ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 A with NGN
1. A healthcare professional is assessing a client for signs of respiratory distress. Which of the following findings should the healthcare professional look for?
- A. Shallow breathing
- B. Bradycardia
- C. Increased appetite
- D. Warm, dry skin
Correct answer: A
Rationale: Corrected Question: A healthcare professional is assessing a client for signs of respiratory distress. Shallow breathing is a key indicator of respiratory distress, reflecting an inadequate exchange of oxygen and carbon dioxide. Bradycardia (Choice B) refers to a slow heart rate and is not typically a direct sign of respiratory distress. Increased appetite (Choice C) and warm, dry skin (Choice D) are unrelated to respiratory distress. Therefore, the correct answer is A.
2. A nurse is preparing to administer a unit of packed RBCs to a client. Which of the following actions should the nurse take first?
- A. Administer an antihistamine prior to transfusion.
- B. Check the client’s vital signs.
- C. Verify the client’s identification with another nurse.
- D. Prime the IV tubing with normal saline.
Correct answer: C
Rationale: The correct first action the nurse should take when preparing to administer packed RBCs to a client is to verify the client’s identification with another nurse. This is crucial to ensure that the correct blood product is administered to the correct client, minimizing the risk of a transfusion reaction. Administering an antihistamine prior to transfusion (Choice A) is not the first priority and is not a standard practice. While checking the client’s vital signs (Choice B) is important, verifying the client’s identification takes precedence to prevent a critical error. Priming the IV tubing with normal saline (Choice D) is a necessary step in the process but should occur after verifying the client's identity.
3. A nurse is providing education to a client about a new prescription for digoxin. Which of the following should be included?
- A. Monitor for increased heart rate
- B. Take the medication at the same time every day
- C. It should be stopped abruptly
- D. Avoid potassium-rich foods
Correct answer: B
Rationale: The correct answer is B: 'Take the medication at the same time every day.' Clients should take digoxin at the same time each day to maintain consistent therapeutic levels, enhancing the drug's effectiveness and minimizing fluctuations in blood concentration. Choice A is incorrect because digoxin, as a medication, may actually help in controlling the heart rate. Choice C is incorrect as digoxin should never be stopped abruptly due to the risk of rebound effects and worsening of the condition. Choice D is unrelated to digoxin therapy, as it is more relevant to medications like potassium-sparing diuretics.
4. A nurse is caring for a client who has been prescribed furosemide. Which of the following foods should the nurse encourage the client to include in their diet?
- A. Table salt
- B. Egg yolks
- C. White wine
- D. Oranges
Correct answer: D
Rationale: Furosemide is a potassium-wasting diuretic, so clients should consume potassium-rich foods like oranges to prevent hypokalemia. Oranges are a good source of potassium. Table salt, egg yolks, and white wine do not provide significant amounts of potassium and are not beneficial for a client taking furosemide.
5. A client is receiving magnesium sulfate for preeclampsia. Which finding indicates magnesium toxicity?
- A. Respiratory rate of 12/min
- B. Diminished deep tendon reflexes
- C. Urine output 40 mL/hr
- D. Systolic blood pressure of 140 mm Hg
Correct answer: B
Rationale: Diminished deep tendon reflexes are a sign of magnesium toxicity. Magnesium sulfate can depress the central nervous system, leading to decreased reflexes. Respiratory rate of 12/min, urine output 40 mL/hr, and systolic blood pressure of 140 mm Hg are not specific findings of magnesium toxicity. Respiratory depression, oliguria, and hypotension are more concerning signs that require immediate attention.
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