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PN ATI Capstone Proctored Comprehensive Assessment 2020 A
1. A client with a seizure disorder has a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply)
- A. PTT
- B. Aspartate aminotransferase (AST)
- C. Alanine aminotransferase (ALT)
- D. All of the Above
Correct answer: D
Rationale: The correct answer is D, 'All of the Above.' Valproic acid can impact liver function and coagulation. Monitoring the Prothrombin Time (PTT), Aspartate Aminotransferase (AST), and Alanine Aminotransferase (ALT) is crucial. PTT is monitored to assess coagulation status, while AST and ALT are liver enzymes that indicate liver function. Monitoring these values helps detect any potential adverse effects of valproic acid on the liver and blood clotting. Choices A, B, and C are incorrect because each of these laboratory values plays a critical role in evaluating the client's response to valproic acid therapy and detecting associated complications.
2. A nurse is reviewing the laboratory values for a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse prepare to take?
- A. Administer vitamin K
- B. Reduce the infusion rate
- C. Give the client a low-dose aspirin
- D. Request an INR
Correct answer: B
Rationale: An aPTT of 90 seconds is elevated, indicating a risk of bleeding due to excessive anticoagulation. The appropriate action is to reduce the infusion rate of heparin to prevent further complications. Administering vitamin K is not indicated for an elevated aPTT due to heparin therapy. Giving the client a low-dose aspirin can further increase the risk of bleeding when combined with heparin. Requesting an INR is not necessary for monitoring heparin therapy; aPTT is the more specific test for assessing heparin's therapeutic effect. Therefore, the correct action for the nurse to prepare to take is to reduce the infusion rate of heparin.
3. A healthcare professional is reviewing the laboratory results for a client who has a prescription for filgrastim. The healthcare professional should recognize that an increase in which of the following values indicates a therapeutic effect of this medication?
- A. Erythrocyte count
- B. Neutrophil count
- C. Lymphocyte count
- D. Thrombocyte count
Correct answer: B
Rationale: Filgrastim is a medication used to stimulate the production of neutrophils in patients with neutropenia. Neutrophils are a type of white blood cell that plays a crucial role in fighting off infections. Therefore, an increase in neutrophil count would indicate a therapeutic effect of filgrastim. The other options, such as erythrocyte count (red blood cells), lymphocyte count, and thrombocyte count (platelets), are not directly affected by filgrastim and would not indicate a therapeutic effect of this medication.
4. A nurse is providing discharge teaching to a client who has heart failure and a new prescription for digoxin 0.215 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching?
- A. I know that blurred vision is something I will expect to happen while taking digoxin.
- B. I will measure my urine output each day and document it in my diary.
- C. I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute.
- D. I will eat fruits and vegetables that have high potassium content every day.
Correct answer: D
Rationale: Clients taking digoxin and furosemide are at risk for hypokalemia. Eating potassium-rich foods can help maintain normal potassium levels.
5. A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40 mg daily, but the client reports she has been taking extra doses to promote weight loss. Which of the following indicates she is dehydrated?
- A. Urine specific gravity of 1.035
- B. Oliguria
- C. Increased urine concentration
- D. Dry mucous membranes
Correct answer: A
Rationale: The correct answer is A: Urine specific gravity of 1.035. A urine specific gravity greater than 1.030 indicates dehydration as the kidneys conserve water in response to dehydration. Choice B, oliguria, refers to decreased urine output, which can be a sign of dehydration but is not specific to it. Choice C, increased urine concentration, is a general term and does not directly indicate dehydration. Choice D, dry mucous membranes, can be a sign of dehydration but is not as specific as a urine specific gravity greater than 1.030.
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