threatening and require immediate medical attention. Oxygen saturation below 90% is considered critically low and can lead to hypoxemia. Reporting this to the provider promptly is crucial to ensure appropriate interventions are implemented to improve oxygenation.
A: Temperature within normal range.
B: Respiratory rate slightly elevated but not critical.
D: pH slightly low but not immediately life-threatening.
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: D
Rationale: The correct answer is D: Instruct the client to use an overbed trapeze to move around in bed. This intervention promotes client independence and mobility while reducing the risk of complications such as pressure ulcers and venous thromboembolism. Using an overbed trapeze allows the client to reposition themselves safely without undue strain on the residual limb. Placing the client on an air mattress (
A) may help with pressure redistribution but does not address mobility needs. Rewrapping the bandage every 8 hr in a circular pattern (
B) can cause constriction and compromise circulation. Turning the client every 4 hr while in bed (
C) is important for preventing pressure ulcers but does not address mobility.
Question 4 of 5
A nurse is reviewing laboratory data for a client who has a new prescription for valproic acid. Which of the following baseline results should the nurse review prior to administering the first dose of the medication?
Correct Answer: D
Rationale: The correct answer is D: Liver function tests. Valproic acid is known to potentially cause liver toxicity.
Therefore, reviewing liver function tests before administering the medication is crucial to assess the baseline liver function and monitor for any potential adverse effects.
A: Potassium level - not directly related to valproic acid administration.
B: Thyroid function tests - not necessary for assessing the safety of starting valproic acid.
C: Uric acid level - not directly related to valproic acid administration.
Question 5 of 5
A nurse is assessing a client who is receiving enteral feedings via an NG tube. The client has developed hyperosmolar dehydration. Which of the following actions should the nurse take when administering the client's feedings?
Correct Answer: D
Rationale:
Correct Answer: D - Add water to the formula
Rationale: Hyperosmolar dehydration occurs when there is an excessive concentration of solutes in the body. By adding water to the formula, the nurse can dilute the concentration of solutes in the enteral feeding, helping to rehydrate the client and prevent further dehydration.
Summary of other choices:
A: Switching to a lactose-free formula is not directly related to treating hyperosmolar dehydration.
B: Repositioning the NG tube is important for preventing complications but does not address the dehydration issue.
C: Increasing the rate of formula delivery may worsen the dehydration by overwhelming the client's system.
E, F, G: No other choices are provided, but they would likely not be relevant to treating hyperosmolar dehydration.