ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 A
1. 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.
2. A client is receiving oxytocin to augment labor. The contractions are occurring every 45 seconds, and the fetal heart rate is 170-180 beats/min. What action should the nurse take?
- A. Increase the oxytocin infusion
- B. Decrease the oxytocin infusion
- C. Discontinue the oxytocin infusion
- D. Maintain the oxytocin infusion
Correct answer: C
Rationale: When contractions occur every 45 seconds with a high fetal heart rate, it indicates uterine hyperstimulation and fetal distress. In this situation, the oxytocin infusion should be discontinued immediately to prevent further complications. Increasing or maintaining the infusion would worsen the hyperstimulation and distress. Decreasing the infusion may not be sufficient to address the current situation and could still lead to complications.
3. A nurse is teaching a group of clients about measures to prevent the development of skin cancer. Which of the following client statements indicates a need for further teaching?
- A. I will avoid going outside between 1000 and 1600.
- B. I will wear a wide-brimmed hat when I go outside.
- C. I will make sure to apply sunscreen with SPF 10 when I’m in the sun.
- D. I will reapply my sunscreen every 2 hours.
Correct answer: C
Rationale: The correct answer is C. An SPF of at least 15 is recommended to effectively protect against harmful UV rays. A sunscreen with an SPF of 10 is insufficient and does not provide adequate protection against skin cancer. Choices A, B, and D demonstrate good understanding of sun protection measures, such as avoiding peak sun hours, wearing protective clothing like a wide-brimmed hat, and reapplying sunscreen every 2 hours, which are all effective strategies to prevent skin cancer.
4. A nurse is assessing a client who has a sodium level of 122 mEq/L. Which of the following findings should the nurse expect?
- A. Decreased deep tendon reflexes
- B. Positive Trousseau’s sign
- C. Hypoactive bowel sounds
- D. Sticky mucous membranes
Correct answer: A
Rationale: A sodium level of 122 mEq/L indicates hyponatremia, which is characterized by decreased deep tendon reflexes. Hyponatremia leads to neurological symptoms such as altered reflexes. Choices B, C, and D are not typically associated with hyponatremia. Positive Trousseau’s sign is related to hypocalcemia, hypoactive bowel sounds can be seen in paralytic ileus or decreased peristalsis, and sticky mucous membranes are not specific findings related to sodium imbalances.
5. A nurse is assessing a client who has schizophrenia and is experiencing negative symptoms. Which of the following findings should the nurse expect?
- A. Hallucinations
- B. Delusions
- C. Flat affect
- D. Paranoia
Correct answer: C
Rationale: The correct answer is C: Flat affect. Negative symptoms of schizophrenia involve deficits in normal emotional responses or other thought processes. These symptoms include a flat affect (reduced emotional expression), social withdrawal, and avolition (lack of motivation). Hallucinations and delusions are characteristic of positive symptoms, which involve the presence of abnormal behaviors or experiences. Paranoia is more associated with delusions rather than negative symptoms.
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