ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A nurse is preparing to administer enteral feedings to a client with a nasogastric (NG) tube. What action should the nurse take first?
- A. Measure the residual gastric volume
- B. Verify tube placement
- C. Flush the tube with 100 mL of water
- D. Administer the feeding in small boluses
Correct answer: B
Rationale: Verifying tube placement is the crucial initial step a nurse should take before administering enteral feedings through an NG tube. This step ensures that the tube is correctly positioned in the stomach, reducing the risk of complications such as aspiration. Measuring residual gastric volume, flushing the tube with water, or administering the feeding in small boluses are all important steps in enteral feeding but should only be done after confirming the correct tube placement.
2. A nurse is preparing to administer furosemide 40 mg IV. Available is furosemide 10 mg/1 mL. How many mL should the nurse administer per dose?
- A. 2
- B. 3
- C. 4
- D. 5
Correct answer: C
Rationale: To calculate the mL needed, divide the total dose by the dose per mL. In this case, 40 mg divided by 10 mg/mL equals 4 mL. Therefore, the nurse should administer 4 mL per dose. Choice A, 2 mL, is incorrect because it would only deliver 20 mg of furosemide, which is half the required dose. Choices B and D are also incorrect as they do not provide the accurate amount needed to achieve the 40 mg dosage.
3. A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include?
- A. The child will continue to sleep and be pain-free
- B. Parents cannot administer additional medication with the button
- C. The pump can deliver baseline and bolus dosages
- D. There is a high risk of overdose, so monitoring is done every 15 minutes
Correct answer: C
Rationale: PCA pumps are designed to deliver both a continuous baseline dose and patient-activated bolus doses, which can help manage pain effectively while minimizing the risk of overdose.
4. A nurse is reviewing the medical record of a client who has hypothyroidism. Which of the following findings should the nurse expect?
- A. Weight gain of 1.4 kg (3 lb) in the past 2 weeks.
- B. Exophthalmos.
- C. Tachycardia.
- D. Heat intolerance.
Correct answer: A
Rationale: The correct answer is A. Weight gain can indicate myxedema, which is a symptom commonly seen in hypothyroidism. Exophthalmos (choice B) is actually a characteristic finding of hyperthyroidism, not hypothyroidism. Tachycardia (choice C) and heat intolerance (choice D) are also more indicative of hyperthyroidism rather than hypothyroidism.
5. A nurse is developing a plan of care for a client who has anorexia nervosa. Which of the following actions should the nurse include in the plan?
- A. Encourage the client to participate in developing a system of rewards.
- B. Arrange for someone to remain with the client for 30 min after meals
- C. Offer the client a selection of beverages at each meal.
- D. Inform the client that a weight gain of 2.3 kg per week is expected.
Correct answer: A
Rationale: Encouraging the client to participate in developing a system of rewards can help motivate and engage them in their treatment plan.
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