ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A nurse is assessing a client who reports pain at the site of an indwelling urinary catheter. What is the nurse's first action?
- A. Irrigate the catheter with normal saline
- B. Notify the provider
- C. Administer prescribed antibiotics
- D. Assess for signs of infection
Correct answer: B
Rationale: When a client reports pain at the site of an indwelling urinary catheter, the nurse's first action should be to notify the provider. This is important to ensure timely assessment and intervention by the healthcare provider. Irrigating the catheter with normal saline or administering antibiotics should not be done without provider's orders as it may mask symptoms or lead to inappropriate treatment. Assessing for signs of infection is important but should come after notifying the provider, who can guide further assessment and treatment.
2. 1. Which patient action indicates good understanding of the nurse�s teaching about administration of aspart (NovoLog) insulin?
- A. The patient avoids injecting the insulin into the upper abdominal area
- B. The patient cleans the skin with soap and water before insulin administration.
- C. The patient stores the insulin in the freezer after administering the prescribed dose.
- D. The patient pushes the plunger down while removing the syringe from the injection site
Correct answer: B
Rationale:
3. A healthcare professional is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which equipment should the professional have on hand for the delivery?
- A. Bag-valve-mask system
- B. Sterile gauze and saline
- C. Soft arm restraints
- D. Endotracheal tube
Correct answer: D
Rationale: An endotracheal tube is crucial for managing the airway of a newborn with a diaphragmatic hernia. In this condition, there may be respiratory distress due to incomplete development of the diaphragm, allowing abdominal organs to move into the chest cavity and compress the lungs. The endotracheal tube helps in securing the airway and providing respiratory support if needed until definitive treatment can be initiated.
4. Which client is most likely to need regular injections of vitamin B12?
- A. The client with malabsorption syndrome.
- B. The client following a vegan eating pattern.
- C. The client whose stomach does not produce intrinsic factors.
- D. The client with alcoholism.
Correct answer: C
Rationale: The correct answer is C. The client whose stomach does not produce intrinsic factors is most likely to need regular injections of vitamin B12. Intrinsic factor is essential for the absorption of vitamin B12. Without intrinsic factor, the client cannot absorb vitamin B12 from food, necessitating the need for regular injections. Choices A, B, and D do not directly impact the production of intrinsic factors in the stomach, so they are less likely to result in the need for vitamin B12 injections.
5. A healthcare professional is assessing a client who is recovering from a lung biopsy. Which assessment finding requires immediate action?
- A. Increased temperature
- B. Absent breath sounds
- C. Productive cough
- D. Incisional discomfort
Correct answer: B
Rationale: Absent breath sounds may indicate a pneumothorax, a serious complication post lung biopsy. This condition requires immediate attention to prevent respiratory distress.
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