ATI RN
RN ATI Capstone Proctored Comprehensive Assessment A
1. A patient with a history of asthma is admitted with shortness of breath. What is the nurse's priority intervention?
- A. Administer a bronchodilator as prescribed.
- B. Encourage the patient to use an incentive spirometer.
- C. Place the patient in a high Fowler's position.
- D. Monitor the patient's oxygen saturation closely.
Correct answer: A
Rationale: The correct answer is to administer a bronchodilator as prescribed. This intervention is the priority for a patient with asthma experiencing shortness of breath as it helps relax the airways, making breathing easier. Encouraging the use of an incentive spirometer (Choice B) is beneficial for lung expansion but not the priority in this acute situation. Placing the patient in a high Fowler's position (Choice C) can also help with breathing but is not as immediate as administering a bronchodilator. While monitoring the patient's oxygen saturation closely (Choice D) is important, the immediate action to address the breathing difficulty is administering a bronchodilator.
2. Which personality disorder is characterized by disregard for others and manipulative behaviors?
- A. Borderline Personality Disorder
- B. Antisocial Personality Disorder
- C. Histrionic Personality Disorder
- D. Narcissistic Personality Disorder
Correct answer: B
Rationale: Antisocial Personality Disorder is the correct answer. This disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others. Individuals with this disorder often display behaviors such as manipulation, exploitation, and a lack of empathy. Choice A, Borderline Personality Disorder, is characterized by unstable moods, behavior, and relationships. Choice C, Histrionic Personality Disorder, is characterized by attention-seeking behavior and excessive emotions. Choice D, Narcissistic Personality Disorder, is characterized by a grandiose sense of self-importance, a need for admiration, and a lack of empathy for others.
3. A patient reports nausea and vomiting after chemotherapy. What is the nurse's priority action?
- A. Administer an antiemetic as prescribed.
- B. Encourage the patient to eat small, frequent meals.
- C. Provide the patient with anti-nausea wristbands.
- D. Encourage the patient to rest after eating.
Correct answer: A
Rationale: The correct answer is to administer an antiemetic as prescribed. Chemotherapy-induced nausea and vomiting can be distressing for patients. Administering an antiemetic helps alleviate these symptoms effectively. Choice B, encouraging the patient to eat small, frequent meals, may be helpful for other gastrointestinal issues but is not the priority when the patient is experiencing nausea and vomiting. Choice C, providing anti-nausea wristbands, may offer some relief but is not as direct and immediate as administering an antiemetic. Choice D, encouraging the patient to rest after eating, is not the priority in this situation where the focus should be on managing the nausea and vomiting.
4. A nurse observes a colleague not using proper hand hygiene. What should the nurse do first?
- A. Ignore the behavior and continue with care
- B. Discuss the behavior with other colleagues
- C. Confront the colleague about the behavior
- D. Report the behavior to the supervisor
Correct answer: D
Rationale: The correct action for the nurse to take first is to report the behavior to the supervisor. Proper hand hygiene is essential in preventing the spread of infections in healthcare settings. By reporting the observed behavior to the supervisor, the nurse is prioritizing patient safety and promoting a culture of accountability. Ignoring the behavior (Choice A) can put patients at risk, discussing it with other colleagues (Choice B) may not address the issue effectively, and confronting the colleague directly (Choice C) might not be the most appropriate initial step and could lead to conflicts rather than a constructive resolution.
5. A client with left hemiparesis is learning how to use a cane. Which of the following instructions should the nurse include?
- A. Place the cane approximately 61 cm (24 in) in front of their feet before advancing
- B. Advance the stronger leg and the cane together to support the weaker leg
- C. Remove the rubber tip when using the cane
- D. Hold the cane on the right side to provide support for the weaker leg
Correct answer: D
Rationale: The correct way to use a cane for a client with left hemiparesis is to hold the cane on the right side to provide support for the weaker left leg. This allows for better stability and weight distribution. Placing the cane approximately 61 cm (24 in) in front of their feet before advancing (Choice A) is not necessary and may lead to improper gait. Advancing the stronger leg and the cane together (Choice B) is incorrect as it does not provide support for the weaker leg. Removing the rubber tip when using the cane (Choice C) is also incorrect as the rubber tip helps provide traction and stability.
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