ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B
1. What teaching points are important for the nurse to discuss with a client with hearing loss who has been fitted for a hearing aid?
- A. Use the highest setting to promote full auditory comprehension
- B. Use mild soap and water to clean the ear mold
- C. Turn the hearing aid off to conserve battery life during hours of sleep only
- D. Immerse the hearing aid in saline solution to keep it hygienic
Correct answer: B
Rationale: The correct teaching point for a client with hearing loss who has been fitted for a hearing aid is to use mild soap and water to clean the ear mold. It is important to keep the ear mold clean to prevent infections and maintain proper functioning. Choice A is incorrect because using the highest setting can lead to discomfort and may not be necessary for all situations. Choice C is incorrect as the hearing aid should generally be turned off when not in use, not just during sleep, to conserve battery life. Choice D is incorrect as immersing the hearing aid in saline solution can damage the device; it should be kept dry to prevent malfunction.
2. A nurse is caring for a client receiving oxytocin IV for labor augmentation. The client’s contractions are occurring every 45 seconds and lasting 90 seconds. What action should the nurse take?
- A. Discontinue the oxytocin infusion
- B. Increase the oxytocin infusion
- C. Decrease the oxytocin infusion
- D. Maintain the oxytocin infusion
Correct answer: A
Rationale: In this scenario, the client is experiencing uterine hyperstimulation with contractions every 45 seconds lasting 90 seconds. This frequency and duration of contractions can lead to fetal distress. The appropriate nursing action is to discontinue the oxytocin infusion immediately to prevent complications. Increasing or maintaining the oxytocin infusion would exacerbate the situation, while decreasing it may not be sufficient to address the issue effectively.
3. A healthcare professional is preparing to transfer a client from a chair to a bed. The client can bear partial weight and has upper body strength. Which device should the healthcare professional use?
- A. Hydraulic lift
- B. Stand-assist lift
- C. Wheelchair
- D. Mechanical lift
Correct answer: B
Rationale: A stand-assist lift is the appropriate device for transferring a client who can bear partial weight and has upper body strength. This device provides support for the client to stand up and be transferred safely. A hydraulic lift is more suitable for transferring clients who cannot bear weight. A wheelchair is used for mobility but not for transferring between a chair and a bed. A mechanical lift is typically used for transferring clients who are unable to bear weight or have limited mobility.
4. A client who signed an informed consent form for surgery but has since expressed doubts about the need for surgery should discuss concerns with the surgeon to obtain informed answers. Which statement should the nurse make?
- A. It's normal to feel unsure; the surgery will be beneficial
- B. You can cancel surgery any time without any consequences
- C. I'll inform the surgeon to answer your questions before surgery
- D. We can reschedule surgery for another day
Correct answer: C
Rationale: The correct answer is C because the nurse should facilitate communication between the client and the surgeon to address any doubts and provide necessary information. Choice A may invalidate the client's concerns and might not address the root of the issue. Choice B oversimplifies the situation and might not consider the potential consequences of canceling surgery. Choice D, while offering an alternative, does not address the client's doubts about the surgery.
5. A nurse is providing education on the use of aspirin. Which of the following should be included?
- A. It can increase the risk of bleeding
- B. It is safe to give to children
- C. It should be taken on an empty stomach
- D. It has no side effects
Correct answer: A
Rationale: The correct answer is A: 'It can increase the risk of bleeding.' Aspirin is known to have antiplatelet effects and can increase the risk of bleeding, especially if taken in high doses or for prolonged periods. Choice B is incorrect because aspirin is not safe for children due to the risk of Reye's syndrome. Choice C is incorrect because aspirin should be taken with food to minimize gastrointestinal side effects. Choice D is incorrect because aspirin, like any medication, can have side effects, such as gastrointestinal bleeding, ulcers, or allergic reactions.
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