LPN LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B
1. A menopausal client is having difficulty getting to sleep and asks what actions she should incorporate into her daily routine to promote sleep. The nurse would encourage which of the following measures to promote sleep?
- A. Consume a warm drink at bedtime
- B. Take an evening walk before bedtime
- C. Take an afternoon nap
- D. Limit alcohol and nicotine prior to bedtime
Correct answer: D
Rationale: The correct answer is D: Limit alcohol and nicotine prior to bedtime. Alcohol and nicotine are stimulants that can disrupt sleep patterns, so avoiding them before bedtime can promote better sleep. Choices A, B, and C are incorrect. Consuming a warm drink at bedtime may lead to frequent urination, disrupting sleep; taking an evening walk before bedtime may increase alertness rather than inducing sleep; and taking an afternoon nap can make it harder to fall asleep at night.
2. A nurse is caring for an older adult patient who is disoriented and has a history of falls. What actions should the nurse take?
- A. Place the bed in the lowest position, instruct the patient to remain in bed, ensure the bedside table is within reach.
- B. Instruct the patient to use the call light, apply an ambulation alarm to the patient’s leg, check on the patient hourly.
- C. Assign a sitter to monitor the patient, raise the bed rails, provide the patient with a call button.
- D. Check on the patient every two hours, provide verbal reminders to use the call light, lock the bed wheels.
Correct answer: B
Rationale: In this scenario, the correct actions for the nurse to take involve ensuring patient safety and fall prevention measures. Choice B is the correct answer because instructing the patient to use the call light allows them to signal for help, applying an ambulation alarm helps detect movement, and checking on the patient hourly increases monitoring frequency. These actions are essential for preventing falls in a disoriented patient with a history of falls. Choices A, C, and D are incorrect: A does not provide adequate monitoring or fall prevention measures, C relies solely on assigning a sitter without utilizing technological aids, and D lacks continuous monitoring and specific fall prevention strategies.
3. A client is being educated about the use of spironolactone. Which of the following should be included in the teaching?
- A. Avoid potassium-rich foods
- B. Take the medication with food
- C. Monitor for signs of toxicity
- D. Discontinue the medication if potassium levels rise
Correct answer: A
Rationale: The correct answer is A: Avoid potassium-rich foods. Spironolactone can lead to hyperkalemia, a condition characterized by high levels of potassium in the blood. To prevent this complication, clients taking spironolactone should avoid potassium-rich foods. Choice B is incorrect because spironolactone can be taken with or without food. Choice C is not directly related to spironolactone use, as toxicity monitoring is not a specific concern with this medication. Choice D is incorrect because discontinuing the medication solely based on elevated potassium levels may not be necessary; instead, dosage adjustments or potassium restriction are often more appropriate.
4. A client has been prescribed metoclopramide. Which of the following should the nurse include in client education regarding this medication?
- A. Notify your provider if you experience restlessness or spasms of the face or neck.
- B. Take the medication only if you feel nauseous.
- C. Avoid drinking any fluids while taking this medication.
- D. Take the medication on an empty stomach.
Correct answer: A
Rationale: The correct answer is A: 'Notify your provider if you experience restlessness or spasms of the face or neck.' Metoclopramide can cause extrapyramidal symptoms, such as restlessness and muscle spasms, particularly of the face and neck. These symptoms should be reported to the provider immediately. Choice B is incorrect because metoclopramide is not meant to be taken only when feeling nauseous; it is used to treat nausea and vomiting. Choice C is incorrect because it is important to stay hydrated while taking metoclopramide. Choice D is incorrect because metoclopramide is usually taken before meals to improve gastric emptying, not necessarily on an empty stomach.
5. A client is being educated by a nurse about the use of carbidopa-levodopa. Which of the following should be included?
- A. It will cure Parkinson's disease
- B. Monitor for dyskinesia
- C. It can be taken with food
- D. It is an opioid medication
Correct answer: B
Rationale: The correct answer is to 'Monitor for dyskinesia.' Carbidopa-levodopa can cause dyskinesia as a side effect, characterized by involuntary movements. Monitoring for this side effect is crucial. Choice A is incorrect because carbidopa-levodopa helps manage symptoms of Parkinson's disease but does not cure it. Choice C is incorrect because carbidopa-levodopa should be taken on an empty stomach to enhance absorption. Choice D is incorrect because carbidopa-levodopa is not an opioid medication.
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