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PN ATI Capstone Fundamentals Quiz
1. When teaching a client about the correct use of a cane, what should the nurse include?
- A. Ensure the cane has a rubber cap
- B. Hold the cane on the stronger side
- C. Flex the elbow slightly when using the cane
- D. Use a quad cane for increased support
Correct answer: B
Rationale: When using a cane, it should be held on the stronger side to provide optimal support and stability. This positioning allows the cane to bear weight effectively and helps in improving balance. Option A about ensuring the cane has a rubber cap is important for preventing slipping but is not directly related to the correct use of the cane. Option C, flexing the elbow slightly, is a general guideline and may vary depending on the individual's height and the type of cane being used. Option D suggesting the use of a quad cane for increased support is not necessary if a standard cane is sufficient for the client's needs.
2. A client who signed an informed consent form for surgery but has since expressed doubts about the need for surgery is being assisted by a nurse. Which of the following statements should the nurse make?
- A. You should not worry about it
- B. The surgeon will answer your questions before surgery
- C. It’s too late to cancel the surgery
- D. You need to trust the medical team
Correct answer: B
Rationale: The correct answer is B because the nurse should encourage the client to express concerns and ensure that the surgeon addresses any questions prior to the procedure. Choice A is incorrect as it dismisses the client's worries. Choice C is incorrect because it does not respect the client's autonomy in decision-making. Choice D is incorrect as it does not address the client's doubts directly or provide reassurance.
3. A nurse is caring for a client who has an indwelling urinary catheter. What should the nurse identify as a sign of catheter occlusion?
- A. Bladder distention
- B. Frequent urination
- C. Dark urine
- D. Increased thirst
Correct answer: A
Rationale: Bladder distention is the correct sign of catheter occlusion. When a catheter is occluded, the urine cannot drain properly, leading to the buildup of urine in the bladder and subsequent distention. Frequent urination, dark urine, and increased thirst are not typical signs of catheter occlusion. Frequent urination can be a sign of conditions like urinary tract infection, dark urine may indicate dehydration or other issues, and increased thirst can be related to various factors like diabetes or medication side effects.
4. While assessing the IV infusion site of a client who reports pain at the site, a nurse notes redness and warmth along the vein. What should the nurse do?
- A. Continue the infusion
- B. Increase the infusion rate
- C. Discontinue the infusion
- D. Apply a cold compress
Correct answer: C
Rationale: The symptoms described indicate phlebitis, which is inflammation of the vein. In this case, the nurse should discontinue the infusion to prevent further complications. Continuing the infusion or increasing the rate can exacerbate the condition. Applying a cold compress is not recommended for phlebitis; instead, a warm compress can help alleviate discomfort.
5. A client expresses anxiety about an upcoming surgery. What should the nurse do?
- A. Reassure the client that everything will be fine
- B. Ask the client to describe feelings
- C. Tell the client to stay positive
- D. Provide information about the surgery
Correct answer: B
Rationale: Asking the client to describe their feelings is the most appropriate action for the nurse to take. This allows the nurse to understand the specific concerns and anxieties the client is experiencing. Choice A may invalidate the client's feelings and not address the root cause of anxiety. Choice C may come across as dismissive and oversimplified. While providing information about the surgery (Choice D) is important, addressing the client's emotional state is the initial priority in this situation.
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