ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A client is being taught how to use a cane. Which instruction should the nurse include?
- A. Use the cane on the stronger side
- B. Use the cane on the weaker side
- C. Ensure the cane has a rubber tip
- D. Hold the cane 1-2 inches from the ground
Correct answer: A
Rationale: The correct answer is to use the cane on the stronger side. This instruction is important because it provides better support and balance. Placing the cane on the stronger side helps to shift weight off the weaker or injured side, reducing the risk of falls and promoting stability. Choices B, C, and D are incorrect. Using the cane on the weaker side would not provide optimal support. While ensuring the cane has a rubber tip and holding it 1-2 inches from the ground are important, they are not as crucial as using the cane on the stronger side for proper support and balance.
2. When teaching a client about the correct use of a cane, what should the nurse include?
- A. Hold the cane on the weaker side
- B. Ensure the cane has a rubber tip
- C. Keep the cane on the dominant side
- D. Use the cane only on stairs
Correct answer: B
Rationale: The correct answer is B. When instructing a client on the use of a cane, it is essential to ensure that the cane has a rubber tip. This rubber tip helps prevent slipping, providing additional stability and safety. Option A, holding the cane on the weaker side, is incorrect as the cane should be held on the stronger side to provide better balance and support. Option C, keeping the cane on the dominant side, is also incorrect because the cane should be held on the stronger side. Option D, using the cane only on stairs, is not comprehensive as the cane can be used for support and balance while walking on level ground as well.
3. A nurse is assisting with meal planning for a client who has been prescribed a mechanical soft diet. Which food should the nurse instruct the client to avoid?
- A. Steamed carrots
- B. Orange slices
- C. Mashed potatoes
- D. Baked chicken
Correct answer: B
Rationale: Correct! Orange slices should be avoided by clients on a mechanical soft diet as they can be difficult to chew and swallow. Steamed carrots, mashed potatoes, and baked chicken are suitable choices for a mechanical soft diet, as they are softer in texture and easier to consume without posing a risk of choking or swallowing difficulties.
4. A client with chronic obstructive pulmonary disease (COPD) is being taught breathing exercises by a nurse. What instruction should the nurse include to improve oxygenation?
- A. Use pursed-lip breathing during activities
- B. Use deep breathing exercises after meals
- C. Perform diaphragmatic breathing during exercise
- D. Breathe in short, shallow breaths
Correct answer: A
Rationale: The correct instruction the nurse should include to improve oxygenation for a client with COPD is to 'Use pursed-lip breathing during activities.' Pursed-lip breathing helps improve oxygenation by slowing down the respiratory rate, reducing the work of breathing, and keeping the airways open. This technique also helps prevent the collapse of small airways during exhalation, allowing for more complete emptying of the lungs. Choices B, C, and D are incorrect because deep breathing exercises after meals, diaphragmatic breathing during exercise, and breathing in short, shallow breaths do not specifically target the improvement of oxygenation in individuals with COPD.
5. A nurse is preparing a client for transfer to another unit. Which finding should the nurse include in the transfer report?
- A. Nutritional status
- B. Client's response to pain medication
- C. Daily vital signs
- D. Most recent lab results
Correct answer: B
Rationale: The correct answer is B: Client's response to pain medication. When transferring a client to another unit, it is crucial to communicate how the client is responding to pain medication to ensure continuity of care and appropriate pain management. While nutritional status, daily vital signs, and most recent lab results are important aspects of the client's care, the client's response to pain medication directly impacts their comfort and well-being during the transfer process.
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