ATI RN
RN ATI Capstone Proctored Comprehensive Assessment A
1. A client is undergoing chemotherapy and expresses concern about hair loss. What is the best response?
- A. Reassure the client that hair loss is not permanent.
- B. Provide resources for wigs or hairpieces.
- C. Encourage the client to cut their hair short in advance.
- D. Advise the client that chemotherapy causes temporary hair loss.
Correct answer: D
Rationale: The best response when a client undergoing chemotherapy expresses concern about hair loss is to advise them that chemotherapy causes temporary hair loss. This response provides accurate information to the client about the side effect they are experiencing. Choice A is incorrect because it may provide false reassurance as for some individuals, hair loss can be a challenging experience. Choice B is not the best initial response as addressing the client's concerns and providing information should come first. Choice C is not the most appropriate response as cutting hair short may not necessarily prevent hair loss and does not address the client's concerns about the temporary nature of chemotherapy-induced hair loss.
2. A client with a new prescription for sumatriptan tablets to treat migraine headaches should report which of the following symptoms to the nurse?
- A. Chew the tablet well before swallowing
- B. Report swelling of the eyelids after dosage
- C. Repeat dose in 1 hour for unrelieved headache
- D. Take daily to prevent headaches
Correct answer: B
Rationale: The correct answer is B because swelling of the eyelids is a side effect of sumatriptan tablets that requires immediate reporting to the healthcare provider to prevent further complications. Choices A, C, and D are incorrect. Chewing the tablet well before swallowing is not necessary for sumatriptan tablets. Repeating the dose in 1 hour for unrelieved headache is incorrect as this medication should not be repeated within 24 hours. Taking sumatriptan daily for headache prevention is also incorrect as it is used for acute treatment, not prevention.
3. 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.
4. Which personality disorder is characterized by disregard for others and manipulative behaviors?
- A. Borderline Personality Disorder
- B. Antisocial Personality Disorder
- C. Histrionic Personality Disorder
- D. Narcissistic Personality Disorder
Correct answer: B
Rationale: Antisocial Personality Disorder is the correct answer. This disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others. Individuals with this disorder often display behaviors such as manipulation, exploitation, and a lack of empathy. Choice A, Borderline Personality Disorder, is characterized by unstable moods, behavior, and relationships. Choice C, Histrionic Personality Disorder, is characterized by attention-seeking behavior and excessive emotions. Choice D, Narcissistic Personality Disorder, is characterized by a grandiose sense of self-importance, a need for admiration, and a lack of empathy for others.
5. What is the most important nursing action when caring for a patient with a central venous catheter (CVC)?
- A. Monitor the patient's blood pressure regularly.
- B. Change the CVC dressing every 72 hours.
- C. Flush the CVC with normal saline every shift.
- D. Avoid using the CVC for blood draws.
Correct answer: B
Rationale: The most important nursing action when caring for a patient with a central venous catheter (CVC) is to change the CVC dressing every 72 hours. This practice reduces the risk of infection and ensures the catheter remains secure. Monitoring the patient's blood pressure regularly is important but not the most crucial action when managing a CVC. Flushing the CVC with normal saline is essential but not the most important action. Avoiding using the CVC for blood draws is a good practice, but it is not the most critical nursing action in this scenario.
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