ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B with NGN
1. A client is experiencing chest pain. Which action should the nurse take first?
- A. Administer aspirin
- B. Provide oxygen
- C. Perform an ECG
- D. Administer nitroglycerin
Correct answer: D
Rationale: Administering nitroglycerin is the priority action when a client is experiencing chest pain as it helps alleviate the pain caused by reduced blood flow to the heart. Oxygen can be beneficial, but nitroglycerin takes precedence in this situation. Aspirin can also be given, but nitroglycerin is the priority. Performing an ECG can provide valuable information but is not the first action to take in this scenario.
2. A patient reports nausea and vomiting after chemotherapy. What is the nurse's priority action?
- A. Administer an antiemetic as prescribed.
- B. Encourage the patient to eat small, frequent meals.
- C. Provide the patient with anti-nausea wristbands.
- D. Encourage the patient to rest after eating.
Correct answer: A
Rationale: The correct answer is to administer an antiemetic as prescribed. Chemotherapy-induced nausea and vomiting can be distressing for patients. Administering an antiemetic helps alleviate these symptoms effectively. Choice B, encouraging the patient to eat small, frequent meals, may be helpful for other gastrointestinal issues but is not the priority when the patient is experiencing nausea and vomiting. Choice C, providing anti-nausea wristbands, may offer some relief but is not as direct and immediate as administering an antiemetic. Choice D, encouraging the patient to rest after eating, is not the priority in this situation where the focus should be on managing the nausea and vomiting.
3. 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.
4. A nurse is caring for a client with pneumonia who has a new prescription for antibiotics. Which of the following actions should the nurse take first?
- A. Administer the antibiotic immediately
- B. Obtain a sputum culture
- C. Notify the provider of the prescription
- D. Check the client's allergy history
Correct answer: B
Rationale: The correct first action for the nurse to take when caring for a client with pneumonia who has a new prescription for antibiotics is to obtain a sputum culture. This is important to identify the specific bacteria causing the pneumonia before administering antibiotics. Administering the antibiotic immediately (Choice A) may not be appropriate without knowing the specific pathogen. Notifying the provider of the prescription (Choice C) is important but not the first action to be taken. Checking the client's allergy history (Choice D) is relevant but not the priority in this situation.
5. A client is administering insulin. Which statement by the client shows proper understanding of insulin administration?
- A. I will inject insulin into my thigh before exercise
- B. I will skip meals to lower blood sugar
- C. I will store my insulin in the freezer
- D. I will rotate injection sites for insulin administration
Correct answer: D
Rationale: The correct answer is D because rotating injection sites prevents tissue damage and ensures better absorption of insulin. Option A is incorrect as injecting insulin into the thigh before exercise can lead to hypoglycemia. Option B is incorrect as skipping meals can cause blood sugar levels to drop dangerously low. Option C is incorrect as insulin should not be stored in the freezer as it can alter its effectiveness.
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