ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B
1. A nurse is caring for an older adult who has a non-palpable skin lesion that is less than 0.5 cm in diameter. Which term should the nurse use to document this finding?
- A. Vesicle
- B. Macule
- C. Papule
- D. Nodule
Correct answer: B
Rationale: The correct answer is B: Macule. A macule is a non-palpable skin lesion smaller than 1 cm in diameter. In this case, the skin lesion described is less than 0.5 cm, making it consistent with a macule. Vesicle (choice A) is a small blister filled with clear fluid, papule (choice C) is a solid, raised skin lesion less than 0.5 cm in diameter, and nodule (choice D) is a palpable, solid lesion larger than 0.5 cm in diameter. Therefore, choices A, C, and D describe skin lesions that do not match the characteristics of the lesion presented in the question.
2. A nurse is providing teaching to a client who has tuberculosis (TB) and is prescribed rifampin. Which of the following statements should the nurse include in the teaching?
- A. This medication can cause your urine to turn a reddish-orange color.
- B. You should expect to take this medication for at least 6 months.
- C. You should avoid eating dairy products while on this medication.
- D. This medication can cause sensitivity to sunlight.
Correct answer: A
Rationale: The correct answer is A. Rifampin can cause harmless red-orange discoloration of bodily fluids, including urine, sweat, and tears. Clients should be informed about this side effect. Choice B is incorrect because the duration of rifampin therapy for TB is typically longer than 6 months. Choice C is incorrect as there is no need to avoid dairy products while on rifampin. Choice D is incorrect as rifampin does not cause sensitivity to sunlight.
3. A nurse is caring for a client who has been prescribed furosemide. Which of the following foods should the nurse encourage the client to include in their diet?
- A. Table salt
- B. Egg yolks
- C. White wine
- D. Oranges
Correct answer: D
Rationale: Furosemide is a potassium-wasting diuretic, so clients should consume potassium-rich foods like oranges to prevent hypokalemia. Oranges are a good source of potassium. Table salt, egg yolks, and white wine do not provide significant amounts of potassium and are not beneficial for a client taking furosemide.
4. A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include a severe allergy to which of the following medications as a contraindication to ceftriaxone?
- A. Gentamicin
- B. Clindamycin
- C. Piperacillin
- D. Sulfamethoxazole-trimethoprim
Correct answer: C
Rationale: Ceftriaxone is a cephalosporin, and individuals with a penicillin allergy (such as Piperacillin) may have cross-sensitivity, making it contraindicated. Gentamicin (Choice A) belongs to the aminoglycoside class, not related to cephalosporins. Clindamycin (Choice B) is a lincosamide antibiotic and is not typically associated with cross-allergies to cephalosporins. Sulfamethoxazole-trimethoprim (Choice D) is a sulfonamide antibiotic, also not directly related to ceftriaxone.
5. A nurse in the telemetry unit is receiving the laboratory findings for an adult male client who is being treated for a myocardial infarction. Which of the following is an expected finding for the client?
- A. Troponin I (TnI) 8 ng/mL
- B. Brain natriuretic peptide (BNP) 10 ng/L
- C. Alanine aminotransferase (ALT) 45 units/L
- D. High-density lipoprotein (HDL) 75 mg/dL
Correct answer: A
Rationale: The correct answer is A. Troponin I is a specific marker for myocardial infarction, and levels of 8 ng/mL are elevated, indicating heart muscle damage. Brain natriuretic peptide (BNP) is more related to heart failure rather than myocardial infarction, making choice B incorrect. Alanine aminotransferase (ALT) is a liver enzyme and not specific to myocardial infarction, so choice C is incorrect. High-density lipoprotein (HDL) is a type of cholesterol and is not typically used to diagnose or monitor myocardial infarction, making choice D incorrect.
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