ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse is caring for a client with a sealed radiation implant. Which action should the nurse take?
- A. Remove dirty linens after double-bagging
- B. Wear a dosimeter badge
- C. Limit visitors to 1 hour per day
- D. Ensure family remains 3 feet away from the client
Correct answer: B
Rationale: The correct answer is B: Wear a dosimeter badge. When caring for a client with a sealed radiation implant, the nurse should wear a dosimeter badge to monitor radiation exposure. This badge helps measure the amount of radiation the nurse is exposed to during care. Choice A is incorrect because removing dirty linens after double-bagging is not directly related to managing radiation exposure. Choice C is incorrect as there is no specific time limit on visitors mentioned in the context of a sealed radiation implant. Choice D is incorrect as there is no evidence supporting the need for family members to stay a specific distance away from the client.
2. A healthcare provider is providing dietary teaching to a client who has chronic kidney disease. Which of the following food choices should the healthcare provider recommend?
- A. A baked potato
- B. A chicken breast
- C. A banana
- D. A cup of orange juice
Correct answer: B
Rationale: The correct answer is B: A chicken breast. Chicken breast is low in potassium, making it a safe option for clients with chronic kidney disease who need to limit their potassium intake. Foods like bananas and orange juice are high in potassium, which should be avoided or limited by individuals with chronic kidney disease to prevent further kidney damage.
3. A nurse on the medical-surgical unit is receiving reports on four clients. Which of the following clients should the nurse assess first?
- A. A client who is receiving warfarin and has an INR of 3.3
- B. A client who has acute kidney injury, creatinine 4 mg/dL, and BUN 52 mg/dL
- C. A client who had an NG tube inserted 6 hours ago and has abdominal distention
- D. A client who is 4 hours postoperative following a thyroidectomy and reports fullness in the throat
Correct answer: D
Rationale: The client who is 4 hours postoperative following a thyroidectomy and reports fullness in the throat should be assessed first. This client may be experiencing airway obstruction due to hematoma or swelling, making it a priority. Options A, B, and C have concerning findings as well, but airway compromise takes precedence over other issues.
4. A nurse providing dietary teaching for a client who is at 29 weeks of gestation and has phenylketonuria. Which of the following suggested foods should the nurse include in the teaching?
- A. A peanut butter sandwich on wheat bread
- B. A sliced apple and red grapes
- C. A chocolate chip cookie with a glass of skim milk
- D. A scrambled egg with cheddar cheese
Correct answer: B
Rationale: The correct answer is B. Clients with phenylketonuria (PKU) must adhere to a strict low-phenylalanine diet to prevent neurological damage. Foods high in phenylalanine such as peanut butter, wheat bread, chocolate chip cookies, milk, scrambled eggs, and cheddar cheese should be avoided. Sliced apples and red grapes are low in phenylalanine, making them safe choices for individuals with PKU. Choice A (peanut butter sandwich on wheat bread), Choice C (chocolate chip cookie with a glass of skim milk), and Choice D (scrambled egg with cheddar cheese) are all high in phenylalanine and should be avoided by individuals with PKU.
5. A nurse is preparing to administer a dose of furosemide. Which of the following should the nurse do before administration?
- A. Check potassium levels
- B. Assess blood glucose levels
- C. Monitor respiratory rate
- D. Administer with food
Correct answer: A
Rationale: The correct answer is to check potassium levels before administering furosemide. Furosemide is a diuretic that can cause hypokalemia (low potassium levels) as a side effect. Monitoring potassium levels is crucial to prevent potential complications related to electrolyte imbalance. Assessing blood glucose levels (choice B) is not directly related to furosemide administration. Monitoring respiratory rate (choice C) is important in certain situations, but it is not the priority before administering furosemide. Administering furosemide with food (choice D) is not a requirement as it can be administered regardless of meals.
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