ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse is caring for a client with a sealed radiation implant. Which action should the nurse take?
- A. Remove dirty linens after double-bagging
- B. Wear a dosimeter badge
- C. Limit visitors to 1 hour per day
- D. Ensure family remains 3 feet away from the client
Correct answer: B
Rationale: The correct answer is B: Wear a dosimeter badge. When caring for a client with a sealed radiation implant, the nurse should wear a dosimeter badge to monitor radiation exposure. This badge helps measure the amount of radiation the nurse is exposed to during care. Choice A is incorrect because removing dirty linens after double-bagging is not directly related to managing radiation exposure. Choice C is incorrect as there is no specific time limit on visitors mentioned in the context of a sealed radiation implant. Choice D is incorrect as there is no evidence supporting the need for family members to stay a specific distance away from the client.
2. A nurse in the emergency department is prioritizing care for four clients. Which of the following clients should the nurse see first?
- A. A 6-year-old with a dislocated shoulder
- B. A 26-year-old with sickle cell disease and severe joint pain
- C. A 76-year-old with confusion, fever, and foul-smelling urine
- D. A 50-year-old with slurred speech, disorientation, and headache
Correct answer: D
Rationale: The client with slurred speech, disorientation, and a headache may be experiencing a stroke, a life-threatening condition that requires immediate attention. Identifying and managing a stroke promptly can reduce the risk of long-term disability or complications. The other options, although important, do not present immediate life-threatening conditions that require urgent intervention. A dislocated shoulder, severe joint pain in sickle cell disease, confusion with fever and foul-smelling urine, while concerning, can be addressed after attending to the client with potential stroke symptoms.
3. A nurse is caring for the mother of an adolescent who was killed in a motor-vehicle crash after a school event. The mother states, 'I never should have let him take the car. It's all my fault!' Which of the following responses by the nurse is appropriate?
- A. You had no way of knowing this would happen.
- B. Most parents blame themselves when losing a child.
- C. Tell me why you feel this is your fault.
- D. You appear to be feeling overwhelmed.
Correct answer: C
Rationale: Choice C is the most appropriate response because it encourages the mother to express her feelings and explore the reasons behind her guilt. This approach allows the mother to process her emotions effectively and address her grief. Choices A and B do not directly address the mother's feelings of guilt and may not help her work through her emotions. Choice D acknowledges the mother's emotional state but does not delve into the underlying issues causing her guilt and grief.
4. A nurse is providing teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates a need for further teaching?
- A. I will take ibuprofen for headaches.
- B. I will use an electric razor to shave.
- C. I will avoid eating large amounts of leafy green vegetables.
- D. I will have my blood levels checked regularly.
Correct answer: A
Rationale: The correct answer is A. Ibuprofen can increase the risk of bleeding when taken with warfarin, as both medications affect clotting. The client should use alternative pain relievers like acetaminophen. Choice B is correct as using an electric razor is a safe choice to prevent cuts that could lead to bleeding. Choice C is correct as warfarin interacts with vitamin K found in leafy green vegetables. Choice D is correct as regular blood level checks are necessary to monitor the effects and adjust the warfarin dosage if needed.
5. A client is being taught about the use of nitroglycerin. Which of the following should be included?
- A. Take it with food
- B. Place the tablet under the tongue
- C. It can be stored in the refrigerator
- D. It has no side effects
Correct answer: B
Rationale: The correct answer is to place the nitroglycerin tablet under the tongue. Nitroglycerin tablets are meant for sublingual absorption during angina episodes to provide quick relief. Option A is incorrect because nitroglycerin should not be taken with food. Option C is incorrect as nitroglycerin should be stored in a cool, dark place, not in the refrigerator. Option D is incorrect because nitroglycerin can have side effects, including headaches, dizziness, and low blood pressure.
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