ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse is preparing to teach a client about the management of hypoglycemia. Which sign should the nurse instruct the client to monitor for?
- A. Diaphoresis
- B. Polyuria
- C. Abdominal pain
- D. Thirst
Correct answer: A
Rationale: The correct answer is A: Diaphoresis. Diaphoresis, which refers to excessive sweating, is a classic symptom of hypoglycemia. Instructing the client to monitor for diaphoresis is crucial as it can help them recognize and address hypoglycemic events promptly. Polyuria (excessive urination), abdominal pain, and thirst are not typical signs of hypoglycemia. Polyuria is more commonly associated with conditions like diabetes mellitus, while abdominal pain and thirst are not specific indicators of low blood sugar levels.
2. A nurse is assessing a client with chronic kidney disease. Which laboratory value would indicate the need for hemodialysis?
- A. Glomerular filtration rate (GFR) of 14 mL/min
- B. BUN 16 mg/dL
- C. Serum magnesium 1.8 mg/dL
- D. Serum phosphorus 4.0 mg/dL
Correct answer: A
Rationale: A GFR of 14 mL/min indicates significant kidney damage and a severe decrease in kidney function. This level of GFR typically indicates the need for hemodialysis to help the kidneys perform their function adequately. BUN, serum magnesium, and serum phosphorus levels are important in assessing kidney function and managing chronic kidney disease but do not specifically indicate the need for hemodialysis. Therefore, choices B, C, and D are incorrect.
3. 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.
4. A client is prescribed metronidazole for a bacterial infection. Which of the following should the nurse teach the client?
- A. Avoid alcohol while taking this medication
- B. It is safe to take during pregnancy
- C. Monitor for increased appetite
- D. It can cause hair loss
Correct answer: A
Rationale: The correct answer is A: 'Avoid alcohol while taking this medication.' Metronidazole can cause a disulfiram-like reaction with alcohol, leading to symptoms like nausea, vomiting, flushing, and headache. Therefore, clients should be instructed to avoid alcohol consumption. Choice B is incorrect because metronidazole is not considered safe during pregnancy, especially in the first trimester. Choice C is incorrect as metronidazole is not known to cause increased appetite. Choice D is also incorrect as hair loss is not a common side effect of metronidazole.
5. A nurse is caring for a 7-month-old infant being treated for severe dehydration. Which finding indicates treatment has been effective?
- A. Skin turgor displays tenting
- B. Flat anterior fontanel
- C. Cool, mottled skin
- D. Hyperpnea
Correct answer: B
Rationale: A flat anterior fontanel indicates improved hydration in infants, as dehydration typically causes sunken fontanels.
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