ATI RN
RN ATI Capstone Proctored Comprehensive Assessment A
1. Which principle is most important for maintaining medical asepsis in a healthcare setting?
- A. Sterilize instruments only when visibly contaminated.
- B. Use sterile gloves for all patient interactions.
- C. Disinfect patient areas only at the end of the day.
- D. Clean hands thoroughly before and after patient contact.
Correct answer: D
Rationale: The correct answer is D: Clean hands thoroughly before and after patient contact. Hand hygiene is crucial for maintaining medical asepsis in a healthcare setting as it helps prevent the spread of infections between patients and healthcare workers. Choice A is incorrect because instruments should be sterilized regularly, not just when visibly contaminated. Choice B is incorrect as sterile gloves are not required for all patient interactions, only for specific procedures. Choice C is incorrect because patient areas should be disinfected regularly throughout the day, not just at the end of the day.
2. A patient reflects a correct understanding about the relationship between the gate control theory of pain and the use of meditation to relieve pain?
- A. Meditation alters the chemical composition of pain neuroregulators, which closes the gate.
- B. Meditation stops the occurrence of pain stimuli.
- C. Meditation controls pain by blocking pain impulses from coming through the gate.
- D. Meditation will help me sleep through the pain because it opens the gate.
Correct answer: C
Rationale: The correct answer is C. According to the gate control theory, meditation helps relieve pain by blocking pain impulses from coming through the gate in the central nervous system. Choice A is incorrect as meditation does not directly alter the chemical composition of pain neuroregulators. Choice B is incorrect because meditation does not stop the occurrence of pain stimuli. Choice D is incorrect as meditation does not open the gate but rather closes it to block pain impulses.
3. A client undergoing surgery refuses to remove religious jewelry. What is the best course of action?
- A. Proceed with surgery while securing the jewelry to the patient.
- B. Remove the jewelry and document the removal.
- C. Document the refusal and delay the surgery.
- D. Remove the jewelry with the family's permission.
Correct answer: B
Rationale: The correct course of action is to remove the jewelry and document the removal. While religious beliefs should be respected, ensuring patient safety during surgery is crucial. Securing the jewelry may not be sufficient to prevent any interference during the surgical procedure. Documenting the removal is important for legal and documentation purposes. Delaying the surgery or removing the jewelry with the family's permission may not be the best options as patient safety should be the top priority in this situation.
4. A nurse is preparing to administer a high dose of morphine to a patient with terminal cancer. What is the nurse's primary consideration before administration?
- A. Ensure the family is aware of the dosage to be administered.
- B. Monitor the patient for respiratory depression.
- C. Administer the morphine in divided doses.
- D. Delay administration until the next assessment.
Correct answer: B
Rationale: The correct answer is B: Monitor the patient for respiratory depression. When administering a high dose of morphine, the nurse's primary consideration should be to monitor the patient for respiratory depression, as morphine can slow down breathing, especially in higher doses. Option A is incorrect because the primary focus should be on the patient's well-being and safety rather than family awareness at this point. Option C is not the best approach as the immediate concern is monitoring the patient closely for any adverse effects. Option D is not advisable as delaying administration without a valid reason can compromise pain management in a terminal cancer patient.
5. Which intervention is essential when caring for a patient with a nasogastric (NG) tube?
- A. Suction the NG tube every 4 hours.
- B. Check the placement of the NG tube before each feeding.
- C. Flush the NG tube with water before and after each medication administration.
- D. Remove the NG tube once the patient feels comfortable.
Correct answer: B
Rationale: Checking the placement of the NG tube before each feeding is crucial to ensure it is correctly positioned and safe to use. Option A is incorrect as routine suctioning can lead to complications and should only be done as needed. Option C is not necessary unless there are specific instructions for flushing. Option D is incorrect as the NG tube should only be removed by healthcare professionals based on medical criteria, not solely based on the patient's comfort.
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