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 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.
3. A healthcare professional is preparing to administer a dose of sertraline. Which of the following should the healthcare professional assess first?
- A. Blood pressure
- B. Heart rate
- C. Respiratory rate
- D. Mood changes
Correct answer: A
Rationale: When administering sertraline, assessing blood pressure is crucial as this medication can potentially affect blood pressure levels. Monitoring blood pressure before giving sertraline helps ensure patient safety and allows for appropriate interventions if any significant changes are noted. Heart rate, respiratory rate, and mood changes are important assessments but are not typically the first priority when administering sertraline. While heart rate and respiratory rate can also be affected by sertraline, blood pressure assessment is a higher priority due to the medication's known effects on blood pressure regulation.
4. A nurse is developing discharge care plans for a client who has osteoporosis. To prevent injury, the nurse should instruct the client to:
- A. Perform weight-bearing exercises
- B. Avoid crossing the legs beyond the midline
- C. Avoid sitting in one position for prolonged periods
- D. Splint the affected area
Correct answer: A
Rationale: The correct answer is A: Perform weight-bearing exercises. Weight-bearing exercises strengthen bones and help prevent fractures, which is crucial for clients with osteoporosis. Choices B, C, and D are incorrect. Avoiding crossing the legs beyond the midline and avoiding sitting in one position for prolonged periods are general recommendations for preventing musculoskeletal issues but are not specific to osteoporosis. Splinting the affected area is not a standard practice for managing osteoporosis and preventing fractures.
5. A community health nurse is reviewing primary prevention for West Nile virus with a group of patients in a rural health clinic. What instructions should the nurse include?
- A. Eliminate areas of standing water.
- B. Wear a mask when outdoors.
- C. Ensure food is cooked thoroughly.
- D. Avoid contact with sick individuals.
Correct answer: A
Rationale: The correct answer is A: 'Eliminate areas of standing water.' Standing water provides breeding grounds for mosquitoes, which spread West Nile virus. By eliminating standing water, individuals can reduce the risk of mosquito breeding and the transmission of the virus. Choices B, C, and D are incorrect. Wearing a mask when outdoors, ensuring food is cooked thoroughly, and avoiding contact with sick individuals are not directly related to primary prevention strategies for West Nile virus.
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