ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A nurse is assessing a client who is at risk for falls. Which of the following findings should the nurse recognize as increasing the client's risk of falling?
- A. Normal gait
- B. Recent history of dizziness
- C. 20/20 vision
- D. Takes a multivitamin daily
Correct answer: B
Rationale: The correct answer is B: Recent history of dizziness. A recent history of dizziness significantly increases the risk of falling, as dizziness can impair balance and coordination. Having a normal gait (choice A) and 20/20 vision (choice C) are not factors that directly increase the risk of falling. Taking a multivitamin daily (choice D) does not inherently contribute to an increased risk of falling unless it causes dizziness as a side effect, which is not specified in the question.
2. A school nurse is developing a teaching plan about testicular cancer for a group of adolescents. What information should the nurse include in the teaching?
- A. Expect pain in the testicles during self-examination.
- B. The testicles should be uniform in size and shape when examined.
- C. Expect testicles to be uniform in consistency when performing a testicular self-examination.
- D. The testicles will shrink if cancer is present.
Correct answer: C
Rationale: The correct answer is C because during a testicular self-examination, it is crucial to note a uniform consistency of the testicles. Any lumps, changes in size, or inconsistencies should be reported to a healthcare provider promptly. Choice A is incorrect because pain is not typically expected during a testicular self-examination. Choice B is incorrect as uniform size and shape are not as relevant as uniform consistency. Choice D is incorrect; testicular cancer usually causes enlargement rather than shrinking of the testicles.
3. A client is prescribed digoxin and has a potassium level of 3.0 mEq/L. Which of the following actions should the nurse take?
- A. Administer digoxin without any modifications
- B. Administer the medication at a lower dose
- C. Monitor serum potassium levels
- D. Discontinue the medication if potassium levels rise
Correct answer: A
Rationale: A potassium level of 3.0 mEq/L indicates hypokalemia, which increases the risk of digoxin toxicity. In this case, the nurse should administer the digoxin without any modifications. Lowering the dose (Choice B) may not be necessary if the potassium level is not critically low. Monitoring serum potassium levels (Choice C) is important but should not delay the administration of digoxin. Discontinuing the medication (Choice D) is not the initial action to take unless the potassium levels become severely low and life-threatening.
4. A 55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism?
- A. Osteoporosis
- B. Scleroderma
- C. Asthma
- D. Peripheral vascular disease
Correct answer: A
Rationale: Clients with a history of osteoporosis should be carefully monitored when prescribed levothyroxine. Chronic overtreatment can cause increased bone loss, which raises the risk of fractures, especially in older adults. Thyroid hormone levels should be regularly monitored to avoid this complication. Scleroderma (choice B), asthma (choice C), and peripheral vascular disease (choice D) are not known to contraindicate the use of levothyroxine for hypothyroidism.
5. A client has been prescribed trazodone. Which of the following should be monitored?
- A. Blood glucose levels
- B. Liver function
- C. Mood changes
- D. Heart rate
Correct answer: C
Rationale: Correct. Trazodone is an antidepressant that can impact mood and behavior. Monitoring for changes in mood or behavior is crucial to assess the effectiveness and potential side effects of the medication. Monitoring blood glucose levels is not typically associated with trazodone use. While trazodone can affect liver function in some cases, monitoring liver function is not the primary concern compared to assessing mood changes. Trazodone can cause changes in heart rate in some patients, but the priority monitoring in this case should be related to its effects on mood.
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