ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A client who is at 24 weeks of gestation is being taught about the signs of preterm labor. Which of the following should the nurse include?
- A. Sudden weight loss
- B. Regular contractions
- C. Shortness of breath
- D. Vaginal spotting
Correct answer: B
Rationale: The correct answer is B: Regular contractions. Regular contractions before 37 weeks of gestation are a significant sign of preterm labor. It is essential for clients to be aware of this symptom and report it promptly to their healthcare provider. Choices A, C, and D are incorrect because sudden weight loss, shortness of breath, and vaginal spotting are not typical signs of preterm labor. Teaching clients about the specific signs of preterm labor can help in early detection and intervention, ultimately improving outcomes for both the client and the baby.
2. A healthcare provider is teaching a client about the use of sertraline. Which of the following should be included?
- A. It can cause weight gain
- B. It is an antipsychotic
- C. Monitor for suicidal thoughts
- D. It has no side effects
Correct answer: C
Rationale: Correct answer: Monitoring for suicidal thoughts is essential when a client is prescribed sertraline, an antidepressant. Choice A is incorrect because weight gain is not typically associated with sertraline. Choice B is incorrect as sertraline is not an antipsychotic medication. Choice D is incorrect because all medications, including sertraline, have potential side effects.
3. During a skin assessment on a client with risk factors for skin cancer, a nurse should understand that a suspicious lesion is:
- A. Scaly and red
- B. Asymmetric with variegated coloring
- C. Firm and rubbery
- D. Brown with a wart-like texture
Correct answer: B
Rationale: The correct answer is B: Asymmetric with variegated coloring. An asymmetric lesion with variegated coloring, meaning different shades of color within the same lesion, is characteristic of melanoma, a type of skin cancer. This type of lesion should raise suspicions and prompt further evaluation. Choices A, C, and D do not typically represent characteristics of suspicious skin lesions associated with skin cancer. Lesions that are scaly and red (Choice A) may indicate other skin conditions like eczema or psoriasis. Firm and rubbery lesions (Choice C) are more suggestive of benign skin growths like dermatofibromas. Lesions that are brown with a wart-like texture (Choice D) are often indicative of seborrheic keratosis, a benign growth, rather than a suspicious lesion related to skin cancer.
4. A nurse is reviewing laboratory results for a client receiving chemotherapy. Which result should the nurse report to the provider?
- A. WBC 3,000/mm³
- B. Hemoglobin 12 g/dL
- C. Platelet count 250,000/mm³
- D. Serum sodium 140 mEq/L
Correct answer: A
Rationale: The correct answer is A: WBC 3,000/mm³. A WBC count of 3,000/mm³ indicates neutropenia, which is a condition characterized by a low level of white blood cells, specifically neutrophils. Neutropenia increases the risk of infection and requires immediate medical attention, especially in clients undergoing chemotherapy. Reporting this result to the provider promptly is crucial for further evaluation and intervention. Choices B, C, and D are within normal ranges and do not pose an immediate risk to the client's health. Hemoglobin of 12 g/dL, platelet count of 250,000/mm³, and serum sodium of 140 mEq/L are all normal values and would not typically require immediate reporting unless there are specific concerns related to the individual client's condition.
5. A nurse is caring for a toddler with respiratory syncytial virus (RSV). Which action should the nurse take?
- A. Use a designated stethoscope for the toddler
- B. Wear an N95 respirator mask when caring for the toddler
- C. Place the toddler in a negative pressure room
- D. Remove the disposable gown before leaving the toddler's room
Correct answer: A
Rationale: Using a designated stethoscope for the toddler is crucial to reduce the risk of spreading RSV to other patients. Choice B is incorrect because N95 respirator masks are not specifically indicated for RSV. Choice C is unnecessary as RSV does not require isolation in a negative pressure room. Choice D is incorrect because the gown should be removed after leaving the room to prevent transmission of pathogens to other areas.
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