ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment B Quizlet
1. A client with HIV and neutropenia requires specific care from the nurse. Which of the following precautions should the nurse take while caring for this client?
- A. Wear an N95 respirator while caring for the client.
- B. Use a dedicated stethoscope for the client.
- C. Insert an indwelling urinary catheter to monitor urinary output.
- D. Monitor the client’s vital signs every 8 hours.
Correct answer: B
Rationale: Using dedicated equipment for a neutropenic client, such as a stethoscope, helps prevent infections. Neutropenic clients have a weakened immune system, making them vulnerable to infections from common pathogens. Wearing an N95 respirator is not necessary unless airborne precautions are required. Inserting a urinary catheter should be avoided unless necessary to prevent introducing pathogens. Monitoring vital signs should be done more frequently, typically every 4 hours, to promptly identify any changes in the client's condition.
2. A nurse is administering a blood transfusion to a client and suspects that the client is having an adverse reaction to the blood. Which of the following actions should the nurse take first?
- A. Maintain IV access
- B. Obtain the client’s vital signs
- C. Contact the provider
- D. Stop the transfusion
Correct answer: D
Rationale: The correct answer is to stop the transfusion. When a nurse suspects an adverse reaction to a blood transfusion, the priority is to stop the infusion immediately to prevent further harm to the client. Maintaining IV access and obtaining vital signs can be important steps but should come after stopping the transfusion to ensure the client's safety. Contacting the provider is necessary but not the first action to take in this situation. Therefore, the nurse should prioritize stopping the transfusion to address the potential adverse reaction.
3. A nurse manager is teaching a group of employees about QSEN. What statement by an employee should the nurse manager identify as quality improvement?
- A. We should track the rate of hospital-acquired infections.
- B. We should evaluate patient satisfaction scores.
- C. We should start tracking how soon patients are discharged after laparoscopic versus open surgery.
- D. We should check the patient's temperature before discharge.
Correct answer: C
Rationale: The correct answer is C. QSEN focuses on quality improvement in healthcare. Tracking how soon patients are discharged after different types of surgeries helps in evaluating the quality of care provided and identifying areas for improvement. Choices A and B focus on monitoring outcomes but do not directly relate to quality improvement initiatives. Choice D is more about a routine assessment before discharge and does not involve a quality improvement process.
4. A client with severe preeclampsia is receiving magnesium sulfate intravenously. Which action should the nurse take when toxicity occurs?
- A. Position the client supine
- B. Prepare an IV bolus of dextrose 5%
- C. Administer calcium gluconate IV
- D. Administer methylergonovine IM
Correct answer: C
Rationale: When toxicity from magnesium sulfate occurs, the nurse should administer calcium gluconate IV as it is the antidote for magnesium sulfate toxicity. Positioning the client supine may not address the toxicity issue. Administering dextrose 5% is not the appropriate intervention for magnesium sulfate toxicity. Methylergonovine is used to manage postpartum hemorrhage and is not indicated for magnesium sulfate toxicity.
5. A nurse is teaching a client who is lactose intolerant about dietary choices. Which food should the nurse recommend to increase calcium intake?
- A. Spinach
- B. Peanut butter
- C. Ground beef
- D. Carrots
Correct answer: A
Rationale: The correct answer is A: Spinach. Spinach is rich in calcium, making it a suitable choice for individuals with lactose intolerance who need to avoid dairy products. Peanut butter, ground beef, and carrots are not significant sources of calcium compared to spinach, and therefore, not the best recommendation for increasing calcium intake in lactose-intolerant individuals.
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