ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A client has been prescribed ferrous sulfate. Which instruction should the nurse provide to the client?
- A. Avoid strawberries, citrus fruits, and melon to improve absorption
- B. Take with fluids other than coffee or tea
- C. Take on a full stomach
- D. Double the dose if you miss a dose one day
Correct answer: B
Rationale: The correct instruction the nurse should provide to a client prescribed ferrous sulfate is to take it with fluids other than coffee or tea. Coffee and tea can inhibit iron absorption. Therefore, choices A, C, and D are incorrect. Avoiding strawberries, citrus fruits, and melon is not necessary for improving absorption of ferrous sulfate, taking it on a full stomach is not recommended, and doubling the dose if a dose is missed can lead to an overdose.
2. A nurse is preparing to administer medications to a client who is NPO and has an NG tube for suction. Which of the following actions should the nurse take?
- A. Mix medications with enteral feedings.
- B. Clamp the NG tube for 30 minutes after medication administration.
- C. Insert medications directly into the NG tube without dilution.
- D. Connect the NG tube to continuous suction after medication.
Correct answer: B
Rationale: The correct action for the nurse to take when administering medications to a client with an NG tube for suction who is NPO is to clamp the NG tube for 30 minutes after medication administration. This is done to allow for proper absorption of the medications before resuming suction. Choice A is incorrect because medications should not be mixed with enteral feedings as it may affect the drug's effectiveness. Choice C is incorrect as medications should not be inserted directly into the NG tube without dilution, as this can cause clogging or affect the tube. Choice D is incorrect because connecting the NG tube to continuous suction after medication administration can interfere with the absorption of the medications.
3. A nurse is caring for a client prescribed hydroxychloroquine. Which of the following should the nurse monitor?
- A. Liver function tests
- B. Eye exams
- C. Blood glucose levels
- D. Complete blood count
Correct answer: B
Rationale: The correct answer is B: Eye exams. Hydroxychloroquine can cause retinal damage, making it essential for the nurse to monitor the client's eyes regularly for any changes. Monitoring liver function tests (choice A), blood glucose levels (choice C), or complete blood count (choice D) are not directly associated with the potential side effects of hydroxychloroquine.
4. A nurse is preparing to perform a sterile dressing change for a client who has a surgical wound. Which of the following actions should the nurse take to prevent contamination during the dressing change?
- A. Use sterile gloves only as necessary
- B. Restart the procedure if the sterile solution splashes onto the sterile field while pouring the solution into the dressing tray
- C. Keep the dressing tray on a nearby surface
- D. Avoid speaking during the procedure
Correct answer: B
Rationale: The correct action to prevent contamination during a sterile dressing change is to restart the procedure if the sterile solution splashes onto the sterile field while pouring the solution into the dressing tray. Any contact with the sterile field by non-sterile items makes the field contaminated and requires restarting the procedure to maintain sterility. Choice A is incorrect because sterile gloves should always be used during a sterile procedure to prevent contamination. Choice C is incorrect as the dressing tray should be placed on a sterile surface, not on the client's bed, to maintain sterility. Choice D is also incorrect as talking during the procedure does not necessarily lead to contamination if proper aseptic technique is maintained.
5. A hospice nurse is providing teaching to a patient who has a new diagnosis of a terminal illness and her family. Which statement should the nurse include in the teaching?
- A. Hospice care will help provide rehabilitation for the patient.
- B. Hospice care focuses on extending life by any means necessary.
- C. Hospice care will help the patient transition to nursing care.
- D. Hospice care continues to help families with grief after a death occurs.
Correct answer: D
Rationale: The correct statement that the nurse should include in the teaching is option D: 'Hospice care continues to help families with grief after a death occurs.' Hospice care not only focuses on providing comfort care for terminal patients but also offers bereavement support to families after the patient's death. Choices A, B, and C are incorrect. Option A is incorrect because hospice care does not provide rehabilitation for the patient; its focus is on comfort and quality of life. Option B is incorrect because hospice care does not aim to extend life but rather to provide quality end-of-life care. Option C is incorrect because hospice care does not transition patients to nursing care; it provides care focused on comfort and symptom management in the patient's preferred setting.
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