ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A nurse is caring for a client with Alzheimer's disease. Which action should the nurse include in the care plan to support the client’s cognitive function?
- A. Place a daily calendar in the kitchen
- B. Replace buttoned clothing with zippered items
- C. Replace carpet with hardwood floors
- D. Create variation in the daily routine
Correct answer: A
Rationale: Placing a daily calendar in the kitchen is beneficial for clients with Alzheimer's disease as it helps in orienting them to time and enhances cognitive function. This visual aid can assist in keeping track of days and activities. Choice B, replacing buttoned clothing with zippered items, is more related to promoting independence in dressing rather than directly supporting cognitive function. Choice C, replacing carpet with hardwood floors, focuses on safety and mobility rather than cognitive function. Choice D, creating variation in the daily routine, may be helpful for engagement and stimulation but does not directly address cognitive function as effectively as using a daily calendar.
2. A nurse is caring for a client who is in labor and receiving electronic fetal monitoring. The nurse is reviewing the monitor tracing and notes early decelerations. What should the nurse expect?
- A. Fetal hypoxia
- B. Abruptio placentae
- C. Post-maturity
- D. Head compression
Correct answer: D
Rationale: When early decelerations are noted on the fetal monitor tracing, it indicates fetal head compression, which is typically a benign finding associated with the progress of labor. Early decelerations mirror the uterine contractions and are often not a cause for concern as they are a normal response to fetal head compression during contractions. Choices A, B, and C are incorrect as they do not align with the expected outcome of early decelerations. Fetal hypoxia, abruptio placentae, and post-maturity would present with different patterns on the fetal monitor tracing and would require different interventions.
3. A healthcare provider is caring for a client prescribed amiodarone. Which of the following should the healthcare provider monitor?
- A. Liver function tests
- B. Serum potassium levels
- C. Blood pressure
- D. All of the above
Correct answer: D
Rationale: Amiodarone is known to potentially affect liver function, potassium levels, and blood pressure. Monitoring all these parameters regularly is crucial to detect any adverse effects early on. Liver function tests are necessary as amiodarone can cause hepatotoxicity. Serum potassium levels should be monitored due to the risk of hypokalemia or hyperkalemia with amiodarone use. Blood pressure monitoring is essential as amiodarone can cause hypotension or hypertension. Choosing 'All of the above' is the correct answer because all these parameters should be monitored to ensure the client's safety and well-being. Monitoring only one or two of these parameters may lead to missing important signs of adverse effects.
4. A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. Which of the following medications should the nurse plan to administer?
- A. Digoxin
- B. Calcium gluconate
- C. Vitamin B6
- D. Propranolol
Correct answer: C
Rationale: The correct answer is C: Vitamin B6 (pyridoxine). Vitamin B6 is often used to treat nausea and vomiting in pregnancy, including hyperemesis gravidarum. It is considered safe for use in pregnant clients. Digoxin (Choice A) is a medication used for heart conditions, not for hyperemesis gravidarum. Calcium gluconate (Choice B) is used to treat calcium deficiencies, not nausea and vomiting in pregnancy. Propranolol (Choice D) is a beta-blocker used for conditions like hypertension and anxiety, not for hyperemesis gravidarum.
5. A nurse is caring for a toddler diagnosed with respiratory syncytial virus (RSV). Which of the following actions should the nurse take?
- A. Use a designated stethoscope when caring for the toddler
- B. Wear an N95 respirator mask
- C. Remove the disposable gown after leaving the toddler’s room
- D. Place the toddler in a room with negative air pressure
Correct answer: A
Rationale: Using a designated stethoscope is the correct action when caring for a toddler diagnosed with RSV. This measure helps prevent the spread of infection to other clients by reducing the risk of contamination. Wearing an N95 respirator mask is not necessary for routine care of a toddler with RSV unless performing aerosol-generating procedures. Removing the disposable gown after leaving the toddler's room is important for infection control but not specific to RSV care. Placing the toddler in a room with negative air pressure is not a standard practice for managing RSV in toddlers.
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