ATI RN
RN ATI Capstone Proctored Comprehensive Assessment A
1. The nurse is caring for a patient who is susceptible to infection. Which instruction will the nurse include in an educational session to decrease the risk of infection?
- A. Teaching the patient to take a temperature
- B. Teaching the patient to select nutritious foods
- C. Teaching the patient about the effects of alcohol
- D. Teaching the patient about fall prevention
Correct answer: B
Rationale: The correct answer is B: Teaching the patient to select nutritious foods. A nutritious diet plays a crucial role in strengthening the body's immune system, making it more capable of fighting off infections. Vitamins, minerals, and other nutrients found in healthy foods support immune function and overall health. Teaching the patient about taking a temperature (choice A) may be important for monitoring for signs of infection but does not directly decrease the risk of infection. Teaching about the effects of alcohol (choice C) and fall prevention (choice D) are important aspects of patient education but are not directly related to decreasing the risk of infection in a susceptible patient.
2. What is the most appropriate method for assessing a patient's pain level?
- A. Observe the patient's facial expressions.
- B. Use a standardized pain scale, such as 0-10.
- C. Ask the patient to rate their pain based on their mood.
- D. Ask the patient's family members to assess the pain.
Correct answer: B
Rationale: The most appropriate method for assessing a patient's pain level is to use a standardized pain scale, such as a 0-10 scale. This method provides an objective and consistent way to measure and communicate the intensity of pain experienced by the patient. Choice A, observing facial expressions, can be subjective and may not always accurately reflect the level of pain. Choice C, asking the patient to rate their pain based on their mood, may be influenced by various factors unrelated to pain. Choice D, involving the patient's family members in assessing the pain, is not ideal as pain is a subjective experience that should be reported by the patient themselves.
3. When caring for a client's tracheostomy at home, which instruction should the nurse include in the teaching?
- A. Clean with alcohol
- B. Cover the tracheostomy when outside
- C. Replace the tube weekly
- D. Use tap water to clean
Correct answer: B
Rationale: Covering the tracheostomy when outside is crucial as it helps prevent dust and other irritants from entering the airway, reducing the risk of complications. Cleaning with alcohol (choice A) can be too harsh for the skin around the tracheostomy site. While replacing the tube weekly (choice C) is important, it is typically done by healthcare providers. Using tap water to clean (choice D) is not recommended as it may introduce contaminants to the tracheostomy site.
4. A client is administering insulin. Which statement by the client shows proper understanding of insulin administration?
- A. I will inject insulin into my thigh before exercise
- B. I will skip meals to lower blood sugar
- C. I will store my insulin in the freezer
- D. I will rotate injection sites for insulin administration
Correct answer: D
Rationale: The correct answer is D because rotating injection sites prevents tissue damage and ensures better absorption of insulin. Option A is incorrect as injecting insulin into the thigh before exercise can lead to hypoglycemia. Option B is incorrect as skipping meals can cause blood sugar levels to drop dangerously low. Option C is incorrect as insulin should not be stored in the freezer as it can alter its effectiveness.
5. A nurse in a clinic is caring for a client who has a urinary tract infection (UTI). Which of the following prescriptions should the nurse verify with a provider?
- A. Trimethoprim-sulfamethoxazole
- B. Hyoscyamine
- C. Oxybutynin
- D. Phenazopyridine
Correct answer: C
Rationale: The correct answer is C, Oxybutynin. Oxybutynin can worsen urinary retention, so the nurse should verify this prescription with the provider. Trimethoprim-sulfamethoxazole (Choice A) is a common antibiotic used to treat UTIs and does not require verification. Hyoscyamine (Choice B) is an anticholinergic medication used for bladder spasms and does not typically worsen UTI symptoms. Phenazopyridine (Choice D) is a urinary analgesic that helps relieve pain, burning, and discomfort caused by a UTI, which may not necessarily require verification in this scenario.
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