ATI RN
ATI Capstone Comprehensive Assessment B
1. A patient may need restraints. Which task can the nurse delegate to a nursing assistive personnel?
- A. Determining the need for restraints
- B. Obtaining an order for a restraint
- C. Assessing the patient's orientation
- D. Applying the restraint
Correct answer: D
Rationale: The correct answer is applying the restraint (Choice D). Nursing assistive personnel can be delegated the task of applying restraints under the supervision and direction of a nurse. Determining the need for restraints (Choice A) and obtaining an order for a restraint (Choice B) involve clinical judgment and assessment, which are responsibilities of the nurse. Assessing the patient's orientation (Choice C) also requires a level of assessment that should be performed by a nurse.
2. A client with a urinary tract infection is prescribed ciprofloxacin. Which instruction should the nurse provide?
- A. Continue taking this medication until you feel better
- B. Take this medication with milk or food
- C. Take the medication with an antacid
- D. Avoid caffeine while taking this medication
Correct answer: D
Rationale: The correct instruction for the nurse to provide to a client taking ciprofloxacin for a urinary tract infection is to avoid caffeine. Ciprofloxacin can interact with caffeine, potentially leading to increased side effects or reduced effectiveness. Choice A is incorrect because antibiotics should be taken for the full prescribed course, even if the client starts feeling better. Choice B is incorrect as ciprofloxacin should not be taken with dairy products or antacids as they can interfere with the absorption of the medication.
3. A patient with diabetes is admitted with high blood sugar levels. What is the nurse's priority intervention?
- A. Administer insulin as prescribed.
- B. Encourage the patient to exercise regularly.
- C. Encourage the patient to drink water.
- D. Provide the patient with a low-sugar diet.
Correct answer: A
Rationale: Administering insulin is the priority intervention for a patient admitted with high blood sugar levels because it helps lower the blood sugar levels effectively and rapidly. Insulin is a crucial medication for managing hyperglycemia in diabetes. Encouraging exercise (choice B) can be beneficial in the long term for managing blood sugar levels but is not the most immediate priority. While staying hydrated (choice C) is important, it is not the priority intervention when dealing with high blood sugar levels. Providing a low-sugar diet (choice D) is essential for long-term diabetes management but is not the immediate action needed to address high blood sugar levels in an admitted patient.
4. A forensic nurse is using the epidemiological triangle to explain factors that contribute to violent behavior. Which of the following factors should the nurse identify as an environmental factor in the epidemiological triangle?
- A. Crowded living conditions
- B. Traumatic brain injury
- C. Alzheimer's disease
- D. Impaired coping abilities
Correct answer: A
Rationale: Crowded living conditions are considered an environmental factor in the epidemiological triangle as they can contribute to the spread of violence. In this context, environmental factors refer to external influences such as social and physical environments. Traumatic brain injury, Alzheimer's disease, and impaired coping abilities are not typically classified as environmental factors in the epidemiological triangle. Traumatic brain injury and Alzheimer's disease are more related to individual health conditions, while impaired coping abilities are more focused on individual psychological factors rather than external environmental influences.
5. A nurse is caring for a newborn in the nursery following a circumcision. The newborn's grandparent, who does not have an identification bracelet, requests to take the newborn to his parents' room. Which of the following actions should the nurse take?
- A. Check the newborn's identification bracelet against the chart
- B. Obtain permission from the newborn's parents
- C. Respectfully deny the grandparent's request
- D. Review the newborn's footprints record
Correct answer: C
Rationale: In this scenario, where the grandparent lacks proper identification, the nurse should respectfully deny the request to take the newborn. It is crucial to prioritize the newborn's safety and security by following hospital policies and procedures. Checking the newborn's identification bracelet against the chart (Choice A) may not be sufficient to address the situation at hand, as the grandparent's lack of identification is the primary concern. While obtaining permission from the newborn's parents (Choice B) is important, the lack of proper identification from the grandparent takes precedence. Reviewing the newborn's footprints record (Choice D) is not necessary in this situation, as the immediate concern is ensuring proper identification and security before allowing the newborn to leave the nursery.
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