ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B
1. A healthcare professional is caring for a client with impaired mobility. Which of the following support devices should the healthcare professional plan to use to prevent the client from developing plantar flexion contractures?
- A. Sheepskin heel pad
- B. Footboard
- C. Trochanter roll
- D. Abduction pillow
Correct answer: B
Rationale: A footboard is the correct choice to prevent plantar flexion contractures by maintaining proper alignment of the feet. Plantar flexion contractures involve the foot pointing downward, and a footboard helps keep the foot in a neutral position. Choice A, the sheepskin heel pad, is used for pressure ulcer prevention and comfort but does not specifically address plantar flexion contractures. Choice C, the trochanter roll, is used for hip positioning, not foot alignment. Choice D, the abduction pillow, is used to maintain proper positioning of the legs but does not directly address plantar flexion contractures.
2. A nurse is caring for a client who has heart failure and is prescribed furosemide. Which of the following outcomes indicates that the medication is effective?
- A. Improvement in visual acuity
- B. Decreased respiratory rate
- C. Weight loss of 1.36 kg (3 lb) in 24 hours
- D. Increased urinary output
Correct answer: D
Rationale: The correct answer is D. Increased urinary output is the desired outcome when administering furosemide to a client with heart failure. Furosemide is a diuretic that promotes the excretion of excess fluids from the body, which helps in reducing fluid overload, a common symptom of heart failure. Choices A, B, and C are not directly related to the action of furosemide in treating heart failure. Visual acuity improvement, decreased respiratory rate, and rapid weight loss are not typical indicators of furosemide effectiveness in managing heart failure.
3. A nurse is providing discharge instructions to a client following a gastrectomy. Which of the following strategies should the nurse include in the teaching?
- A. Drink fluids between meals
- B. Eat three large meals each day
- C. Lie down for 30 minutes after meals
- D. Avoid drinking liquids with meals
Correct answer: D
Rationale: The correct strategy to include in the teaching after a gastrectomy is to avoid drinking liquids with meals. This helps prevent dumping syndrome, a condition characterized by rapid emptying of undigested food and fluids from the stomach into the small intestine. Choices A, B, and C are incorrect. Drinking fluids between meals is appropriate to maintain hydration, eating three large meals can exacerbate dumping syndrome, and lying down after meals is not recommended as it can increase the risk of reflux.
4. Which of the following foods is a good source of protein?
- A. Chicken
- B. Tofu
- C. Cheddar cheese
- D. Almonds
Correct answer: C
Rationale: Cheddar cheese is indeed a good source of protein, providing a significant amount per serving. While chicken and tofu are also high in protein, cheddar cheese can be a beneficial source, especially for individuals looking for non-meat options. Almonds, while nutritious, are not as high in protein compared to the other options listed.
5. A nurse is caring for a client who had a total thyroidectomy and has a serum calcium level of 7.6 mg/dL. Which of the following findings should the nurse expect?
- A. Shortened QT intervals
- B. Hypoactive deep tendon reflexes
- C. Tingling of the extremities
- D. Constipation
Correct answer: C
Rationale: The correct answer is C: Tingling of the extremities. Tingling is a common symptom of hypocalcemia, which is expected with low calcium levels after a thyroidectomy. Option A, shortened QT intervals, is associated with hypercalcemia rather than hypocalcemia. Option B, hypoactive deep tendon reflexes, is not typically related to hypocalcemia. Option D, constipation, is not a common finding associated with low calcium levels.
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