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PN ATI Capstone Proctored Comprehensive Assessment 2020 B
1. A nurse is preparing to administer total parenteral nutrition (TPN) to a client. Which of the following findings indicates a need to obtain a new bag of TPN before administering?
- A. The TPN solution has an oily appearance and a layer of fat on top of the solution.
- B. The TPN solution contains added electrolytes, vitamins, and trace elements.
- C. The bag of TPN was prepared by the pharmacy 12 hours prior.
- D. The bag of TPN is labeled with the client's name, medical record number, and prescription.
Correct answer: A
Rationale: A TPN solution with an oily appearance and a layer of fat on top indicates that the solution is 'cracked' and should not be used as it may have separated or deteriorated. This finding suggests a need to obtain a new bag of TPN before administering. Options B, C, and D are normal aspects of TPN administration. Option B confirms the presence of essential components in the TPN solution, option C provides information about the preparation time, and option D ensures proper identification and matching of the TPN with the correct client.
2. A healthcare provider is reviewing the medical records of a group of older adults (OA). The provider should identify that which of the following is a risk factor that places OA at an increased risk for developing infections?
- A. Improved circulation
- B. Increased immune function
- C. Lowered immune system function
- D. Dehydration
Correct answer: C
Rationale: The correct answer is C: 'Lowered immune system function.' As individuals age, their immune system tends to weaken, making them more susceptible to infections. Choices A, B, and D are incorrect because improved circulation and increased immune function would typically reduce the risk of infections, while dehydration can impact overall health but is not directly related to immune system function in the context of infection risk.
3. A home health nurse is providing teaching to a patient who has a new diagnosis of a gastric ulcer and a new prescription for sucralfate oral suspension. What statement by the patient indicates an understanding of the teaching?
- A. I will take this medicine with meals.
- B. I will take this medicine right before bed.
- C. I will take this medicine 1 hour before meals and at bedtime.
- D. I will take this medicine only when I have symptoms.
Correct answer: C
Rationale: The correct answer is C because sucralfate should be taken on an empty stomach, 1 hour before meals, and at bedtime to coat the ulcer and protect it from stomach acid. Choice A is incorrect because taking it with meals may reduce its effectiveness. Choice B is incorrect as it should not be taken right before bed. Choice D is incorrect as sucralfate should be taken regularly as prescribed, not just when symptoms occur.
4. A client is being educated by a nurse about the use of carbidopa-levodopa. Which of the following should be included?
- A. It will cure Parkinson's disease
- B. Monitor for dyskinesia
- C. It can be taken with food
- D. It is an opioid medication
Correct answer: B
Rationale: The correct answer is to 'Monitor for dyskinesia.' Carbidopa-levodopa can cause dyskinesia as a side effect, characterized by involuntary movements. Monitoring for this side effect is crucial. Choice A is incorrect because carbidopa-levodopa helps manage symptoms of Parkinson's disease but does not cure it. Choice C is incorrect because carbidopa-levodopa should be taken on an empty stomach to enhance absorption. Choice D is incorrect because carbidopa-levodopa is not an opioid medication.
5. A healthcare professional is assessing a client for signs of anaphylaxis. Which of the following findings should the healthcare professional look for?
- A. Bradycardia
- B. Hypotension
- C. Increased appetite
- D. Decreased respiratory rate
Correct answer: B
Rationale: Hypotension is a critical sign of anaphylaxis. During anaphylaxis, there is a widespread vasodilation leading to a drop in blood pressure, which manifests as hypotension. This can be accompanied by other symptoms such as swelling, difficulty breathing, hives, and itching. Bradycardia (choice A) is not typically associated with anaphylaxis; instead, tachycardia is more common due to the body's response to the allergic reaction. Increased appetite (choice C) is unrelated to anaphylaxis, as individuals experiencing anaphylaxis often feel unwell and may have nausea or vomiting. Decreased respiratory rate (choice D) is also not a typical finding in anaphylaxis; instead, respiratory distress and wheezing are more commonly observed.
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