ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A nurse is preparing to administer a medication to a client with a nasogastric (NG) tube. What action should the nurse take?
- A. Administer the medication with a straw
- B. Flush the NG tube with 30 mL of water before administration
- C. Crush all medications together
- D. Mix the medication with pudding
Correct answer: B
Rationale: The correct action for the nurse to take when administering medication to a client with a nasogastric (NG) tube is to flush the NG tube with 30 mL of water before administration. Flushing the tube with water helps ensure the patency of the tube and prevents clogging. Choice A is incorrect because administering the medication with a straw is not a recommended practice for NG tube administration. Choice C is incorrect because crushing all medications together may lead to potential drug interactions. Choice D is incorrect because mixing the medication with pudding is not a standard method for administering medication through an NG tube.
2. When performing an abdominal assessment on a client, what action should the nurse take first?
- A. Palpate the abdomen
- B. Auscultate bowel sounds
- C. Inspect the abdomen
- D. Percuss the abdomen
Correct answer: B
Rationale: The correct answer is to auscultate bowel sounds. This action should be taken first because it ensures that bowel sounds are not altered by physical manipulation. Inspecting the abdomen (choice C) may provide visual cues but does not address functional assessment. Palpating the abdomen (choice A) should follow auscultation to prevent altering bowel sounds. Percussing the abdomen (choice D) is typically done after auscultation and palpation.
3. A nurse is caring for a client who is receiving continuous enteral feedings. What finding indicates intolerance to the feeding?
- A. Weight gain
- B. Nausea
- C. Constipation
- D. Elevated heart rate
Correct answer: B
Rationale: Nausea is a common sign of intolerance to enteral feedings and should be addressed promptly. Weight gain is not typically associated with intolerance to enteral feedings; instead, it may indicate other issues such as fluid retention. Constipation is also not a direct indicator of intolerance to enteral feedings. While an elevated heart rate can occur for various reasons, it is less specific to enteral feeding intolerance compared to nausea.
4. A nurse is providing discharge instructions to a client with chronic obstructive pulmonary disease (COPD). What instruction should the nurse include to help improve oxygenation?
- A. Avoid physical activity
- B. Use pursed-lip breathing during activities
- C. Limit sun exposure
- D. Perform weight-bearing exercises
Correct answer: B
Rationale: The correct answer is B: 'Use pursed-lip breathing during activities.' Pursed-lip breathing improves oxygenation by keeping airways open longer, facilitating better exhalation of carbon dioxide. Choice A is incorrect because avoiding physical activity can lead to deconditioning and worsen oxygenation. Choice C is irrelevant to improving oxygenation in COPD. Choice D is not directly related to improving oxygenation in COPD; weight-bearing exercises are important for bone health but not for oxygenation.
5. A nurse is providing discharge teaching to a client with a new diagnosis of hypertension. What instruction should the nurse include?
- A. Reduce sodium intake to 4 grams per day
- B. Avoid foods high in potassium
- C. Take prescribed antihypertensive medications daily
- D. Limit fluid intake to 1 liter per day
Correct answer: C
Rationale: The correct answer is C: 'Take prescribed antihypertensive medications daily.' When providing discharge teaching to a client with hypertension, one of the key instructions is to ensure the consistent intake of prescribed antihypertensive medications. This is crucial for controlling blood pressure levels and reducing the risk of complications associated with hypertension. Choices A, B, and D are incorrect because reducing sodium intake, avoiding foods high in potassium, and limiting fluid intake are important dietary modifications for various health conditions, but they are not the priority when it comes to managing hypertension. The primary focus should be on medication adherence to effectively manage hypertension.
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