ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 A with NGN
1. A nurse is preparing to administer a dose of enalapril. Which of the following should the nurse assess first?
- A. Heart rate
- B. Blood pressure
- C. Serum creatinine
- D. Potassium levels
Correct answer: B
Rationale: The correct answer is to assess blood pressure first. Enalapril is an ACE inhibitor commonly used to manage hypertension. It is crucial to evaluate the patient's blood pressure before administering enalapril to ensure it is within safe limits. Assessing other parameters like heart rate, serum creatinine, and potassium levels is also important but assessing blood pressure takes precedence due to the medication's mechanism of action and potential effects on blood pressure regulation.
2. Before an amniocentesis, what action by the client will need to be completed?
- A. Increase fluid intake
- B. Empty the bladder
- C. Avoid eating for 12 hours
- D. Take a sedative
Correct answer: B
Rationale: Before an amniocentesis, the client should empty their bladder. This is necessary to reduce the risk of bladder puncture during the procedure. A full bladder can be in the path of the needle, increasing the risk of injury. Increasing fluid intake (choice A) is not necessary before an amniocentesis. Avoiding eating for 12 hours (choice C) is not a standard preparation for an amniocentesis. Taking a sedative (choice D) is not routinely required for this procedure.
3. A nurse is performing a newborn assessment and notes a soft, swollen area on the newborn's scalp that does not cross the suture line. Which of the following should the nurse document?
- A. Cephalohematoma
- B. Caput succedaneum
- C. Subdural hematoma
- D. Molding
Correct answer: A
Rationale: The correct answer is A, cephalohematoma. A cephalohematoma is a collection of blood between the periosteum and the skull that does not cross the suture line. It is caused by trauma during birth and typically resolves on its own. Choice B, caput succedaneum, is characterized by diffuse edema over a newborn's scalp that crosses suture lines. Choice C, subdural hematoma, is a more serious condition involving bleeding between the dura mater and the brain. Choice D, molding, refers to the shaping of the fetal head during passage through the birth canal. Therefore, the nurse should document cephalohematoma in this scenario as it aligns with the description of a soft, swollen area on the newborn's scalp that does not cross the suture line.
4. A healthcare provider is reviewing a client’s care plan. Which of the following goals is most appropriate?
- A. Client will inject insulin twice daily
- B. Client will keep appointments with the healthcare provider for 6 months
- C. Client's A1c will be 5% within one year
- D. Client's blood glucose will stay between 60-120 mg/dL
Correct answer: C
Rationale: The correct answer is C. A1c is a key indicator of long-term diabetes management, reflecting average blood sugar levels over the past 2-3 months. Achieving a target A1c of 5% indicates good control of blood sugar levels and reduces the risk of diabetes-related complications. Choices A, B, and D are not as appropriate as they focus on short-term tasks or individual blood glucose readings, rather than long-term management and outcomes.
5. A client is being educated by a nurse about the use of bupropion. Which of the following should be included?
- A. It can cause weight gain
- B. It may increase seizure risk
- C. It is an SSRI
- D. It has no side effects
Correct answer: B
Rationale: The correct answer is B. Bupropion may lower the seizure threshold, increasing the risk of seizures, especially in clients with a history of seizures. Choice A is incorrect because bupropion is associated with weight loss rather than weight gain. Choice C is incorrect as bupropion is not an SSRI; it is an aminoketone antidepressant. Choice D is incorrect as bupropion, like all medications, can have side effects, and it is essential for clients to be aware of them.
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