ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A nurse is planning care for a client who has a new diagnosis of deep vein thrombosis (DVT). Which action should the nurse take?
- A. Massage the affected extremity
- B. Elevate the affected leg
- C. Apply cold packs to the affected leg
- D. Keep the leg dependent to increase circulation
Correct answer: B
Rationale: Elevating the leg promotes venous return and reduces swelling, which is crucial for clients with DVT. Massaging the affected extremity can dislodge the clot and worsen the condition. Applying cold packs can cause vasoconstriction, potentially increasing the risk of clot formation. Keeping the leg dependent can impede circulation and increase the risk of clot migration.
2. A nurse is providing teaching to a client who has mild persistent asthma and has been prescribed montelukast. Which of the following statements should the nurse include in the teaching?
- A. This medication can be used to help manage asthma symptoms during an acute asthma attack
- B. This medication should be taken before exercise and physical activity
- C. This medication should be taken regularly as prescribed without discontinuing abruptly
- D. This medication helps decrease swelling and mucus production
Correct answer: D
Rationale: Montelukast works as a leukotriene receptor antagonist, reducing inflammation and mucus production, which helps prevent asthma attacks but is not used for acute treatment. It is important for the client to understand that montelukast should be taken regularly to manage asthma symptoms and should not be abruptly discontinued. Taking the medication before exercise is not a typical instruction for montelukast.
3. When teaching a client about the use of risperidone, which of the following should be included?
- A. It is an SSRI
- B. Monitor for metabolic syndrome
- C. It has no side effects
- D. It can be taken with alcohol
Correct answer: B
Rationale: The correct answer is B: 'Monitor for metabolic syndrome.' Risperidone is not an SSRI but an atypical antipsychotic. Choice A is incorrect. Choice C is also incorrect as risperidone, like any medication, can have side effects. Choice D is wrong because alcohol consumption should generally be avoided while taking risperidone. Educating clients about monitoring for metabolic syndrome, weight gain, and other potential side effects is crucial in managing their health effectively while on this medication.
4. A nurse is caring for a client who is 36 weeks pregnant and reports leaking fluid. Which of the following tests should the nurse use to confirm that the client's membranes have ruptured?
- A. Nonstress test
- B. Biophysical profile
- C. Fern test
- D. Amniocentesis
Correct answer: C
Rationale: The correct answer is the Fern test. The Fern test is specifically used to confirm the rupture of membranes. A sample of vaginal fluid is examined under a microscope, and the presence of a fern-like pattern indicates the presence of amniotic fluid. The Nonstress test (Choice A) is used to monitor fetal heart rate and movement, not to confirm ruptured membranes. The Biophysical profile (Choice B) is a prenatal ultrasound evaluation to assess fetal well-being, not to confirm ruptured membranes. Amniocentesis (Choice D) involves the aspiration of amniotic fluid for various diagnostic purposes, not specifically to confirm ruptured membranes.
5. A healthcare provider is assessing a client for allergies before administering propofol. Which of the following allergies is a contraindication to the medication?
- A. Eggs
- B. Milk
- C. Shrimp
- D. Peanuts
Correct answer: A
Rationale: The correct answer is A: Eggs. Propofol is contraindicated in clients with egg allergies because it contains egg lecithin, which can trigger allergic reactions in sensitive individuals. Milk, shrimp, and peanuts are not contraindications for propofol administration.
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