a patient is admitted with signs of stroke which of the following diagnostic tests should the nurse anticipate as the priority

ATI RN

RN ATI Capstone Proctored Comprehensive Assessment Form A

1. A patient is admitted with signs of stroke. Which of the following diagnostic tests should the nurse anticipate as the priority?

A. CT scan
B. MRI
C. X-ray
D. Ultrasound

Correct answer: A

Rationale: A CT scan is the priority diagnostic test to identify and confirm the location and severity of a stroke.

2. After placing the patient back in bed, what should the nurse do next?

A. Re-assess the patient.
B. Complete an incident report.
C. Notify the health care provider.
D. Do nothing, no harm has occurred.

Correct answer: C

Rationale: After placing the patient back in bed, the nurse should notify the health care provider. This is important because the health care provider needs to be informed of the incident and assess the patient further to ensure no underlying injuries or issues exist. Re-assessing the patient is crucial but notifying the health care provider takes precedence in this situation. Completing an incident report is important for documentation purposes but not the immediate next step. Doing nothing is incorrect as there was an incident involving a fall that needs further evaluation.

3. What is the priority intervention for a patient experiencing chest pain?

A. Administer nitroglycerin as prescribed.
B. Encourage the patient to take deep breaths.
C. Monitor the patient's blood pressure closely.
D. Encourage the patient to rest in a comfortable position.

Correct answer: A

Rationale: The correct answer is to administer nitroglycerin as prescribed. Nitroglycerin helps relieve chest pain by dilating blood vessels and improving blood flow, addressing the immediate concern of chest pain. Encouraging deep breaths may not be appropriate for chest pain, monitoring blood pressure, although important, is not the priority when the patient is experiencing chest pain, and while resting in a comfortable position is beneficial, administering nitroglycerin is the priority intervention to address the chest pain.

4. A nurse is preparing to administer aspirin 650mg PO every 12 hr. The amount available is aspirin 325mg tablets. How many tablets should the nurse administer?

A. 1 tablet
B. 2 tablets
C. 3 tablets
D. 4 tablets

Correct answer: B

Rationale: The correct answer is 2 tablets. Each tablet of aspirin is 325mg. To achieve the required dose of 650mg, the nurse should administer 2 tablets. Choice A (1 tablet) is incorrect because it would only provide 325mg, which is half the required dose. Choices C (3 tablets) and D (4 tablets) are incorrect as they would exceed the required dose.

5. A nurse manager assigns a new nurse to care for a client with unstable blood pressure. What is the nurse's priority action?

A. Ask the charge nurse for assistance.
B. Recheck the blood pressure before calling for help.
C. Monitor the client's blood pressure closely.
D. Administer antihypertensive medication immediately.

Correct answer: B

Rationale: The correct answer is to recheck the blood pressure before calling for help. When caring for a client with unstable blood pressure, the nurse's priority is to ensure an accurate assessment. Rechecking the blood pressure will confirm the instability and guide further actions. Asking the charge nurse for assistance (Choice A) is important but should come after assessing the situation. Monitoring the client's blood pressure closely (Choice C) is essential, but the immediate action should be to recheck and confirm the current status. Administering antihypertensive medication immediately (Choice D) without a confirmed assessment can be dangerous and is not the initial priority.