ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A client in the second trimester of pregnancy asks how to treat constipation. Which of the following should the nurse recommend?
- A. Decrease intake of vitamins and supplements to every other day
- B. Eat 15 g of fiber per day
- C. Consume 48 ounces of water daily
- D. Drink hot water with lemon juice each morning
Correct answer: D
Rationale: The correct answer is D: Drink hot water with lemon juice each morning. Drinking hot water with lemon juice can help stimulate bowel movements, making it a natural and safe recommendation for pregnant clients experiencing constipation. Choice A is incorrect because reducing vitamin and supplement intake may not directly address constipation. Choice B, eating 15 g of fiber per day, could be helpful but may not be as effective as the correct answer for immediate relief. Choice C, consuming 48 ounces of water daily, is essential for overall health but may not be as directly effective as the correct answer in alleviating constipation.
2. A healthcare professional is preparing to administer a dose of naloxone. Which of the following should the healthcare professional assess?
- A. Heart rate
- B. Respiratory rate
- C. Blood pressure
- D. Temperature
Correct answer: B
Rationale: Correct. Naloxone is used to reverse opioid overdose, which can cause respiratory depression. Assessing the respiratory rate before administering naloxone is crucial to monitor the patient's breathing. Choices A, C, and D are important assessments in general patient care but are not specifically crucial before administering naloxone for opioid overdose.
3. A nurse in a provider's office is assessing the motor skill development of a 15-month-old toddler during a well-child visit. What gross motor skills should the nurse expect to observe?
- A. Walks without assistance using a wide stance
- B. Climbs stairs with assistance
- C. Runs smoothly
- D. Kicks a ball forward
Correct answer: A
Rationale: The correct answer is A. At 15 months, toddlers typically walk independently but may do so with a wide stance for balance. Choice B, climbing stairs with assistance, is more common around 18 months. Choice C, running smoothly, is usually achieved around 2 years of age. Choice D, kicking a ball forward, generally develops around 2 to 3 years of age. Therefore, for a 15-month-old toddler, the nurse should expect the child to walk without assistance using a wide stance for balance.
4. The nurse instructs the patient about incentive spirometry as part of preoperative teaching. Which phase of the nursing process does this illustrate?
- A. Assessment
- B. Planning
- C. Implementation
- D. Evaluation
Correct answer: C
Rationale: Instructing a patient about incentive spirometry falls under the implementation phase of the nursing process. During this phase, nursing interventions are put into action. Assessment (choice A) involves collecting data about the patient's condition, planning (choice B) involves setting goals and creating a care plan, and evaluation (choice D) involves assessing the outcomes of nursing interventions. Therefore, the correct answer is C, as it reflects the active teaching and intervention part of the process.
5. While caring for a client receiving patient-controlled analgesia (PCA), which of the following interventions should the nurse take?
- A. Encourage the client to use the PCA before dressing changes.
- B. Monitor the client's respiratory status.
- C. Provide oxygen therapy to the client as needed.
- D. Ensure the PCA pump is functioning properly.
Correct answer: A
Rationale: Corrected Rationale: The nurse should encourage the client to use the PCA pump before activities like dressing changes, which are likely to cause pain, to ensure effective pain management. Monitoring the client's respiratory status (Choice B) is important but not the priority in this scenario. Providing oxygen therapy (Choice C) is not a routine intervention for all clients on PCA unless specifically indicated. Ensuring the PCA pump is functioning properly (Choice D) is essential, but encouraging the client to use the PCA before painful activities takes precedence to manage pain effectively.
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