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. A healthcare provider is reviewing a client's lab results. Which of the following lab values should the provider report?
- A. Magnesium 1.9 mEq/L
- B. Potassium 3.6 mEq/L
- C. Sodium 126 mEq/L
- D. Chloride 99 mEq/L
Correct answer: C
Rationale: The correct answer is C: Sodium 126 mEq/L. A sodium level of 126 mEq/L is below the normal range, indicating hyponatremia, which can have serious health implications and should be reported to the healthcare provider for further evaluation and intervention. Choices A, B, and D are within or close to the normal ranges for magnesium, potassium, and chloride, respectively, and do not require immediate reporting as they are not significantly abnormal.
3. What are the nursing interventions for a patient with acute kidney injury (AKI)?
- A. Preparing the patient for dialysis if necessary
- B. Providing dietary modifications to reduce potassium
- C. Monitoring urine output and electrolytes
- D. Administering fluids and monitoring blood pressure
Correct answer: A
Rationale: The correct nursing intervention for a patient with acute kidney injury (AKI) includes preparing the patient for dialysis if necessary. While choices B, C, and D are also important aspects of managing AKI, the critical intervention in severe cases is to prepare the patient for dialysis to support kidney function. Providing dietary modifications to reduce potassium, monitoring urine output and electrolytes, and administering fluids are essential components of the overall care plan for AKI patients, but in cases where the condition is severe or if conservative management fails, dialysis may be required to support the patient's kidney function and prevent further complications.
4. A patient is receiving enteral feedings through a nasogastric (NG) tube. What is the most appropriate nursing intervention?
- A. Flush the NG tube with water before and after each feeding.
- B. Check the placement of the NG tube before each feeding.
- C. Administer medications through the NG tube every 4 hours.
- D. Increase the feeding rate if the patient is tolerating well.
Correct answer: B
Rationale: Checking the placement of the NG tube before each feeding is crucial as it ensures the tube is correctly positioned, reducing the risk of complications such as aspiration or improper delivery of feedings. Flushing the NG tube with water before and after each feeding can disrupt the feeding schedule and is not a standard procedure. Administering medications through the NG tube every 4 hours may not be necessary for all patients and should be based on specific medication requirements. Increasing the feeding rate without proper assessment and monitoring can lead to feeding intolerance or complications, making it an inappropriate intervention.
5. A healthcare professional is assessing a client who has a hip fracture. Which of the following findings should the healthcare professional expect?
- A. Hip pallor
- B. Leg abduction
- C. Muscle spasms
- D. Leg lengthening
Correct answer: C
Rationale: Muscle spasms are a common finding in clients with hip fractures. The muscle spasms occur due to the body's natural response to the injury, causing involuntary contractions. Hip pallor (Choice A) is not typically associated with hip fractures. Leg abduction (Choice B) and leg lengthening (Choice D) are not typical findings in clients with hip fractures, as the fracture usually results in limited range of motion and shortening of the affected limb.
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