ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B with NGN
1. A patient prescribed warfarin is being taught about dietary restrictions by a healthcare provider. Which of the following foods should the patient be instructed to limit?
- A. Bananas
- B. Spinach
- C. Potatoes
- D. Apples
Correct answer: B
Rationale: The correct answer is B: Spinach. Spinach is high in vitamin K, which can interfere with the effectiveness of warfarin, an anticoagulant medication. Patients taking warfarin should limit foods high in vitamin K to maintain the medication's effectiveness and consistent dosage. Bananas, potatoes, and apples are not high in vitamin K and do not typically interfere with warfarin therapy.
2. A client is prescribed 1g of potassium phosphate IV to be infused continuously over 6 hr. Available is 1 g in 250 ml of dextrose 5%. What rate should the nurse set the IV pump to run at?
- A. 40 ml/hr
- B. 42 ml/hr
- C. 44 ml/hr
- D. 46 ml/hr
Correct answer: B
Rationale: To calculate the IV rate, divide the total volume by the total time in hours. In this case, 1 g in 250 ml is to be infused over 6 hours. Therefore, 250 ml / 6 hr = 42 ml/hr. This means the IV pump should be set to run at 42 ml/hr. Choices A, C, and D are incorrect as they do not accurately calculate the infusion rate based on the provided information.
3. A nurse is monitoring a client following a thoracentesis. The nurse should identify which of the following manifestations as a complication and contact the provider immediately?
- A. Increased heart rate
- B. Decreased temperature
- C. Serosanguineous drainage from the puncture site
- D. Discomfort at the puncture site
Correct answer: A
Rationale: Correct Answer: A nurse should identify an increased heart rate as a complication following a thoracentesis and contact the provider immediately. An increased heart rate may indicate a pneumothorax or other serious complications. Choices B, C, and D are incorrect because decreased temperature, serosanguineous drainage, and discomfort at the puncture site are expected findings following a thoracentesis and do not indicate a significant complication requiring immediate provider notification.
4. Which of the following is an adverse effect of Lithium Carbonate that requires client education?
- A. Increased risk of infection
- B. Gastrointestinal distress
- C. Increased white blood cell count
- D. Nausea and vomiting
Correct answer: B
Rationale: The correct answer is B: Gastrointestinal distress. When taking Lithium Carbonate, clients may experience gastrointestinal distress as an adverse effect. It is crucial to educate clients about this potential side effect to help them manage it effectively. Choices A, C, and D are incorrect. Increased risk of infection (Choice A) is not a typical adverse effect of Lithium Carbonate. Similarly, increased white blood cell count (Choice C) is not associated with this medication's adverse effects. Nausea and vomiting (Choice D) are general side effects of many medications but are not specifically attributed to Lithium Carbonate.
5. A client is vomiting, and a nurse is providing care. Which of the following actions should the nurse take first?
- A. Administer an antiemetic to the client
- B. Notify housekeeping
- C. Prevent the client from aspirating
- D. Provide the client with an emesis basin
Correct answer: C
Rationale: Preventing aspiration is the priority when caring for a client who is vomiting to reduce the risk of pneumonia or other respiratory complications. Aspiration can occur when vomitus enters the airway, leading to respiratory distress. Ensuring the airway is protected during vomiting episodes is essential. Administering an antiemetic (Choice A) can be considered after addressing the immediate risk of aspiration. Notifying housekeeping (Choice B) and providing an emesis basin (Choice D) are important but are secondary to preventing aspiration, which is crucial for the client's safety and well-being.
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