ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 A with NGN
1. 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.
2. Which of the following is a primary focus of tertiary prevention in mental health?
- A. Identifying early signs of mental illness
- B. Preventing the occurrence of mental health problems
- C. Rehabilitation and prevention of further deterioration
- D. Providing a safe environment to prevent harm
Correct answer: C
Rationale: The correct answer is C: Rehabilitation and prevention of further deterioration. Tertiary prevention in mental health aims to provide interventions and support to individuals who already have a mental illness to prevent further deterioration and promote recovery. Choice A, identifying early signs of mental illness, is more aligned with primary prevention which focuses on preventing the onset of mental health problems. Choice B, preventing the occurrence of mental health problems, pertains to secondary prevention which involves early detection and intervention to prevent the progression of mental health issues. Choice D, providing a safe environment to prevent harm, is important but it is not the primary focus of tertiary prevention which is more centered on rehabilitation and improving the quality of life for individuals with existing mental health conditions.
3. A patient is being taught to use TD nitroglycerin patches to treat angina pectoris. What instructions should be included?
- A. Apply a patch every 12 hours
- B. Apply a new patch every morning
- C. Use it only when symptoms appear
- D. Rotate the application site weekly
Correct answer: B
Rationale: The correct answer is to apply a new patch every morning. Nitroglycerin patches should be applied in the morning and removed at bedtime to provide a 14-hour nitrate-free interval, preventing tolerance development. Choice A is incorrect because applying a patch every 12 hours may lead to tolerance. Choice C is incorrect because nitroglycerin patches are used prophylactically, not just when symptoms appear. Choice D is incorrect because rotating the application site weekly is not necessary; the same site can be used as long as there is no skin irritation.
4. A public health nurse is developing guidelines for the management of a botulism outbreak. Which of the following information should the nurse include?
- A. High-risk individuals should receive immunoglobulin E (IgE)
- B. Implement airborne precautions for clients who have botulism
- C. Administer an aminoglycoside medication
- D. Rinse skin with soap and water following exposure to the botulism toxin
Correct answer: D
Rationale: The correct answer is D. Rinsing the skin with soap and water following exposure to the botulism toxin is crucial as it helps remove the toxin from the skin, preventing further absorption. Choices A, B, and C are incorrect. Immunoglobulin E (IgE) is not used in the management of botulism. Airborne precautions are not necessary for botulism as it is not transmitted through the air. Aminoglycoside medications are not the treatment of choice for botulism.
5. A patient has impaired skin integrity, and a nurse is providing care. What action should the nurse take to promote healing?
- A. Apply a dry, sterile dressing to the wound.
- B. Use sterile saline to clean the wound.
- C. Apply a warm compress to promote circulation.
- D. Keep the wound open to air for faster healing.
Correct answer: B
Rationale: The correct action to promote healing in a patient with impaired skin integrity is to use sterile saline to clean the wound. Sterile saline helps prevent infection and promotes healing of wounds by keeping the area clean. Applying a dry, sterile dressing (Choice A) may not be effective as it does not address the need for wound cleaning. Applying a warm compress (Choice C) may not be suitable for all types of wounds and could potentially cause harm. Keeping the wound open to air (Choice D) is generally not recommended as it can lead to infection and slow down the healing process.
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