ATI RN
RN ATI Capstone Proctored Comprehensive Assessment A
1. A healthcare provider orders a medication dose three times higher than usual. What is the nurse's first step?
- A. Administer the medication but monitor the patient closely.
- B. Verify the dosage with the prescribing provider.
- C. Administer a lower dose to minimize the risk.
- D. Hold the medication and wait for further clarification.
Correct answer: B
Rationale: The correct answer is B: Verify the dosage with the prescribing provider. When faced with an unusual medication dose, the nurse's initial action should be to confirm the order with the healthcare provider who prescribed it. This step is crucial to prevent medication errors and ensure patient safety. Choices A, C, and D are incorrect because administering the medication without clarification, administering a lower dose without approval, or holding the medication without consulting the provider can all pose risks to the patient's well-being.
2. Which of the following actions is a means of maintaining medical asepsis to reduce and prevent the spread of microorganisms?
- A. Sterilizing contaminated items
- B. Routinely cleaning the hospital environment
- C. Reapplying a sterile dressing
- D. Applying a sterile gown and gloves
Correct answer: A
Rationale: The correct answer is A: Sterilizing contaminated items. Maintaining medical asepsis involves ensuring that items are free of microorganisms to prevent infections. Sterilizing contaminated items is a crucial step in this process as it eliminates all microorganisms, including spores. Choices B, C, and D do not directly address the process of reducing and preventing the spread of microorganisms. While routinely cleaning the hospital environment is important for cleanliness, it does not guarantee the elimination of all microorganisms. Reapplying a sterile dressing and applying a sterile gown and gloves are specific actions related to personal protective equipment and wound care, not the general maintenance of medical asepsis.
3. If a nurse is uncomfortable documenting a verbal prescription, what should the nurse do?
- A. Document the prescription without seeking clarification.
- B. Clarify the verbal prescription with the healthcare provider.
- C. Refuse to document the prescription.
- D. Speak with the client's family to clarify the situation.
Correct answer: B
Rationale: When a nurse is uncomfortable documenting a verbal prescription, the best course of action is to clarify the prescription with the healthcare provider. This is crucial to ensure that the information is accurate and to provide safe and appropriate care. Option A is incorrect because blindly documenting without seeking clarification can lead to errors. Option C is incorrect as refusing to document the prescription altogether is not in the best interest of the patient. Option D is also incorrect as speaking with the client's family is not the appropriate step to clarify a verbal prescription; the healthcare provider should be the primary source for this clarification.
4. A patient is admitted with suspected pneumonia. What is the nurse's priority assessment?
- A. Auscultate the patient's lung sounds.
- B. Assess the patient's oxygen saturation.
- C. Monitor the patient's white blood cell count.
- D. Monitor the patient's skin integrity.
Correct answer: B
Rationale: The correct answer is to assess the patient's oxygen saturation. In suspected pneumonia, ensuring adequate oxygenation is critical to monitor respiratory function. Auscultating lung sounds is important but assessing oxygen saturation takes precedence as it directly reflects the patient's oxygen levels. Monitoring white blood cell count is more related to infection assessment rather than immediate respiratory status. Checking skin integrity is essential for overall patient care but is not the priority in a patient with suspected pneumonia.
5. Which of the following is a correct method of safely using a sterile dressing?
- A. Reuse a dressing that appears clean.
- B. Discard a dressing after 24 hours of use.
- C. Change a dressing only if there is visible drainage.
- D. Change a dressing every 4 hours regardless of condition.
Correct answer: B
Rationale: The correct method of safely using a sterile dressing is to discard it after 24 hours of use. This is important to prevent contamination and promote proper wound healing. Choice A is incorrect because reusing a dressing, even if it appears clean, can introduce contaminants. Choice C is incorrect as dressing changes should not be based solely on visible drainage; they should be done within the recommended time frame. Choice D is incorrect because changing a dressing every 4 hours, regardless of its condition, can lead to unnecessary wastage and disturbance to the wound healing process.
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