ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment A
1. A nurse is caring for a client who has a new prescription for enalapril. The nurse should monitor the client for which of the following adverse effects of this medication?
- A. Ecchymosis
- B. Jaundice
- C. Hypotension
- D. Hypokalemia
Correct answer: C
Rationale: The correct answer is C: Hypotension. Enalapril, an ACE inhibitor, can lead to hypotension, especially after the first dose. Choices A, B, and D are incorrect because enalapril is not typically associated with ecchymosis, jaundice, or hypokalemia as common adverse effects. Therefore, the nurse should primarily monitor the client for signs of hypotension.
2. A client with ulcerative colitis has been prescribed sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?
- A. Jaundice
- B. Constipation
- C. Oral candidiasis
- D. Sedation
Correct answer: A
Rationale: The correct answer is A: Jaundice. Sulfasalazine can cause liver damage as a possible adverse effect, which can manifest as jaundice. Monitoring for jaundice is crucial to detect liver-related adverse effects early. Choices B, C, and D are incorrect. Constipation, oral candidiasis, and sedation are not typically associated with sulfasalazine use. Therefore, the nurse should focus on educating the client specifically about monitoring for jaundice.
3. A nurse is preparing to administer an enteral tube feeding through an NG tube at 250 mL over 4 hr. The nurse should set the pump to deliver how many mL/hr? (Round the answer to the nearest whole number)
- A. 63 mL/hr
- B. 36 mL/hr
- C. 78 mL/hr
- D. 90 mL/hr
Correct answer: A
Rationale: To calculate the rate for the enteral tube feeding, divide the total volume by the total time: 250 mL / 4 hr = 62.5 ≈ 63 mL/hr. Therefore, the nurse should set the pump to deliver 63 mL/hr. Choices B, C, and D are incorrect as they do not match the correct calculation result. B is too low, C is too high, and D is also too high based on the correct calculation.
4. A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the client for which of the following adverse effects?
- A. Thrombophlebitis
- B. Hyperactive reflexes
- C. Muscle weakness
- D. Hypoglycemia
Correct answer: C
Rationale: The correct answer is C: Muscle weakness. Chlorothiazide, a thiazide diuretic, can lead to hypokalemia, which can cause muscle weakness. Thrombophlebitis (choice A) is not typically associated with chlorothiazide use. Hyperactive reflexes (choice B) and hypoglycemia (choice D) are also not commonly linked to this medication. Therefore, monitoring for muscle weakness is crucial when a client is prescribed chlorothiazide.
5. A client is receiving IV gentamicin three times daily. Which of the following findings indicates that the client is experiencing an adverse effect of this medication?
- A. Hypoglycemia
- B. Proteinuria
- C. Nasal congestion
- D. Visual disturbances
Correct answer: B
Rationale: The correct answer is B: Proteinuria. Proteinuria can indicate nephrotoxicity, a known adverse effect of gentamicin. Gentamicin is known to cause kidney damage, leading to proteinuria. Hypoglycemia is not typically associated with gentamicin use but may be related to insulin administration or other medical conditions. Nasal congestion is not a common adverse effect of gentamicin. Visual disturbances are also not typically reported with gentamicin use.
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