a nurse is caring for an older adult who has a non palpable skin lesion that is less than 05 cm in diameter which term should the nurse use to documen a nurse is caring for an older adult who has a non palpable skin lesion that is less than 05 cm in diameter which term should the nurse use to documen
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Nursing Elites

ATI LPN

PN ATI Capstone Proctored Comprehensive Assessment 2020 B

1. A nurse is caring for an older adult who has a non-palpable skin lesion that is less than 0.5 cm in diameter. Which term should the nurse use to document this finding?

Correct answer: B

Rationale: The correct answer is B: Macule. A macule is a non-palpable skin lesion smaller than 1 cm in diameter. In this case, the skin lesion described is less than 0.5 cm, making it consistent with a macule. Vesicle (choice A) is a small blister filled with clear fluid, papule (choice C) is a solid, raised skin lesion less than 0.5 cm in diameter, and nodule (choice D) is a palpable, solid lesion larger than 0.5 cm in diameter. Therefore, choices A, C, and D describe skin lesions that do not match the characteristics of the lesion presented in the question.

2. A client has a new prescription for captopril. Which of the following instructions should the nurse include?

Correct answer: D

Rationale: The correct answer is to monitor for a dry cough. Captopril is known to cause a persistent dry cough as a common side effect. If a dry cough develops, it should be reported to the healthcare provider promptly, as it may necessitate discontinuation of the medication. Choice A is incorrect because captopril is usually taken on an empty stomach. Choice B is incorrect as hypokalemia is not a common side effect of captopril. Choice C is incorrect as captopril is typically taken during the day and not specifically at bedtime.

3. Which symptom is most commonly associated with generalized anxiety disorder (GAD)?

Correct answer: B

Rationale: The correct answer is B: Persistent and excessive worry. Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry about a variety of things, even when there is little or no reason to worry. This worry is difficult to control and can significantly impact daily life. While panic attacks, recurrent intrusive thoughts, and compulsive behaviors can occur in other anxiety disorders, persistent and excessive worry is the hallmark symptom of GAD. Therefore, choices A, C, and D are incorrect as they do not represent the primary symptom associated with GAD.

4. Which option below is an example of a meal or snack that contains complementary proteins?

Correct answer: B

Rationale: The correct answer is B, a peanut butter sandwich. A peanut butter sandwich combines grains from the bread and proteins from the nuts in the peanut butter, providing complementary proteins. This combination offers all essential amino acids. Choices A, C, and D do not contain complementary proteins as they lack the combination of different protein sources necessary to provide a complete amino acid profile.

5. Which of the following conditions is a contraindication for breastfeeding?

Correct answer: A

Rationale: Maternal HIV infection is a contraindication for breastfeeding because it poses a risk of transmission to the infant. HIV can be transmitted through breast milk, putting the baby at risk of acquiring the infection. Therefore, it is recommended that mothers with HIV do not breastfeed to prevent the transmission of the virus to their infants.

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