ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B with NGN
1. A nurse is preparing to administer a dose of iron supplement. Which of the following should the nurse do?
- A. Give it with milk
- B. Administer it on an empty stomach
- C. Check blood pressure
- D. Monitor for allergic reactions
Correct answer: B
Rationale: The correct answer is B: Administer it on an empty stomach. Iron supplements are best absorbed on an empty stomach to enhance their absorption. It is important to avoid giving them with milk or dairy products as these can inhibit iron absorption. Checking blood pressure and monitoring for allergic reactions are not directly related to the administration of iron supplements and are not the primary considerations in this case.
2. What is the most appropriate intervention for a client with phlebitis at the IV site?
- A. Apply a warm compress to the site
- B. Discontinue the IV and notify the provider
- C. Increase the IV flow rate to prevent dehydration
- D. Monitor the site for signs of infection
Correct answer: B
Rationale: The most appropriate intervention for a client with phlebitis at the IV site is to discontinue the IV and notify the provider. Phlebitis is inflammation of the vein, and continuing the IV can lead to complications such as infection or thrombosis. Applying a warm compress may provide symptomatic relief but does not address the root cause. Increasing the IV flow rate is not indicated and may worsen the inflammation. Monitoring for signs of infection is important, but the priority is to remove the source of inflammation by discontinuing the IV.
3. A nurse is caring for a newborn in the nursery following a circumcision. The newborn's grandparent, who does not have an identification bracelet, requests to take the newborn to his mother's room. What action should the nurse take?
- A. Notify security.
- B. Respectfully deny the grandparent’s request.
- C. Contact the mother for verification.
- D. Escort the grandparent and newborn to the room.
Correct answer: B
Rationale: The correct action for the nurse to take is to respectfully deny the grandparent's request. In healthcare settings, strict security protocols are in place to ensure the safety of newborns. Only individuals with proper identification bracelets are allowed to transport newborns to prevent unauthorized individuals from taking them. Contacting the mother for verification would be time-consuming and may not be feasible immediately. Escorting the grandparent and newborn without proper identification would violate security protocols and compromise the newborn's safety. Notifying security should be done only if there is a threat or concern for safety, which is not the case in this scenario. Therefore, the best course of action is for the nurse to respectfully deny the grandparent's request to uphold the safety and security measures in place.
4. How is motivation typically described?
- A. As a stagnant, unchanging force
- B. As a fluid, dynamic process that changes over time
- C. As a process that requires great force to change
- D. As a process that differs every day
Correct answer: B
Rationale: Motivation is commonly described as a fluid and dynamic process that evolves and changes over time. It is not stagnant but rather fluctuates based on various internal and external factors. Choice A is incorrect as motivation is not stagnant but dynamic. Choice C is incorrect as motivation does not necessarily require great force to change. Choice D is incorrect as motivation is not something that differs drastically every day, but rather changes gradually over time.
5. What is the priority when managing a client with a chest tube postoperatively?
- A. Clamp the chest tube for 30 minutes every 4 hours
- B. Check for air leaks and proper functioning of the chest tube
- C. Encourage deep breathing and coughing every 2 hours
- D. Encourage frequent coughing to clear secretions
Correct answer: B
Rationale: The priority when managing a client with a chest tube postoperatively is to check for air leaks and ensure the proper functioning of the chest tube. This is crucial to prevent complications such as pneumothorax or hemothorax. Clamping the chest tube intermittently can lead to a buildup of pressure in the pleural space and should not be done without a specific medical indication. Encouraging deep breathing and coughing helps with lung expansion but is not the priority over ensuring the chest tube's proper function. Encouraging frequent coughing may increase the risk of dislodging the chest tube or causing complications.
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