ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B
1. A patient is being treated for dehydration. Which lab result would support the diagnosis?
- A. Elevated hemoglobin
- B. Low sodium level
- C. High white blood cell count
- D. Elevated BUN
Correct answer: D
Rationale: Elevated BUN levels are a characteristic finding in dehydration due to reduced kidney perfusion and increased reabsorption of urea. Hemoglobin levels might be elevated in conditions like polycythemia vera, not directly related to dehydration. A low sodium level could be seen in conditions like hyponatremia. A high white blood cell count is more indicative of infection or inflammation rather than dehydration.
2. A nurse manager assigns a new nurse to care for a client with unstable blood pressure. What is the nurse's priority action?
- A. Ask the charge nurse for assistance.
- B. Recheck the blood pressure before calling for help.
- C. Monitor the client's blood pressure closely.
- D. Administer antihypertensive medication immediately.
Correct answer: B
Rationale: The correct answer is to recheck the blood pressure before calling for help. When caring for a client with unstable blood pressure, the nurse's priority is to ensure an accurate assessment. Rechecking the blood pressure will confirm the instability and guide further actions. Asking the charge nurse for assistance (Choice A) is important but should come after assessing the situation. Monitoring the client's blood pressure closely (Choice C) is essential, but the immediate action should be to recheck and confirm the current status. Administering antihypertensive medication immediately (Choice D) without a confirmed assessment can be dangerous and is not the initial priority.
3. When considering a bone marrow transplant for a client with leukemia, which ethical principle pertains to minimizing harm to the client?
- A. Justice
- B. Nonmaleficence
- C. Autonomy
- D. Beneficence
Correct answer: B
Rationale: The correct answer is B: Nonmaleficence. Nonmaleficence is the ethical principle that emphasizes the obligation to do no harm, making it crucial in medical decision-making. In the context of a bone marrow transplant for a client with leukemia, the primary concern is to minimize harm and avoid causing any unnecessary suffering or adverse effects. Choices A, C, and D are incorrect: Justice relates to fairness in resource allocation and treatment decisions, Autonomy involves respecting the patient's right to make decisions about their own care, and Beneficence refers to the obligation to act in the patient's best interest and promote their well-being, which may involve some level of risk or harm for overall benefit.
4. The nurse is performing hand hygiene before assisting a healthcare provider with insertion of a chest tube. While washing hands, the nurse touches the sink. Which action will the nurse take next?
- A. Repeat handwashing using antiseptic soap.
- B. Inform the healthcare provider and recruit another nurse to assist.
- C. Extend the handwashing procedure to 5 minutes.
- D. Rinse and dry hands and begin assisting the healthcare provider.
Correct answer: A
Rationale: The correct answer is A. The sink is considered a contaminated area. When hand hygiene is compromised during the process, it is essential to repeat handwashing using antiseptic soap to ensure proper hygiene. Choice B is incorrect because the situation can be managed by proper handwashing. Choice C is incorrect as extending the handwashing procedure to 5 minutes is not necessary in this scenario. Choice D is incorrect as the hands need to be properly cleaned before assisting the healthcare provider.
5. A nurse manager is teaching a group of staff members about proper body mechanics. Which of the following statements by a staff member indicates an understanding of the teaching?
- A. I should get assistance when lifting more than 35 pounds
- B. I will twist at my waist when moving an object
- C. I should hold objects 1 ft away from my body when I walk
- D. I will roll my shoulders forward to reduce strain on my back
Correct answer: A
Rationale: Choice A is the correct answer because lifting more than 35 pounds without assistance can cause injury, so getting help is crucial for proper body mechanics. Choice B is incorrect as twisting at the waist can lead to back injuries. Choice C is incorrect as holding objects closer to the body, not 1 ft away, is recommended to reduce strain. Choice D is incorrect as rolling shoulders forward can increase strain on the back instead of reducing it.
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