ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B
1. A nurse is caring for a client prescribed metoprolol. Which of the following should the nurse monitor for as an adverse effect of this medication?
- A. Bradycardia
- B. Hypotension
- C. Tachycardia
- D. Hyperglycemia
Correct answer: B
Rationale: The correct answer is B: Hypotension. Metoprolol, a beta-blocker, can lead to a decrease in blood pressure, resulting in hypotension. Monitoring blood pressure regularly is essential to detect and manage this adverse effect. Choices A, C, and D are incorrect because metoprolol typically does not cause bradycardia, tachycardia, or hyperglycemia as its primary adverse effects.
2. A nurse is performing a dressing change for a client who has a sacral wound using negative pressure wound therapy. Which of the following actions should the nurse take first?
- A. Apply skin preparation to wound edges
- B. Cleanse the wound with normal saline
- C. Don sterile gloves
- D. Determine the client's pain level
Correct answer: D
Rationale: The correct answer is to determine the client's pain level first. Assessing the client's pain is crucial before proceeding with any procedure, including dressing changes. This step ensures that appropriate pain management measures can be implemented, making the wound care process as comfortable as possible for the patient. Applying skin preparation to wound edges (choice A) can come after addressing the pain. While cleansing the wound with normal saline (choice B) and donning sterile gloves (choice C) are important steps in wound care, they should follow the assessment of the client's pain level to prioritize the patient's comfort and well-being.
3. A nurse is teaching about foot care to a client who has diabetes mellitus (DM). What statement indicates understanding?
- A. I should wear my slippers whenever I am out of bed
- B. I can walk barefoot at home
- C. I should apply lotion between my toes
- D. I can soak my feet in warm water
Correct answer: A
Rationale: The correct answer is A. Wearing slippers or shoes when out of bed is crucial for clients with diabetes as it protects the feet from injury. Walking barefoot, as mentioned in option B, can increase the risk of cuts, sores, and infections in diabetic patients. Applying lotion between the toes, as stated in option C, can lead to maceration and increase the risk of fungal infections. Similarly, soaking feet in warm water, as mentioned in option D, can cause skin breakdown and should be avoided by diabetic patients.
4. A client is in the transition phase of labor. Which of the following actions should the nurse take?
- A. Assist the client to void every 3 hours
- B. Monitor contractions every 30 minutes
- C. Place the client in a lithotomy position
- D. Encourage the client to use a pant-blow breathing pattern
Correct answer: D
Rationale: Encouraging the client to use a pant-blow breathing pattern is crucial during the transition phase of labor. This phase is characterized by intense contractions and emotional responses. Pant-blow breathing helps manage pain and anxiety, providing comfort and support to the client. Voiding every 3 hours is not specific to the transition phase and may not address immediate needs. Monitoring contractions every 30 minutes is important but may not be as directly beneficial as focusing on coping mechanisms like breathing techniques. Placing the client in a lithotomy position is generally not recommended during the transition phase as it can impede progress and comfort.
5. A nurse is assessing a client who is Jewish and observes kosher dietary practices. Which of the following behaviors should the nurse expect to find?
- A. Meat and dairy products are eaten together
- B. Fasting occurs during Hanukkah
- C. Shellfish is eaten regularly
- D. Meat and dairy products are consumed separately
Correct answer: D
Rationale: The correct answer is D: 'Meat and dairy products are consumed separately.' Kosher dietary laws prohibit the consumption of meat and dairy products together. Observing this separation is a key aspect of Jewish dietary practices. Choice A is incorrect as meat and dairy products are not eaten together in kosher dietary practices. Choice B is incorrect as fasting does not typically occur during Hanukkah. Choice C is incorrect as shellfish is not eaten in kosher dietary practices due to being non-kosher.
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