a nurse is caring for a client recovering from bowel surgery who has a nasogastric ng tube connected to low intermittent suction which of the followin
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Nursing Elites

ATI LPN

PN ATI Capstone Proctored Comprehensive Assessment A

1. A nurse is caring for a client recovering from bowel surgery who has a nasogastric (NG) tube connected to low intermittent suction. Which of the following assessment findings should indicate to the nurse that the NG tube may not be functioning properly?

Correct answer: C

Rationale: Abdominal rigidity can indicate a serious complication, such as a blockage or infection, requiring immediate intervention to determine if the NG tube is functioning properly. Choices A, B, and D are not indicative of a malfunctioning NG tube. Greenish-yellow drainage fluid may be normal, an aspirate pH of 3 is within the expected range for gastric contents, and air bubbles in the NG tube are not abnormal as long as they are moving.

2. A 55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism?

Correct answer: A

Rationale: Clients with a history of osteoporosis should be carefully monitored when prescribed levothyroxine. Chronic overtreatment can cause increased bone loss, which raises the risk of fractures, especially in older adults. Thyroid hormone levels should be regularly monitored to avoid this complication. Scleroderma (choice B), asthma (choice C), and peripheral vascular disease (choice D) are not known to contraindicate the use of levothyroxine for hypothyroidism.

3. A nurse is admitted to a psychiatric unit and fails to follow her medication regimen. What does this behavior indicate?

Correct answer: C

Rationale: The correct answer is C, 'Lack of health literacy.' The nurse's inability to follow the medication regimen suggests she may lack health literacy, meaning she may not fully understand how to manage her own health care. Choice A, 'Early cognitive impairment,' is not supported by the information provided in the question as there is no mention of cognitive decline. Choice B, 'Lack of motivation,' is less likely as the behavior is more indicative of a knowledge deficit rather than a lack of drive. Choice D, 'Worsening health state,' is also less likely as the behavior described does not directly imply a worsening health condition but rather a misunderstanding or lack of knowledge on managing health.

4. A nurse is caring for a client who is postoperative following a thyroidectomy. The client reports tingling in the fingers and around the mouth. The nurse should anticipate which of the following interventions?

Correct answer: A

Rationale: Tingling in the fingers and around the mouth is a sign of hypocalcemia, which can occur after thyroid surgery due to accidental damage to the parathyroid glands. Hypocalcemia is common after thyroidectomy due to potential parathyroid damage. Calcium gluconate is the appropriate intervention to treat hypocalcemia. Providing a high-protein diet or administering levothyroxine are not indicated for hypocalcemia. Applying a warm compress to the client's neck would not address the underlying issue of hypocalcemia.

5. A nurse reviewing a patient’s care plan notes a goal of 'Patient will ambulate 50 feet three times in the hallway today.' Which domain of Bloom’s taxonomy is this goal in?

Correct answer: C

Rationale: The psychomotor domain involves physical activity and motor skills, such as ambulation, making it the correct domain for this goal. Choices A, B, and D are incorrect: Affective domain focuses on emotions and attitudes, physical domain is not a recognized domain in Bloom's taxonomy, and cognitive domain pertains to knowledge and intellectual skills, none of which directly relate to the physical act of ambulation.

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