ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A healthcare provider is performing a cultural assessment of a group of clients to maintain respect for their value systems and beliefs. Which of the following should the provider identify as examples of cultural variables?
- A. Health literacy, income, gender
- B. Eye contact, personal space, touch
- C. Physical activity, ethnicity, eye contact
- D. Body language, facial expressions, religion
Correct answer: B
Rationale: The correct answer is B: Eye contact, personal space, and touch are cultural variables that can influence healthcare interactions. These factors vary across cultures and can impact how individuals perceive communication and interactions. Choices A, C, and D include elements that are not specifically cultural variables affecting communication and interactions in the same way as eye contact, personal space, and touch.
2. A nurse is reviewing a client's health history and identifies chronic constipation as a potential complication of immobility. What intervention should the nurse include in the plan of care?
- A. Increase fiber intake
- B. Encourage the client to walk daily
- C. Use a stool softener as needed
- D. Use a laxative daily
Correct answer: A
Rationale: Increasing fiber intake is the appropriate intervention to include in the plan of care for a client with chronic constipation due to immobility. Fiber helps add bulk to the stool, making it easier to pass, thereby preventing constipation. Encouraging the client to walk daily (choice B) is also beneficial as it promotes mobility and can help alleviate constipation associated with immobility. Using a stool softener as needed (choice C) and using a laxative daily (choice D) are not the first-line interventions for managing constipation related to immobility. Stool softeners and laxatives should be used judiciously and under healthcare provider guidance.
3. When providing discharge teaching to a client prescribed home oxygen therapy, what information should the nurse include?
- A. Increase the oxygen flow rate during activity
- B. Avoid smoking and open flames near oxygen
- C. Store the oxygen tank in a warm, dry place
- D. Turn off the oxygen when not in use
Correct answer: B
Rationale: The correct answer is B: 'Avoid smoking and open flames near oxygen.' This information is crucial to prevent fire hazards when using home oxygen therapy. Smoking and open flames near oxygen can lead to serious accidents. Choice A is incorrect because increasing the oxygen flow rate during activity without healthcare provider guidance can be dangerous. Choice C is incorrect as oxygen tanks should be stored in a well-ventilated area, not necessarily warm and dry. Choice D is incorrect as oxygen should not be turned off and on by the client, as it can affect the therapy's effectiveness and cause safety issues.
4. A client with diabetes mellitus is being taught about foot care by a nurse. What statement indicates understanding?
- A. I will soak my feet in hot water every day
- B. I will wear cotton socks at all times
- C. I will cut my toenails in a rounded shape
- D. I will apply lotion between my toes after bathing
Correct answer: B
Rationale: The correct answer is B. Wearing cotton socks is essential for clients with diabetes as it helps protect the feet and reduces the risk of skin breakdown. Choice A is incorrect because soaking feet in hot water can lead to burns or skin damage. Choice C is incorrect as clients with diabetes should cut their toenails straight across to prevent ingrown toenails. Choice D is incorrect as applying lotion between the toes can create a moist environment that may increase the risk of fungal infections.
5. A nurse is assessing a client who reports a burning sensation at the site of a peripheral IV. The site is red and warm. What should the nurse do?
- A. Increase the IV flow rate
- B. Discontinue the IV line
- C. Apply a cold compress
- D. Elevate the limb
Correct answer: B
Rationale: When a client presents with symptoms of phlebitis at the IV site, such as redness, warmth, and pain, it is essential to discontinue the IV line. Increasing the IV flow rate could exacerbate the condition by further irritating the vein. Applying a cold compress may provide temporary relief but does not address the underlying issue of phlebitis. Elevating the limb is not the primary intervention for phlebitis and discontinuing the IV line takes precedence to prevent complications.
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