ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 A with NGN
1. A nurse is assessing a client with pancreatitis. Which of the following findings should the nurse look for?
- A. Increased appetite
- B. Abdominal pain
- C. Weight gain
- D. Elevated blood pressure
Correct answer: B
Rationale: The correct answer is B: Abdominal pain. Abdominal pain, often severe, is a hallmark sign of pancreatitis. Other common symptoms include nausea, vomiting, and tenderness in the abdomen. Choices A, C, and D are incorrect because increased appetite, weight gain, and elevated blood pressure are not typically associated with pancreatitis. Therefore, the nurse should primarily focus on assessing for abdominal pain in a client with suspected pancreatitis.
2. A nurse is preparing to assist a provider with the insertion of a nontunneled percutaneous central venous catheter into a client’s subclavian vein. Which of the following actions should the nurse take?
- A. Position the client in a high-Fowler’s position
- B. Place the client in Trendelenburg position
- C. Place a rolled towel under the client’s neck
- D. Assist the client into a side-lying position
Correct answer: B
Rationale: The correct action for the nurse to take when assisting with the insertion of a nontunneled percutaneous central venous catheter into the subclavian vein is to place the client in Trendelenburg position. This position helps distend the veins and reduces the risk of air embolism during the insertion procedure. Option A, positioning the client in a high-Fowler’s position, would not be appropriate as it does not facilitate venous distention. Option C, placing a rolled towel under the client’s neck, is not directly related to the procedure and does not serve a specific purpose in this context. Option D, assisting the client into a side-lying position, is also not the correct choice as Trendelenburg position is preferred for this procedure to aid in vein distention.
3. A nurse is discussing immunity with a client who has received an immunization. The nurse should identify that an immunization functions as part of which of the following types of immunity?
- A. Innate immunity
- B. Passive immunity
- C. Acquired immunity
- D. Natural immunity
Correct answer: C
Rationale: Immunizations provide acquired immunity. They work by introducing antigens into the body, which triggers the immune system to produce antibodies specific to that antigen. Choice A, 'Innate immunity,' refers to the natural defense mechanisms an organism is born with and does not involve immunizations. Choice B, 'Passive immunity,' is the transfer of pre-formed antibodies and does not involve immunizations. Choice D, 'Natural immunity,' is a general term that encompasses all immunity that is not acquired through deliberate immunization or passive transfer of antibodies.
4. A client is newly diagnosed with hypothyroidism and prescribed levothyroxine. Which of the following instructions should the nurse include?
- A. Take the medication with food.
- B. Take the medication in the evening.
- C. Take the medication on an empty stomach.
- D. Take the medication only when experiencing symptoms.
Correct answer: C
Rationale: The correct instruction is to take levothyroxine on an empty stomach. This is necessary for proper absorption and effectiveness of the medication. Taking it with food can interfere with absorption. Timing is also crucial; it is usually recommended to take levothyroxine in the morning to prevent potential interactions with food and other medications throughout the day. Taking the medication in the evening may lead to sleep disturbances. Lastly, waiting to take the medication only when symptoms occur is not appropriate as levothyroxine is typically taken regularly to maintain thyroid hormone levels within the body.
5. 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.
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