ATI RN
ATI Capstone Comprehensive Assessment B
1. A nurse is preparing to administer a blood transfusion. What is the most important action to ensure patient safety?
- A. Check the patient's vital signs every 15 minutes during the transfusion.
- B. Verify the patient's identity with two identifiers before starting the transfusion.
- C. Ensure the blood product is administered within 4 hours of removal from the blood bank.
- D. Ensure the patient has signed the informed consent form.
Correct answer: B
Rationale: The most important action to ensure patient safety when administering a blood transfusion is to verify the patient's identity with two identifiers before starting the transfusion. This step is crucial to prevent transfusion errors, such as giving the blood to the wrong patient. Checking vital signs, ensuring timely administration, and confirming informed consent are also important aspects of blood transfusion safety but verifying the patient's identity is the highest priority to prevent errors.
2. Nursing care of children focuses on improving quality by:
- A. Improving sanitation
- B. Focusing on curing childhood illnesses
- C. Addressing problems caused by communicable disease
- D. Providing a holistic environment for optimal growth and development
Correct answer: D
Rationale: The correct answer is D because nursing care for children should encompass a holistic approach that considers not only physical health but also emotional, social, and developmental aspects. Providing a holistic environment promotes optimal growth and development by addressing all these dimensions. Choices A, B, and C are incorrect because while sanitation, curing illnesses, and addressing communicable diseases are important aspects of child healthcare, they do not encompass the comprehensive care provided by a holistic approach.
3. A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, 'You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing:'
- A. A higher dosage
- B. Once-weekly dosing
- C. A lower dosage
- D. A different drug
Correct answer: C
Rationale: During the maintenance therapy stage for bipolar I disorder, it is common to lower the dosage of lithium to prevent side effects while still maintaining stability. Lowering the dosage helps to find the lowest effective dose that can still manage symptoms effectively with minimal side effects.
4. Which of the following groups of psychologists would be most likely to focus on individual uniqueness, freedom, and potential for growth as a person?
- A. Behaviorists
- B. Psychoanalysts
- C. Humanists
- D. Gestalt psychologists
Correct answer: C
Rationale: The correct answer is C: Humanists. Humanistic psychologists emphasize individual uniqueness, freedom, and the potential for personal growth. They believe in the importance of personal experiences and self-actualization. Behaviorists (choice A) focus on observable behaviors and environmental influences. Psychoanalysts (choice B) are more concerned with unconscious processes and early childhood experiences. Gestalt psychologists (choice D) concentrate on perception and the organization of experience, rather than individual uniqueness and personal growth.
5. A client has a new prescription for Enoxaparin. Which of the following instructions should the nurse include?
- A. Massage the injection site after administration.
- B. Aspirate before injecting the medication.
- C. Administer the medication into the abdomen.
- D. Administer the medication via intramuscular injection.
Correct answer: C
Rationale: The correct answer is to administer the medication into the abdomen. Enoxaparin is a medication that is administered subcutaneously, typically in the abdomen to ensure proper absorption. Massaging the injection site should be avoided as it can lead to bruising or bleeding under the skin. Aspirating before injecting the medication is not necessary for subcutaneous injections like Enoxaparin. Administering the medication via intramuscular injection is incorrect as Enoxaparin should be given subcutaneously.
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