ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse is caring for a client who has mild anxiety. Which of the following findings should the nurse expect?
- A. Feelings of dread
- B. Rapid speech
- C. Purposeless activity
- D. Heightened perceptual field
Correct answer: D
Rationale: In mild anxiety, the client is expected to have a heightened perceptual field. This means that their perception is increased, enhancing their awareness and ability to concentrate. Feelings of dread (Choice A) are more common in moderate to severe anxiety. Rapid speech (Choice B) and purposeless activity (Choice C) are more indicative of moderate to severe anxiety where the individual may exhibit signs of agitation and restlessness.
2. A nurse is planning to delegate to an AP the task of fasting blood glucose testing for a client who has diabetes mellitus. Which of the following actions should the nurse take?
- A. Determine if the AP is qualified to perform the test
- B. Help the AP perform the blood glucose test
- C. Assign the AP to ask the client if they have taken diabetic medication today
- D. Have the AP check the medical record for prior blood glucose test results
Correct answer: A
Rationale: Before delegating any task, the nurse must determine whether the AP is qualified to perform it. In this scenario, verifying the AP's competency to conduct fasting blood glucose testing is crucial for patient safety and compliance with facility protocols. The other choices are incorrect because they do not address the essential step of assessing the AP's ability to perform the delegated task. While helping the AP or assigning tasks related to diabetic medication or medical records are important, the primary concern should be confirming the AP's competence for the specific delegated duty of blood glucose testing.
3. A nurse is planning a staff education session regarding biological weapons of mass destruction. What should the nurse include in the session?
- A. Rabies, cholera, meningitis
- B. Smallpox, anthrax, botulism
- C. Ebola, hepatitis B, tetanus
- D. Tuberculosis, influenza, measles
Correct answer: B
Rationale: The correct answer is B: Smallpox, anthrax, botulism. These are known biological weapons that can be used in mass casualty situations. Rabies, cholera, and meningitis (Choice A) are not typically used as biological weapons. Ebola, hepatitis B, and tetanus (Choice C) are serious diseases but are not commonly associated with biological warfare. Tuberculosis, influenza, and measles (Choice D) are infectious diseases but are not typically used as biological weapons of mass destruction.
4. During a change-of-shift assessment, a nurse is evaluating four clients. Which finding should the nurse report to the provider first?
- A. A client with cystic fibrosis who has a productive cough and reports thirst
- B. A client with gastroenteritis who is lethargic and confused
- C. A client with diabetes mellitus whose blood glucose is 185 mg/dL
- D. A client with sickle cell anemia who reports pain 15 minutes after receiving analgesics
Correct answer: B
Rationale: Lethargy and confusion in a client with gastroenteritis are concerning findings that may indicate severe dehydration or electrolyte imbalance, requiring immediate intervention. While the other options are important, they do not pose an immediate life-threatening risk compared to the altered mental status in a client with gastroenteritis.
5. A nurse is providing teaching for a client who has a new prescription for sertraline. Which of the following statements by the client indicates understanding?
- A. I will feel better immediately after starting this medication.
- B. I can expect to urinate frequently while taking this medication.
- C. I may experience difficulty sleeping while taking this medication.
- D. I should decrease my sodium intake while taking this medication.
Correct answer: C
Rationale: The correct answer is C: 'I may experience difficulty sleeping while taking this medication.' Sertraline can cause insomnia, especially when first starting the medication, so the client should be aware of this potential side effect. Choices A, B, and D are incorrect because feeling better immediately, increased urination, and decreasing sodium intake are not commonly associated side effects of sertraline.
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