ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 A with NGN
1. A client with leukemia is considered for a bone marrow transplant. Which principle of healthcare ethics is being practiced by minimizing harm to the client?
- A. Justice
- B. Beneficence
- C. Nonmaleficence
- D. Autonomy
Correct answer: C
Rationale: The correct answer is C: Nonmaleficence. Nonmaleficence is the ethical principle that focuses on avoiding harm to the patient. In this scenario, by considering a bone marrow transplant for the client with leukemia, healthcare professionals are practicing nonmaleficence by aiming to minimize harm. Choice A, Justice, pertains to fairness in the distribution of resources and decisions, which is not the primary focus in this situation. Choice B, Beneficence, involves promoting the patient's well-being, which is related but not directly addressing the act of minimizing harm. Choice D, Autonomy, refers to respecting the patient's right to make decisions about their own care, which is not the key principle at play when minimizing harm in this context.
2. What are the main differences between a stroke caused by ischemia and one caused by hemorrhage?
- A. Blockage in a blood vessel supplying the brain
- B. Bleeding in the brain due to a ruptured aneurysm
- C. Administering thrombolytics if within the treatment window
- D. Avoiding anticoagulants and preparing for surgery
Correct answer: A
Rationale: The correct answer is A: "Blockage in a blood vessel supplying the brain." Ischemic stroke is caused by a blockage in a blood vessel supplying the brain, leading to reduced blood flow. Hemorrhagic stroke, on the other hand, is caused by bleeding in the brain due to a ruptured blood vessel. Choices B, C, and D are incorrect. Administering thrombolytics, avoiding anticoagulants, and preparing for surgery are specific management strategies that may apply to ischemic or hemorrhagic strokes but do not define the main differences between the two types of strokes.
3. A patient recovering from a stroke has difficulty swallowing. Which action should the nurse prioritize?
- A. Begin feeding the patient soft solids.
- B. Place the patient on NPO (nothing by mouth) status.
- C. Provide ice chips to help soothe the throat.
- D. Start the patient on a clear liquid diet.
Correct answer: B
Rationale: The correct answer is to place the patient on NPO (nothing by mouth) status. Patients recovering from a stroke with difficulty swallowing are at high risk for aspiration, which can lead to serious complications like aspiration pneumonia. Therefore, the priority is to keep the patient on NPO until a thorough evaluation by a healthcare provider is completed. Choice A is incorrect as feeding the patient soft solids can increase the risk of aspiration. Choice C is incorrect as providing ice chips may further compromise swallowing safety. Choice D is incorrect as starting the patient on a clear liquid diet can also increase the risk of aspiration in this scenario.
4. Which action should the nurse take to minimize the risk of medication errors?
- A. Prepare medications ahead of time to ensure they are ready.
- B. Ensure two nurses double-check medications before administration.
- C. Administer medications at the same time each day.
- D. Rely on memory to administer the correct medications.
Correct answer: B
Rationale: The correct answer is B because ensuring two nurses double-check medications before administration is a crucial step in minimizing the risk of medication errors. This practice helps in verifying the accuracy of medication orders and reducing the chances of mistakes. Choice A may not necessarily prevent errors as preparing medications ahead of time does not guarantee accuracy. Choice C, administering medications at the same time each day, is important for consistency but does not directly address the risk of errors. Choice D, relying on memory, is highly discouraged as it increases the likelihood of errors due to human forgetfulness.
5. What are the key components of a pain assessment in a postoperative patient?
- A. Checking the effectiveness of pain interventions
- B. Observing for nonverbal signs of pain like grimacing
- C. Assessing the location, duration, and quality of the pain
- D. Asking the patient to rate their pain on a scale of 1-10
Correct answer: A
Rationale: The correct answer is A because in a postoperative patient, it is crucial to evaluate the effectiveness of the pain interventions that have been implemented. While choices B, C, and D are important aspects of a pain assessment, they do not specifically address the key component of assessing the effectiveness of the interventions applied postoperatively.
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