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PN ATI Capstone Fundamentals Quiz
1. A nurse is updating a plan of care after evaluating a client who has dysphagia. Which interventions should the nurse include in the plan?
- A. Have the client lie down after meals
- B. Encourage the client to speak while eating
- C. Have the client sit upright for 1 hour following meals
- D. Offer thin liquids with meals
Correct answer: C
Rationale: The correct intervention for a client with dysphagia is to have them sit upright for 1 hour following meals. This position facilitates swallowing and reduces the risk of aspiration. Choice A is incorrect because having the client lie down after meals can increase the risk of aspiration. Choice B is incorrect as talking while eating can lead to choking. Choice D is incorrect as thin liquids may be harder for a client with dysphagia to swallow safely.
2. A nurse is preparing to perform a sterile dressing change for a client who has a surgical wound. Which of the following actions should the nurse take to prevent contamination during the dressing change?
- A. Use sterile gloves only as necessary
- B. Restart the procedure if the sterile solution splashes onto the sterile field while pouring the solution into the dressing tray
- C. Keep the dressing tray on a nearby surface
- D. Avoid speaking during the procedure
Correct answer: B
Rationale: The correct action to prevent contamination during a sterile dressing change is to restart the procedure if the sterile solution splashes onto the sterile field while pouring the solution into the dressing tray. Any contact with the sterile field by non-sterile items makes the field contaminated and requires restarting the procedure to maintain sterility. Choice A is incorrect because sterile gloves should always be used during a sterile procedure to prevent contamination. Choice C is incorrect as the dressing tray should be placed on a sterile surface, not on the client's bed, to maintain sterility. Choice D is also incorrect as talking during the procedure does not necessarily lead to contamination if proper aseptic technique is maintained.
3. A nurse is caring for a client who has a prescription for a narcotic medication. After administration, the nurse is left with an unused portion. What should the nurse do?
- A. Discard the medication in the trash
- B. Return the medication to the pharmacy
- C. Discard the medication with another nurse as a witness
- D. Store the medication for future use
Correct answer: C
Rationale: The correct action for the nurse to take when left with an unused portion of a narcotic medication is to discard the medication with another nurse as a witness. This procedure ensures accountability and proper disposal of controlled substances. Choice A is incorrect as discarding in the trash can lead to potential misuse or environmental harm. Choice B is incorrect because returning controlled substances to the pharmacy is not the appropriate method for disposal. Choice D is incorrect as storing the medication for future use is not permitted with controlled substances.
4. A nurse is performing a cultural assessment of a group of clients to maintain respect for their value systems and beliefs. Which of the following should the nurse identify as examples of cultural variables?
- A. Eye contact
- B. Personal space
- C. Touch
- D. All of the above
Correct answer: D
Rationale: In a cultural assessment, it is essential to consider various cultural variables that can impact communication and interactions. Eye contact, personal space, and touch are examples of cultural variables that can vary among different cultural groups. These variables influence how individuals perceive and engage in communication. Understanding and respecting these differences are crucial for effective and culturally sensitive care. Therefore, the correct answer is 'All of the above.' Choices A, B, and C are incorrect because each of them represents a cultural variable that should be considered during a cultural assessment.
5. A client is found on the floor of their room experiencing a seizure. Which of the following actions is the priority for the nurse?
- A. Place the client on their side with their head forward
- B. Call for help
- C. Protect the client's head
- D. Restrain the client
Correct answer: A
Rationale: During a seizure, the priority action for the nurse is to place the client on their side with their head forward. This position helps maintain an open airway and prevents aspiration, which is crucial in managing the client's safety during a seizure. Calling for help is important but ensuring the client's immediate safety by positioning them correctly takes precedence. Protecting the client's head can be done concurrently while positioning the client. Restraint is not appropriate during a seizure as it can lead to injuries and complications.
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