ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B
1. The nurse is evaluating a client who had a cardiac catheterization with a left antecubital insertion site. Which of the following pulses should the nurse palpate?
- A. Brachial pulse in the right arm
- B. Radial pulse in the right arm
- C. Brachial pulse in the left arm
- D. Radial pulse in the left arm
Correct answer: D
Rationale: The correct answer is to palpate the radial pulse in the left arm. When the antecubital insertion site is on the left side, it is important to assess the radial pulse on the same side to monitor circulation accurately. Palpating the brachial pulse in the right or left arm or the radial pulse in the right arm would not provide direct information about the circulation related to the catheterization site.
2. A healthcare professional is planning care for a client who is scheduled for a lumbar puncture. Which of the following actions should the healthcare professional include?
- A. Restrict the client's fluid intake for 4 hours following the procedure
- B. Apply cold compresses to the puncture site after the procedure
- C. Instruct the client to increase oral fluid intake after the procedure
- D. Keep the client in a prone position for 12 hours after the procedure
Correct answer: C
Rationale: The correct action to include in caring for a client scheduled for a lumbar puncture is to instruct the client to increase oral fluid intake after the procedure. Increasing oral fluid intake helps replace cerebrospinal fluid lost during the lumbar puncture and reduces the risk of headaches. Restricting fluid intake (Choice A) is not recommended as it can lead to dehydration. Applying cold compresses (Choice B) is not necessary after a lumbar puncture. Keeping the client in a prone position for 12 hours (Choice D) is not required after a lumbar puncture and can cause discomfort and complications.
3. The nurse asks a client who is about to have a cardiac catheterization about any allergies. The client states, 'I always get a rash when I eat shellfish.' Which of the following is the priority nursing action?
- A. Attach a wristband indicating the client's allergy
- B. Ask the client if any other foods cause such a reaction
- C. Notify the dietary department of the client's allergy
- D. Notify the provider of the client's allergy
Correct answer: D
Rationale: Notifying the provider of the client's shellfish allergy is crucial to prevent a potential reaction from the contrast dye. While attaching a wristband indicating the allergy may be necessary, the priority is to inform the provider. Asking the client about other foods causing a similar reaction or notifying the dietary department, although important, are not the priority in this situation.
4. A newly licensed nurse tells a charge nurse that he is unsure about accepting telephone medication prescriptions. Which of the following providers should the charge nurse identify as having the legal ability to give telephone medication prescriptions?
- A. Anesthesiologists
- B. Physician assistants
- C. Hospital pharmacists
- D. Nurse practitioners
Correct answer: A
Rationale: The correct answer is A: Anesthesiologists. Anesthesiologists are licensed providers who have the legal authority to give telephone medication prescriptions. Physician assistants (choice B), hospital pharmacists (choice C), and nurse practitioners (choice D) do not typically have the legal ability to provide medication prescriptions over the phone. In this scenario, the charge nurse should inform the newly licensed nurse that anesthesiologists are one of the providers who can legally give telephone medication prescriptions.
5. A nurse notices another nurse skipping hand hygiene. What is the appropriate course of action?
- A. Ignore the situation to maintain team harmony.
- B. Report the behavior to the supervisor.
- C. Discuss the issue with the nurse directly.
- D. Do nothing and continue with patient care.
Correct answer: B
Rationale: Correct hand hygiene is crucial for preventing the spread of infections and ensuring patient safety. When a nurse observes another healthcare worker skipping hand hygiene practices, it is essential to report this behavior to the supervisor. Reporting ensures that appropriate action is taken to address the issue and maintain a safe environment for patients. Ignoring the situation (Choice A) may compromise patient safety. Discussing the issue directly with the nurse (Choice C) may not always be effective in ensuring compliance. Doing nothing and continuing with patient care (Choice D) disregards the importance of infection control protocols.
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