ATI RN
RN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse in a clinic is caring for a client who has a urinary tract infection (UTI). Which of the following prescriptions should the nurse verify with a provider?
- A. Trimethoprim-sulfamethoxazole
- B. Hyoscyamine
- C. Oxybutynin
- D. Phenazopyridine
Correct answer: C
Rationale: The correct answer is C, Oxybutynin. Oxybutynin can worsen urinary retention, so the nurse should verify this prescription with the provider. Trimethoprim-sulfamethoxazole (Choice A) is a common antibiotic used to treat UTIs and does not require verification. Hyoscyamine (Choice B) is an anticholinergic medication used for bladder spasms and does not typically worsen UTI symptoms. Phenazopyridine (Choice D) is a urinary analgesic that helps relieve pain, burning, and discomfort caused by a UTI, which may not necessarily require verification in this scenario.
2. A client with a history of falls is under the care of a nurse. Which intervention is most important to implement?
- A. Increase the frequency of bed checks.
- B. Use bed alarms to prevent falls.
- C. Keep the room well lit during the day.
- D. Encourage the client to use a walker for mobility.
Correct answer: B
Rationale: Using bed alarms to prevent falls is the most important intervention to implement for a client with a history of falls. Bed alarms can provide timely alerts to the healthcare team, allowing for quick assistance to prevent falls. Increasing the frequency of bed checks may not necessarily prevent falls as effectively as direct intervention with bed alarms. Keeping the room well lit is important for general safety but may not address the immediate risk of falls. Encouraging the client to use a walker for mobility is beneficial but may not be as crucial as implementing bed alarms to prevent falls in this scenario.
3. A client with renal calculi is admitted. What is the priority nursing intervention?
- A. Monitor urinary output every shift.
- B. Administer pain medication as ordered.
- C. Strain all urine for stones.
- D. Increase fluid intake to flush the urinary tract.
Correct answer: C
Rationale: The correct answer is to strain all urine for stones. This is the priority nursing intervention for a client with renal calculi as it helps in identifying and preventing stones from passing unnoticed. Monitoring urinary output, administering pain medication, and increasing fluid intake are important aspects of care for this client, but the priority is to ensure that any passed stones are collected and analyzed to guide further treatment.
4. A nurse is assessing a client's wound dressing and observes a watery red drainage. The nurse should document this drainage as which of the following?
- A. Purulent
- B. Serous
- C. Sanguineous
- D. Serosanguineous
Correct answer: D
Rationale: The correct answer is D, serosanguineous. Serosanguineous drainage is thin, watery, and pale red, indicating a mixture of serous fluid and blood. Choice A (purulent) refers to thick, yellow or green drainage indicating infection. Choice B (serous) is thin, clear drainage. Choice C (sanguineous) is bright red, indicating fresh bleeding.
5. A nurse sees another nurse administering medication without using alcohol swabs. What is the first action the nurse should take?
- A. Ignore the situation to maintain a good working relationship.
- B. Report the behavior to the nurse manager.
- C. Ask the colleague to be more careful next time.
- D. Report the issue after speaking to other colleagues.
Correct answer: B
Rationale: The correct action for the nurse to take when witnessing unsafe medication administration practices, such as not using alcohol swabs, is to report the behavior to the nurse manager immediately. Patient safety is the top priority, and any actions that compromise it must be addressed promptly. Ignoring the situation (Choice A) is not appropriate as it puts patients at risk. Asking the colleague to be more careful (Choice C) may not be effective in ensuring immediate correction of the unsafe practice. Reporting the issue after speaking to other colleagues (Choice D) delays necessary action and may compromise patient safety further.
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