ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form A
1. A client is being taught how to use a PCA pump postoperatively. Which statement indicates understanding?
- A. I should wait until the pain is severe before using the PCA pump.
- B. My family can press the button for me when I'm asleep.
- C. I will press the button when I start to feel pain.
- D. I will only press the button once per hour.
Correct answer: C
Rationale: The correct answer is C because the client should press the PCA pump button when they start to feel pain. This approach helps maintain pain control effectively. Choice A is incorrect because waiting for the pain to become severe before using the PCA pump can lead to inadequate pain management. Choice B is incorrect because only the client should operate the PCA pump to ensure the correct dosage is administered. Choice D is incorrect because the client should press the button as needed when experiencing pain, rather than limiting its use to once per hour.
2. A nurse is teaching a client about the use of gabapentin. Which of the following should be included?
- A. It can cause drowsiness
- B. It has no side effects
- C. It is a pain reliever
- D. It can be taken with food
Correct answer: A
Rationale: The correct answer is A: 'It can cause drowsiness.' Gabapentin is known to cause drowsiness, and clients should be warned about this side effect. Choice B is incorrect because gabapentin, like any medication, can have side effects. Choice C is incorrect because although gabapentin is used for pain management, it is not classified as a pain reliever. Choice D is incorrect because gabapentin should be taken as prescribed by the healthcare provider, and specific instructions regarding food intake should be provided based on individual needs.
3. A client has a stool culture positive for C. difficile. What action should the nurse take?
- A. Place the client in a negative pressure room
- B. Use alcohol-based hand rub after providing care
- C. Wear a face shield before entering the room
- D. Place the client in a private room
Correct answer: D
Rationale: When caring for a client with a C. difficile infection, it is essential to isolate them in a private room to prevent the spread of spores through contact with surfaces. Placing the client in a negative pressure room (Choice A) is not necessary for C. difficile. Using alcohol-based hand rub (Choice B) and wearing a face shield (Choice C) are important infection control measures but are not specific to the isolation requirements for C. difficile.
4. A client is being educated by a nurse on nutritional intake. Which of the following should the nurse include in the teaching?
- A. Carbohydrates should be at least 45% of your caloric intake
- B. Protein should be at least 55% of your caloric intake
- C. Carbohydrates should be at least 30% of your caloric intake
- D. Protein should be at least 60% of your caloric intake
Correct answer: A
Rationale: Carbohydrates should make up 45-65% of daily caloric intake as they are the body’s main source of energy. This aligns with general dietary recommendations. Choice B is incorrect as protein should typically make up about 10-35% of daily caloric intake, not 55%. Choice C is also incorrect, as carbohydrates should ideally be between 45-65%, not 30%. Choice D is incorrect because protein should generally account for around 10-35% of total caloric intake, not 60%.
5. A nurse is planning care for a newly admitted adolescent client who has bacterial meningitis. Which of the following instructions is appropriate for the nurse to include in the plan of care?
- A. Initiate droplet precautions
- B. Assist the client to a supine position
- C. Perform Glasgow Coma Scale assessment every 24 hours
- D. Recommend prophylactic acyclovir for the client’s family
Correct answer: A
Rationale: The correct answer is A: 'Initiate droplet precautions.' Bacterial meningitis requires droplet precautions to prevent the spread of infection, as the bacteria can be transmitted through respiratory secretions. Choice B is incorrect because assisting the client to a supine position is not specific to the care of a client with bacterial meningitis and may not be appropriate for all clients. Choice C is incorrect because while performing Glasgow Coma Scale assessments is important in managing clients with neurological conditions, it is not directly related to preventing the spread of bacterial meningitis. Choice D is incorrect because recommending prophylactic acyclovir for the client's family is not a standard precautionary measure for preventing the spread of bacterial meningitis.
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