ATI RN
RN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse is providing discharge teaching for a client prescribed warfarin. What should be included in the teaching?
- A. Avoid foods rich in vitamin K
- B. Take warfarin with meals
- C. Take aspirin for pain relief
- D. Report unusual bleeding or bruising
Correct answer: D
Rationale: The correct answer is D. When a client is prescribed warfarin, they should be educated to report any unusual bleeding or bruising promptly. Choices A, B, and C are incorrect. Avoiding foods rich in vitamin K is not necessary when taking warfarin, as long as intake remains consistent. Warfarin does not need to be taken with meals, and aspirin should not be taken for pain relief due to its blood-thinning effects, which can increase the risk of bleeding when combined with warfarin.
2. A nurse discovers a discrepancy in the narcotics log. What is the appropriate next step?
- A. Correct the log and notify the pharmacy.
- B. Report the discrepancy to the nurse manager.
- C. Re-administer the narcotic.
- D. Dispose of the narcotic and note the discrepancy.
Correct answer: B
Rationale: When a nurse discovers a discrepancy in the narcotics log, the appropriate next step is to report the discrepancy to the nurse manager. This is important to ensure that the issue is properly investigated and addressed. Choice A is incorrect because simply correcting the log and notifying the pharmacy may not address the root cause of the discrepancy. Choice C is incorrect as re-administering the narcotic without clarification could lead to potential harm or legal issues. Choice D is incorrect as disposing of the narcotic without following proper protocols and documentation could result in further complications.
3. The healthcare provider is assessing an immobile patient for deep vein thrombosis (DVT). What should the healthcare provider do?
- A. Lightly rub the lower leg to check for redness and tenderness.
- B. Apply elastic stockings every 4 hours.
- C. Measure the calf circumference of both legs.
- D. Flex the foot while assessing for patient discomfort.
Correct answer: C
Rationale: Measuring the calf circumference of both legs is crucial when assessing for DVT in an immobile patient. A significant increase in the circumference of one calf compared to the other suggests the presence of a deep vein thrombosis. Option A is incorrect because rubbing the lower leg may dislodge a clot if present. Option B is incorrect as elastic stockings should not be removed frequently as this can increase the risk of clot formation. Option D is incorrect as dorsiflexing the foot can lead to pain and should not be done to assess for DVT.
4. Which of the following foods is a good source of protein?
- A. Chicken
- B. Tofu
- C. Cheddar cheese
- D. Almonds
Correct answer: C
Rationale: Cheddar cheese is indeed a good source of protein, providing a significant amount per serving. While chicken and tofu are also high in protein, cheddar cheese can be a beneficial source, especially for individuals looking for non-meat options. Almonds, while nutritious, are not as high in protein compared to the other options listed.
5. A nurse is completing an assessment of a recently widowed older adult client. He states he is unable to drive and is afraid to cook on the stove. Which of the following community resources should the nurse recommend?
- A. Hospice care
- B. Meals on Wheels
- C. Home health services
- D. American Association of Retired Persons
Correct answer: B
Rationale: The correct answer is B: Meals on Wheels. Meals on Wheels is a community resource that provides food for older adults who are unable to cook for themselves, promoting independence and ensuring proper nutrition. Hospice care (choice A) focuses on providing comfort and support for individuals with life-limiting illnesses; it is not primarily aimed at providing meals. Home health services (choice C) typically involve skilled nursing care and therapy services provided in the home setting, rather than meal delivery. The American Association of Retired Persons (choice D) offers advocacy, support, and resources for older adults but does not directly address the specific needs mentioned in the client's situation.
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