ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment A
1. A client is recovering from an acute myocardial infarction. Which of the following interventions should the nurse include in the plan of care?
- A. Draw a troponin level every four hours
- B. Perform an EKG every 12 hours
- C. Plan for oxygen therapy with a rebreather mask
- D. Obtain a cardiac rehabilitation consult
Correct answer: D
Rationale: The correct answer is to obtain a cardiac rehabilitation consult. Cardiac rehabilitation is an essential part of the care plan for a client recovering from a myocardial infarction. It helps in improving recovery, enhancing quality of life, and reducing the risk of future cardiac events. Drawing troponin levels and performing EKGs are important for diagnosing and monitoring myocardial infarctions but are not interventions in the post-MI care plan. Oxygen therapy may be necessary based on the client's condition but is not specific to post-MI care.
2. A client with chronic kidney disease is being educated by a nurse about managing their condition. Which of the following statements shows an understanding of the teaching?
- A. I will need to take an iron supplement.
- B. I will consume foods high in phosphorus.
- C. I will reduce my intake of carbohydrates.
- D. I will monitor my blood glucose level daily.
Correct answer: A
Rationale: The correct answer is A. Clients with chronic kidney disease often develop anemia due to reduced erythropoietin production, leading to decreased red blood cell production. Iron supplementation is frequently required to enhance red blood cell production. Choices B, C, and D are incorrect because in chronic kidney disease, there is a need to restrict phosphorus intake, control carbohydrate intake for blood sugar management, and monitor electrolytes and fluid balance rather than blood glucose levels.
3. A nurse is planning care to prevent complications in a client with immobility. Which of the following interventions should the nurse include?
- A. Massage lower extremities daily to prevent DVT
- B. Remove anti-embolism stockings for 3 hours each day
- C. Limit intake of foods high in calcium to prevent renal calculi
- D. Encourage the client to lie supine to prevent constipation
Correct answer: B
Rationale: The correct answer is B because removing anti-embolism stockings for short periods prevents skin breakdown while ensuring that the stockings remain effective in promoting circulation. Choice A is incorrect because massaging lower extremities daily does not prevent DVT; instead, it may dislodge a clot. Choice C is incorrect as limiting intake of foods high in calcium does not prevent renal calculi; rather, it may help reduce the risk of kidney stones. Choice D is incorrect because encouraging the client to lie supine does not prevent constipation; instead, encouraging mobility and adequate fluid intake can help prevent constipation in immobile clients.
4. A nurse is caring for a group of patients. Which of the following clients should the nurse refer to a social worker?
- A. A patient who requests to secure an emergency notification system in the home.
- B. A client who requires placement in an assisted living facility.
- C. A patient who requests to get school assignments while hospitalized on a pediatric unit.
- D. A patient who is experiencing food insecurity.
Correct answer: B
Rationale: The correct answer is B because social workers are involved in arranging care services like placement in assisted living facilities. This client's need for placement in an assisted living facility requires the expertise and assistance of a social worker. Choices A, C, and D do not necessarily require the intervention of a social worker. Choice A can be addressed by a nurse or healthcare provider, choice C can be managed by hospital staff or educators, and choice D may involve a nutritionist or community outreach programs.
5. A healthcare professional is preparing to administer a hepatitis B vaccine. Which of the following should the healthcare professional verify?
- A. Client's allergy to eggs
- B. Client's vaccination history
- C. Client's weight
- D. Client's blood pressure
Correct answer: B
Rationale: The correct answer is B: Client's vaccination history. Before administering the hepatitis B vaccine, it is essential to verify the client's vaccination history to ensure they are due for the vaccine. This helps in preventing unnecessary vaccinations and ensures the appropriate timing and dosage. Option A, the client's allergy to eggs, is not directly related to administering the hepatitis B vaccine. Option C, the client's weight, and option D, the client's blood pressure, are not factors that need to be specifically verified before administering the hepatitis B vaccine.
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