ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment A
1. 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.
2. A nurse is caring for a client who has a prescription for enalapril. The nurse should monitor the client for which of the following adverse effects of this medication?
- A. Bradycardia
- B. Hyperkalemia
- C. Hyperglycemia
- D. Tinnitus
Correct answer: B
Rationale: The correct answer is B: Hyperkalemia. Enalapril, an ACE inhibitor, can lead to hyperkalemia by reducing aldosterone levels, which results in potassium retention. Bradycardia (Choice A) is not a common adverse effect of enalapril. Hyperglycemia (Choice C) and tinnitus (Choice D) are also not typically associated with enalapril use.
3. A nurse is assessing a male adolescent client who has heart failure. Based on the client’s chart, which of the following actions should the nurse plan to take?
- A. Withhold spironolactone
- B. Administer ferrous sulfate
- C. Administer furosemide
- D. Withhold digoxin
Correct answer: C
Rationale: The correct answer is to administer furosemide. Furosemide is a diuretic commonly used in heart failure to manage fluid retention, helping alleviate symptoms like edema and shortness of breath. Withholding spironolactone, a potassium-sparing diuretic, could lead to electrolyte imbalances. Administering ferrous sulfate is used to treat iron deficiency anemia, not heart failure. Withholding digoxin, a medication used in heart failure to improve heart function, can worsen the client's condition.
4. A healthcare professional is preparing to administer 250 mg of an antibiotic IM. Available is 3 g/5 mL. How many mL would the healthcare professional administer per dose?
- A. 0.4 mL
- B. 0.3 mL
- C. 0.5 mL
- D. 0.6 mL
Correct answer: A
Rationale: To calculate the mL to be administered, convert 250 mg to grams (0.25 g). Then, set up a proportion: (0.25 g / 3 g) x 5 mL = 0.4167 mL, which rounds to 0.4 mL. Therefore, the healthcare professional would administer 0.4 mL per dose. Choice B (0.3 mL) is incorrect because it does not reflect the accurate calculation. Choice C (0.5 mL) is incorrect as it does not consider the correct conversion and calculation. Choice D (0.6 mL) is incorrect as it provides a value higher than the accurate calculation.
5. A nurse is preparing to administer a dose of ampicillin. Which of the following actions should the nurse take?
- A. Administer it with food
- B. Check for penicillin allergy
- C. Monitor liver function
- D. Administer it intramuscularly
Correct answer: B
Rationale: The correct answer is to 'Check for penicillin allergy.' Before administering ampicillin, it is crucial to assess the patient for any history of penicillin allergy. This is essential to prevent an adverse allergic reaction, as ampicillin belongs to the penicillin class of antibiotics. Administering ampicillin with food (Choice A) is not a standard requirement and does not impact its effectiveness. Monitoring liver function (Choice C) is not directly related to the immediate pre-administration assessment for ampicillin. Administering ampicillin intramuscularly (Choice D) is not typically the route of administration for this antibiotic, as it is usually given intravenously or orally.
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