ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A healthcare provider is assessing the pain level of a client who has dementia and difficulty communicating. Which pain assessment technique should the healthcare provider use?
- A. Verbal self-report
- B. Pain scale
- C. Behavioral indicators
- D. Observing facial expressions
Correct answer: C
Rationale: In clients with dementia and difficulty communicating, using behavioral indicators such as agitation and restlessness is more reliable for assessing pain than relying on verbal self-report, pain scales, or observing facial expressions. Verbal self-report may not be possible due to communication challenges, pain scales may be difficult for the client to comprehend, and observing facial expressions alone may not provide a comprehensive assessment of pain in individuals with dementia.
2. What is the function of the corpus luteum?
- A. is where fertilization usually takes place
- B. secretes hormones that prepare the lining of the uterus to receive a fertilized ovum
- C. is one of two long, thin structures that lead to the hollow, softly lined uterus
- D. is one of two walnut-sized organs located deep inside a woman's abdomen
Correct answer: B
Rationale: The correct answer is B. The corpus luteum is a temporary endocrine structure in the ovary that forms after ovulation. It secretes hormones, particularly progesterone, which help prepare the uterine lining for possible implantation of a fertilized ovum. This process is crucial for maintaining a potential pregnancy. Choices A, C, and D are incorrect. Choice A is inaccurate as fertilization typically occurs in the fallopian tubes. Choice C describes the fallopian tubes, not the corpus luteum. Choice D refers to the ovaries, not specifically the corpus luteum.
3. A client has a small-bore jejunostomy and is receiving a continuous tube feeding with a high-viscosity formula. Which of the following actions should the nurse take to prevent the tubing from clogging?
- A. Replace the bag and tubing every 24 hours
- B. Flush the tubing with 10 mL water every 6 hours
- C. Administer the feeding by gravity drip
- D. Heat the formula prior to infusion
Correct answer: B
Rationale: To prevent clogging when using high-viscosity formulas in a small-bore jejunostomy, the nurse should flush the tubing with 10 mL of water every 6 hours. This action helps maintain tube patency and prevent blockages. Replacing the bag and tubing every 24 hours (Choice A) is unnecessary and does not specifically address preventing clogging. Administering the feeding by gravity drip (Choice C) or heating the formula prior to infusion (Choice D) are not effective interventions for preventing tubing clogging.
4. What is the correct action when a patient reports cramping during enema administration?
- A. Lower the height of the solution container
- B. Increase the flow of the enema solution
- C. Stop the procedure and remove the tubing
- D. Continue the enema at a slower rate
Correct answer: A
Rationale: The correct action to take when a patient reports cramping during enema administration is to lower the height of the solution container. Lowering the height reduces the pressure and speed of the solution entering the rectum, alleviating cramping. Increasing the flow of the enema solution (Choice B) can worsen the discomfort. Stopping the procedure and removing the tubing (Choice C) is not necessary unless there are severe complications. Continuing the enema at a slower rate (Choice D) may not effectively address the immediate cramping issue and could still cause discomfort to the patient.
5. Why is testosterone therapy prescribed for a 70-year-old man being treated for osteoporosis?
- A. To increase bone density
- B. To reduce the risk of fractures
- C. To enhance sexual performance
- D. To restore testosterone levels
Correct answer: D
Rationale: The primary reason for prescribing testosterone therapy for osteoporosis in men is to restore testosterone levels, not specifically to increase bone density. Testosterone plays a crucial role in maintaining bone density, so by restoring testosterone levels, it indirectly helps in maintaining bone density. Choices A and B are partially correct but do not address the primary reason for testosterone therapy in this context. Choice C is incorrect as the main focus of testosterone therapy in osteoporosis treatment is not related to enhancing sexual performance.
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