ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A nurse is preparing to administer a medication through a nasogastric (NG) tube. What action should the nurse take first?
- A. Flush the NG tube with 60 mL of water
- B. Verify tube placement
- C. Crush the medications and dissolve them in water
- D. Administer all medications together
Correct answer: B
Rationale: Verifying tube placement is the priority before administering any medications through a nasogastric tube. This step ensures that the tube is correctly positioned in the stomach to prevent complications such as aspiration. Flushing the tube with water, crushing medications, or administering them together should only be done after confirming the correct placement of the NG tube. Therefore, option B is the correct first action to take in this scenario.
2. A nurse is planning a community education program about colorectal cancer. What risk factors should the nurse identify as modifiable?
- A. Age and gender
- B. High-fat diet, smoking, alcohol consumption
- C. Ethnicity and race
- D. Exposure to radiation
Correct answer: B
Rationale: The correct answer is B: High-fat diet, smoking, alcohol consumption. These are modifiable risk factors for colorectal cancer as individuals can make lifestyle changes to reduce their risk. Age and gender (choice A) are non-modifiable risk factors. Ethnicity and race (choice C) can influence the risk of colorectal cancer but are not modifiable factors. Exposure to radiation (choice D) is not a common modifiable risk factor for colorectal cancer.
3. A client scheduled for cataract surgery tells the nurse, 'I see just fine and have decided to cancel my surgery.' What should the nurse do?
- A. Proceed with the surgery as planned
- B. Document the refusal and inform the surgeon
- C. Explain the benefits of the surgery
- D. Respect the client's decision
Correct answer: C
Rationale: In this scenario, the nurse should explain the benefits of the surgery to the client. By providing more information, the client may reconsider their decision after understanding the positive impact the surgery could have on their vision. Proceeding with the surgery against the client's wishes (Choice A) is not ethical and goes against the principle of autonomy. While documenting the refusal and informing the surgeon (Choice B) is important for the client's medical record, it is crucial to first try to educate the client about the benefits. Simply respecting the client's decision (Choice D) without attempting to provide more information may not be in the client's best interest.
4. A client at risk for pressure injuries is being cared for by a nurse. What intervention should the nurse implement?
- A. Keep the client in one position
- B. Use a special mattress for the client
- C. Turn the client every 4 hours
- D. Provide extra pillows for positioning
Correct answer: B
Rationale: The correct intervention for a client at risk for pressure injuries is to use a special mattress. Special mattresses help reduce the risk of pressure injuries by redistributing pressure on bony areas, thus preventing tissue damage. Keeping the client in one position (choice A) can actually increase the risk of pressure injuries due to prolonged pressure on specific areas. Turning the client every 4 hours (choice C) is important for preventing pressure injuries, but using a special mattress is a more effective intervention. Providing extra pillows for positioning (choice D) may offer some comfort but does not address the primary intervention of pressure redistribution that a special mattress provides.
5. A client is reviewing information about advance directives with a newly admitted client. Which statement by the client indicates understanding?
- A. I can change my living will whenever I want.
- B. I do not need a living will if I have a durable power of attorney.
- C. My family will make decisions for me if I am unable to.
- D. I need a living will only if I am seriously ill.
Correct answer: A
Rationale: The correct answer is A because the client understanding that they can change their living will whenever they want shows comprehension of advance directives. Choices B, C, and D are incorrect: B is inaccurate as both documents serve different purposes; C may not always be the case based on the client's wishes and legal documents; D is incorrect because a living will is not only for serious illness but also for end-of-life care decisions.
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