ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B
1. What are the nursing interventions for a patient with pneumonia?
- A. Providing fluids and rest
- B. Monitoring lung sounds and respiratory rate
- C. Encouraging coughing and deep breathing exercises
- D. Administering antibiotics and providing oxygen therapy
Correct answer: B
Rationale: The correct nursing interventions for a patient with pneumonia include monitoring lung sounds and respiratory rate to assess the effectiveness of treatment and the patient's respiratory status. Providing fluids and rest (Choice A) can be supportive measures but are not specific nursing interventions for pneumonia. Encouraging coughing and deep breathing exercises (Choice C) can be helpful for airway clearance but may not be appropriate for all patients with pneumonia. Administering antibiotics and providing oxygen therapy (Choice D) are medical interventions rather than nursing interventions.
2. 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.
3. Which nursing action will best promote patient safety when administering medications?
- A. Check the patient's wristband before administering medications.
- B. Confirm the patient's allergies prior to administration.
- C. Document the medications immediately after administration.
- D. Prepare medications at the medication cart to minimize distractions.
Correct answer: B
Rationale: Confirming the patient's allergies before administering medications is crucial for patient safety as it helps prevent adverse reactions. Checking the patient's wristband is important for identification but may not directly impact medication safety. Documenting medications after administration is necessary but does not primarily promote safety during administration. Preparing medications at the medication cart, rather than the nurse's station, is preferred to ensure accuracy and proper medication handling, but it is not directly related to confirming allergies for safety.
4. 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.
5. Which intervention is essential when caring for a patient with a nasogastric (NG) tube?
- A. Suction the NG tube every 4 hours.
- B. Check the placement of the NG tube before each feeding.
- C. Flush the NG tube with water before and after each medication administration.
- D. Remove the NG tube once the patient feels comfortable.
Correct answer: B
Rationale: Checking the placement of the NG tube before each feeding is crucial to ensure it is correctly positioned and safe to use. Option A is incorrect as routine suctioning can lead to complications and should only be done as needed. Option C is not necessary unless there are specific instructions for flushing. Option D is incorrect as the NG tube should only be removed by healthcare professionals based on medical criteria, not solely based on the patient's comfort.
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