ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B with NGN
1. When reinforcing teaching about self-care with a patient who has pelvic inflammatory disease and does not speak English, what action by the nurse is appropriate?
- A. Provide written instructions in English.
- B. Use family members as translators.
- C. Seek assistance from a facility-approved interpreter.
- D. Use online translation tools.
Correct answer: C
Rationale: When communicating with a patient who does not speak English, it is crucial to seek assistance from a facility-approved interpreter. Using family members as translators can lead to inaccuracies, breaches in confidentiality, and discomfort for the patient. Online translation tools may not provide accurate or context-specific translations, which can result in misunderstandings. Providing written instructions in English would not be effective if the patient does not understand the language.
2. A healthcare provider is preparing to administer an influenza vaccine to an adult client. Which of the following is a contraindication?
- A. Client has a low-grade fever
- B. Client is allergic to eggs
- C. Client had recent surgery
- D. Client is on corticosteroid therapy
Correct answer: B
Rationale: The correct answer is B: Client is allergic to eggs. The influenza vaccine is contraindicated in individuals with an allergy to eggs because some influenza vaccines are produced using egg-based processes. Choices A, C, and D are not contraindications for administering the influenza vaccine. A low-grade fever, recent surgery, and corticosteroid therapy are not contraindications for receiving the influenza vaccine.
3. A client with burn injuries covering their upper body is concerned about their altered appearance. Which of the following statements should the nurse make?
- A. “It is okay to not want to touch the burned areas of your body.”
- B. “Cosmetic surgery should be performed within the next year to be effective.”
- C. “Reconstructive surgery can completely restore your previous appearance.”
- D. “It could be helpful for you to attend a support group for people who have burn injuries.”
Correct answer: D
Rationale: The nurse should encourage the client to attend a support group for individuals with burn injuries. Support groups can provide emotional support, promote acceptance of altered appearance, and help the client cope with the changes. Choice A is incorrect because it may not address the client's emotional needs. Choice B is incorrect as suggesting a timeline for cosmetic surgery may not be appropriate without considering the client's physical and emotional readiness. Choice C is incorrect as reconstructive surgery may not completely restore the client's previous appearance and may set unrealistic expectations.
4. A patient with chronic kidney disease reports feeling light-headed after taking their medication. What should the nurse instruct the patient to do?
- A. Take the medication with food
- B. Take the medication at bedtime
- C. Stand up slowly to prevent dizziness
- D. Increase fluid intake
Correct answer: C
Rationale: Patients with chronic kidney disease are prone to orthostatic hypotension, which can cause dizziness. To prevent this, the nurse should instruct the patient to stand up slowly. Options A, B, and D do not directly address the issue of orthostatic hypotension and dizziness in this scenario.
5. A client has been prescribed albuterol. Which of the following is a priority adverse effect the nurse should monitor?
- A. Tachycardia
- B. Bradycardia
- C. Dizziness
- D. Hypertension
Correct answer: A
Rationale: Corrected Rationale: Albuterol, a beta-2 adrenergic agonist, can lead to tachycardia due to its stimulant effect on beta-2 receptors in the heart. Monitoring for tachycardia is crucial as it can be a sign of excessive sympathetic stimulation and may lead to severe complications. Bradycardia, dizziness, and hypertension are less likely adverse effects of albuterol, making them lower priority for monitoring in this context.
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