ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse is preparing to administer 2.5 mL of medication intramuscularly to an adult client. Which site is safest for the nurse to use?
- A. Ventrogluteal
- B. Dorsogluteal
- C. Vastus lateralis
- D. Rectus femoris
Correct answer: A
Rationale: The correct answer is 'Ventrogluteal.' The ventrogluteal site is recommended for intramuscular injections in adults because it is free of major blood vessels and nerves, reducing the risk of injury or complications. Choice B, 'Dorsogluteal,' is not recommended due to the proximity of the sciatic nerve and major blood vessels. Choices C and D, 'Vastus lateralis' and 'Rectus femoris,' are sites commonly used for intramuscular injections but are more suitable for pediatric or specific population groups, not typically for adults.
2. A nurse is caring for a client who has a deep vein thrombosis (DVT). Which of the following interventions should the nurse include in the plan of care?
- A. Encourage the client to ambulate frequently.
- B. Apply warm, moist compresses to the affected leg.
- C. Massage the affected leg.
- D. Place the client in a supine position.
Correct answer: B
Rationale: The correct intervention for a client with deep vein thrombosis (DVT) is to apply warm, moist compresses to the affected leg. This helps alleviate pain and improve circulation in the affected area, aiding in the treatment of DVT. Encouraging the client to ambulate frequently (Choice A) is contraindicated as it can dislodge the clot and lead to complications. Massaging the affected leg (Choice C) is also contraindicated as it can dislodge the clot and potentially cause an embolism. Placing the client in a supine position (Choice D) is not specifically indicated for DVT treatment; elevation of the affected leg is preferred over placing the client completely supine.
3. A client presents with symptoms suggestive of rheumatoid arthritis. Which of the following laboratory tests should be ordered to confirm this diagnosis?
- A. Erythrocyte sedimentation rate (ESR)
- B. Rheumatoid factor
- C. Antinuclear antibody
- D. Serum calcium
Correct answer: B
Rationale: Rheumatoid factor is a specific marker for rheumatoid arthritis. It is often elevated in clients with this autoimmune condition, helping to confirm the diagnosis. Erythrocyte sedimentation rate (ESR) and antinuclear antibody tests can be supportive but are not specific for rheumatoid arthritis. Serum calcium levels are not typically used to confirm this diagnosis.
4. A healthcare professional is preparing to administer heparin 8,000 units subcutaneously every eight hrs. The amount available is heparin injection 10,000 units/mL. How many milliliters should the healthcare professional administer per dose?
- A. 0.7 mL
- B. 0.8 mL
- C. 1.0 mL
- D. 1.2 mL
Correct answer: B
Rationale: Calculation: 8000 units / 10,000 units per mL = 0.8 mL. To correctly administer the prescribed dose of 8000 units, the healthcare professional should draw up 0.8 mL from the 10,000 units/mL vial. Options A, C, and D are incorrect as they do not accurately reflect the calculation based on the available concentration of heparin.
5. A nurse is assessing a client who has diabetes insipidus and is receiving desmopressin. Which of the following should the nurse monitor?
- A. Fasting blood glucose
- B. Carbohydrate intake
- C. Hematocrit
- D. Weight
Correct answer: D
Rationale: The correct answer is D: Weight. Desmopressin can cause fluid retention, so monitoring the client's weight is crucial to detect signs of water intoxication or overhydration, which can occur with the medication. Monitoring fasting blood glucose (choice A) is not directly related to desmopressin use in diabetes insipidus. Carbohydrate intake (choice B) is important for diabetes management but is not specifically relevant to monitoring desmopressin therapy. Hematocrit (choice C) is not typically influenced by desmopressin use in diabetes insipidus.
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