ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 A with NGN
1. The nurse is caring for a patient in the hospital. The nurse observes the nursing assistive personnel (NAP) turning off the handle faucet with bare hands. Which professional practice principle supports the need for follow-up with the NAP?
- A. The nurse is responsible for providing a safe environment for the patient.
- B. This step is crucial in the process of handwashing.
- C. Different scopes of practice allow for procedure modifications.
- D. Leaving the water running wastes resources and money.
Correct answer: A
Rationale: The correct answer is A. The nurse is responsible for providing a safe environment for the patient. In this situation, the nurse should follow up with the nursing assistive personnel (NAP) who turned off the handle faucet with bare hands to ensure infection control practices are maintained. This action is crucial to prevent the spread of infections in the hospital setting. Choice B is incorrect because the question is not specifically about handwashing procedures but about infection control practices. Choice C is incorrect as it does not address the potential risk of infection transmission. Choice D is incorrect as it is unrelated to the main concern of infection control in this scenario.
2. A client requires suctioning every 2 hours. To whom should the nurse delegate this task?
- A. Delegate to a licensed practical nurse (LPN)
- B. Delegate to a registered nurse (RN)
- C. Delegate to a nursing assistant (NA)
- D. Perform the task independently
Correct answer: A
Rationale: The correct answer is to delegate the task to a licensed practical nurse (LPN). LPNs can typically perform suctioning, but it is essential to consider the state's practice guidelines and hospital policy. Option B, delegating to a registered nurse (RN), is not necessary for this task as LPNs are usually competent to handle suctioning. Option C, delegating to a nursing assistant (NA), may not be appropriate as suctioning may require a higher level of training and expertise. Option D, performing the task independently, is not the best choice as delegation is a key aspect of nursing practice to ensure tasks are appropriately assigned based on competency levels.
3. How should a healthcare provider manage a patient with deep vein thrombosis (DVT)?
- A. Monitoring for signs of pulmonary embolism
- B. Applying compression stockings
- C. Administering anticoagulants as prescribed
- D. Encouraging leg elevation to reduce swelling
Correct answer: A
Rationale: Corrected Rationale: Monitoring for signs of pulmonary embolism is crucial in patients with deep vein thrombosis (DVT) as it can be a life-threatening complication. While administering anticoagulants as prescribed is important for preventing clot progression, the immediate concern is detecting potential pulmonary embolism. Applying compression stockings and encouraging leg elevation are beneficial measures for managing DVT symptoms but are not as critical as monitoring for pulmonary embolism.
4. A nurse is evaluating a client receiving hemodialysis. Which of the following lab values requires immediate intervention?
- A. Sodium 135 mEq/L
- B. Potassium 6.5 mEq/L
- C. Calcium 9 mg/dL
- D. Chloride 98 mEq/L
Correct answer: B
Rationale: The correct answer is B. Potassium levels above 5.0 mEq/L can lead to cardiac issues, and a level of 6.5 mEq/L requires immediate intervention. Hyperkalemia can cause life-threatening cardiac arrhythmias. Choices A, C, and D are within normal ranges and do not require immediate intervention in the context of hemodialysis monitoring.
5. A nurse is developing a plan of care for an older adult who is at risk for falls. Which of the following actions should the nurse include?
- A. Lock beds and wheelchairs when not in use
- B. Administer a sedative at bedtime
- C. Provide information about home safety checks
- D. Teach balance and strengthening exercises
Correct answer: A
Rationale: The correct action for the nurse to include in the plan of care for an older adult at risk for falls is to lock beds and wheelchairs when not in use. This measure is crucial for preventing falls and ensuring patient safety in healthcare settings. Administering sedatives at bedtime (Choice B) is not recommended as it does not address the underlying risk factors for falls and may increase the risk of injury. Providing information about home safety checks (Choice C) is important for fall prevention in the home environment but is not directly related to healthcare settings. Teaching balance and strengthening exercises (Choice D) is beneficial for fall prevention but may not be suitable for all older adults at risk for falls, especially in acute care settings.
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