ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 A with NGN
1. A patient is admitted with suspected pneumonia. What is the nurse's priority assessment?
- A. Auscultate the patient's lung sounds.
- B. Assess the patient's oxygen saturation.
- C. Monitor the patient's white blood cell count.
- D. Monitor the patient's skin integrity.
Correct answer: B
Rationale: The correct answer is to assess the patient's oxygen saturation. In suspected pneumonia, ensuring adequate oxygenation is critical to monitor respiratory function. Auscultating lung sounds is important but assessing oxygen saturation takes precedence as it directly reflects the patient's oxygen levels. Monitoring white blood cell count is more related to infection assessment rather than immediate respiratory status. Checking skin integrity is essential for overall patient care but is not the priority in a patient with suspected pneumonia.
2. A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements indicates an understanding of the teaching?
- A. I should avoid taking acetaminophen while taking this medication
- B. I will take this medication at the same time each day
- C. I will need to get my blood tested regularly while taking this medication
- D. I should increase my intake of leafy green vegetables
Correct answer: C
Rationale: The correct answer is C. Warfarin therapy requires regular blood testing to monitor INR levels and ensure therapeutic dosing. Option A is incorrect because acetaminophen can be taken with warfarin. Option B is not specific to warfarin administration. Option D is incorrect as it does not address the key monitoring requirement of blood testing while on warfarin.
3. A nurse is caring for a patient with an infection. Which laboratory result is most important to monitor?
- A. White blood cell count (WBC)
- B. C-reactive protein (CRP)
- C. Erythrocyte sedimentation rate (ESR)
- D. Hemoglobin and hematocrit levels
Correct answer: A
Rationale: The correct answer is A: White blood cell count (WBC). Monitoring the white blood cell count is crucial when caring for a patient with an infection as it helps assess the body's response to the infection. An elevated white blood cell count often indicates an active infection or inflammation, while a decreasing count may signal improvement or potential complications. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are nonspecific markers of inflammation and not as specific to monitoring infection progression as the white blood cell count. Hemoglobin and hematocrit levels are important for assessing oxygen-carrying capacity and blood volume, but they are not the primary indicators for monitoring infection.
4. What is a key characteristic of Illness Anxiety Disorder?
- A. Excessive focus on minor symptoms without medical evidence of illness
- B. The need for consistent reassurance from healthcare professionals
- C. Compulsive behavior to avoid physical illness
- D. Development of avoidance behaviors to reduce anxiety
Correct answer: A
Rationale: The correct answer is A: "Excessive focus on minor symptoms without medical evidence of illness." Illness Anxiety Disorder, formerly known as hypochondriasis, is characterized by a preoccupation with having a serious illness despite no medical evidence to support the presence of an illness. Individuals with this disorder often interpret normal bodily sensations as signs of severe illness. Choice B is incorrect because while individuals with Illness Anxiety Disorder may seek reassurance from healthcare professionals, the excessive focus on minor symptoms is the key characteristic. Choice C is incorrect as compulsive behaviors to avoid physical illness are more characteristic of illnesses like Obsessive-Compulsive Disorder. Choice D is incorrect as the development of avoidance behaviors to reduce anxiety is more commonly seen in conditions like specific phobias or social anxiety disorder.
5. What are the key components of a pain assessment in a postoperative patient?
- A. Checking the effectiveness of pain interventions
- B. Observing for nonverbal signs of pain like grimacing
- C. Assessing the location, duration, and quality of the pain
- D. Asking the patient to rate their pain on a scale of 1-10
Correct answer: A
Rationale: The correct answer is A because in a postoperative patient, it is crucial to evaluate the effectiveness of the pain interventions that have been implemented. While choices B, C, and D are important aspects of a pain assessment, they do not specifically address the key component of assessing the effectiveness of the interventions applied postoperatively.
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