ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 A with NGN
1. Which intervention is most effective in managing a patient with chronic pain?
- A. Administer opioid medications as prescribed.
- B. Teach the patient relaxation techniques.
- C. Encourage the patient to perform range of motion exercises.
- D. Recommend complete bed rest to minimize pain.
Correct answer: B
Rationale: The most effective intervention in managing a patient with chronic pain is teaching the patient relaxation techniques. Relaxation techniques can help reduce stress, decrease muscle tension, and improve pain management in patients with chronic pain. Administering opioids as prescribed may have risks of dependence and side effects, making it less favorable as a first-line intervention. Encouraging range of motion exercises can be beneficial, but relaxation techniques directly target stress reduction, a common exacerbating factor in chronic pain. Recommending complete bed rest is generally discouraged in chronic pain management as it can lead to deconditioning and worsen pain over time.
2. When caring for a patient with a nasogastric (NG) tube, what is the most appropriate intervention to prevent aspiration?
- A. Flush the NG tube with water before each feeding.
- B. Check the placement of the NG tube before each feeding.
- C. Elevate the head of the bed to 30-45 degrees.
- D. Provide the patient with oral care every 4 hours.
Correct answer: C
Rationale: Elevating the head of the bed to 30-45 degrees is the most appropriate intervention to prevent aspiration in a patient with an NG tube. This position helps reduce the risk of regurgitation and aspiration by promoting the proper flow of contents through the gastrointestinal tract and minimizing the chances of stomach contents entering the airway. Flushing the NG tube with water before each feeding may not directly prevent aspiration. Checking the placement of the NG tube is important but does not specifically address the prevention of aspiration. Providing oral care every 4 hours is essential for maintaining oral hygiene but is not directly related to preventing aspiration in a patient with an NG tube.
3. Which of the following is a correct method of safely using a sterile dressing?
- A. Reuse a dressing that appears clean.
- B. Discard a dressing after 24 hours of use.
- C. Change a dressing only if there is visible drainage.
- D. Change a dressing every 4 hours regardless of condition.
Correct answer: B
Rationale: The correct method of safely using a sterile dressing is to discard it after 24 hours of use. This is important to prevent contamination and promote proper wound healing. Choice A is incorrect because reusing a dressing, even if it appears clean, can introduce contaminants. Choice C is incorrect as dressing changes should not be based solely on visible drainage; they should be done within the recommended time frame. Choice D is incorrect because changing a dressing every 4 hours, regardless of its condition, can lead to unnecessary wastage and disturbance to the wound healing process.
4. A nurse is presenting educational materials for a group of middle-aged clients about menopausal hormone therapy following a total hysterectomy. Which of the following information should the nurse include?
- A. Take at different times of the day
- B. Prevents from having a cerebral hemorrhage
- C. Prevents osteoporotic fractures
- D. Take an extra dose if missed a day
Correct answer: C
Rationale: The correct information the nurse should include is that menopausal hormone therapy helps prevent osteoporotic fractures by maintaining bone density. Option A is incorrect as hormone therapy should be taken consistently at the same time each day for optimal effectiveness. Option B is incorrect as menopausal hormone therapy is not primarily aimed at preventing cerebral hemorrhage. Option D is incorrect because taking an extra dose is not recommended if a dose is missed; instead, the missed dose should be taken as soon as remembered, unless it is close to the time for the next dose.
5. When administering IV fluids to a dehydrated patient, what is the nurse's priority assessment?
- A. Monitor the patient's electrolyte levels.
- B. Assess the patient's blood pressure regularly.
- C. Monitor the patient's heart rate every 4 hours.
- D. Check the patient's urine output hourly.
Correct answer: B
Rationale: The correct answer is to assess the patient's blood pressure regularly. Monitoring blood pressure is crucial when administering IV fluids to a dehydrated patient as it helps in evaluating the patient's fluid status. Changes in blood pressure can indicate the effectiveness of the fluid therapy, the patient's response to treatment, and the possibility of complications such as fluid overload or hypovolemia. Monitoring electrolyte levels (Choice A) is essential but not the priority when assessing a dehydrated patient receiving IV fluids. Heart rate (Choice C) should be monitored more frequently than every 4 hours in such a situation. Checking urine output (Choice D) is important but not as critical as assessing blood pressure in this scenario.
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