ATI RN
RN ATI Capstone Proctored Comprehensive Assessment A
1. A patient is receiving an opioid analgesic for pain management. What is the most important assessment for the nurse to perform?
- A. Monitor the patient's blood pressure.
- B. Assess the patient's respiratory rate.
- C. Monitor the patient's oxygen saturation.
- D. Assess the patient's heart rate.
Correct answer: B
Rationale: The correct answer is to assess the patient's respiratory rate. When a patient is receiving opioids, it is crucial to monitor their respiratory rate as opioids can depress the respiratory system, leading to respiratory depression and potential respiratory failure. Monitoring blood pressure, oxygen saturation, and heart rate are important assessments as well, but the priority lies in assessing respiratory rate due to the risk of respiratory depression associated with opioid use.
2. What are the priority nursing assessments for a patient who has just undergone major surgery?
- A. Providing analgesia as prescribed
- B. Monitoring for signs of infection
- C. Assessing the surgical site for bleeding
- D. Monitoring the patient's vital signs
Correct answer: B
Rationale: The correct answer is to monitor for signs of infection. After major surgery, one of the priority nursing assessments is to watch for signs of infection, such as increased temperature, redness, swelling, or drainage at the surgical site. While providing analgesia is important for pain management, monitoring for infection takes precedence as it can lead to severe complications if not detected early. Assessing the surgical site for bleeding is crucial but is usually more relevant immediately after surgery. Monitoring the patient's vital signs is essential, but the specific focus on infection assessment is crucial in the immediate postoperative period.
3. When preparing to give a report during a shift change, what information is most critical to communicate?
- A. Include a full family medical history.
- B. Focus on changes in the patient's condition.
- C. Summarize the patient's treatment plan.
- D. Provide updates on the patient's lab results.
Correct answer: B
Rationale: During a shift change report, the most critical information to communicate is focusing on changes in the patient's condition. This helps ensure that all healthcare providers are aware of any significant developments or deterioration in the patient's health status, allowing for timely and appropriate interventions. Choices A, C, and D are not as crucial during a shift report. While a full family medical history and treatment plan are important aspects of patient care, they are not the primary focus during a shift change report. Providing updates on lab results may be important but may not be as time-sensitive or immediately impactful as changes in the patient's condition.
4. The healthcare provider is assessing how a patient's pain is affecting mobility. Which assessment question is most appropriate?
- A. What activities, if any, has your pain prevented you from doing?
- B. When does your pain medication typically take effect on your pain?
- C. Would you please rate your pain on a scale from 0 to 10 for me?
- D. Have you considered working with a physical therapist?
Correct answer: A
Rationale: The most appropriate assessment question in this scenario is asking the patient, 'What activities, if any, has your pain prevented you from doing?' This question helps the healthcare provider understand how pain is impacting the patient's daily activities and mobility, providing valuable insight into the limitations caused by the pain. Choice B focuses on pain medication effectiveness, which is not directly related to mobility assessment. Choice C aims at pain intensity assessment but does not directly address mobility issues. Choice D suggests a solution rather than gathering information about the current impact of pain on mobility.
5. A nurse is using the ecologic model for population health to develop interventions to address HIV in a community. Which of the following interventions should the nurse include to address financial factors affecting community health?
- A. Have adolescents lead peer discussions in schools about safe sexual practices
- B. Distribute condoms through remote community clinics
- C. Create commercial advertisements describing the long-term effects of HIV
- D. Include information about perinatal HIV transmission at prenatal education classes
Correct answer: B
Rationale: The correct answer is B. Distributing condoms addresses financial barriers by providing access to essential protective measures in remote areas. Choice A focuses on education rather than direct intervention related to financial factors. Choice C involves advertising and not a direct intervention to address financial factors. Choice D pertains to education about HIV transmission rather than directly addressing financial barriers affecting community health.
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