ATI RN
ATI Capstone Fundamentals Assessment Proctored
1. A healthcare professional is preparing to transfer a client from a chair to the bed. The client can bear partial weight and has upper body strength. Which device should the professional use?
- A. Gait belt
- B. Mechanical lift
- C. Stand-assist lift
- D. Slide board
Correct answer: C
Rationale: A stand-assist lift is the most suitable device for transferring a client who can bear partial weight and has upper body strength. This lift provides support and assistance for clients to stand up and be safely transferred. A gait belt is used for providing support during walking or transferring short distances for clients who need minimal assistance with balance and strength. A mechanical lift is typically used for clients who are non-weight bearing or have limited weight-bearing capacity. A slide board is utilized for transferring clients who are unable to bear weight on their legs and need assistance in sliding from one surface to another.
2. A healthcare professional is preparing to administer multiple medications to a client with dysphagia. What action should the healthcare professional take?
- A. Offer the medications with a full glass of water
- B. Crush the medications and mix them together
- C. Provide the medications through a straw
- D. Mix the medications with applesauce
Correct answer: C
Rationale: Clients with dysphagia have difficulty swallowing, so providing medications through a straw can help control the flow and prevent aspiration. Offering medications with a full glass of water (Choice A) may increase the risk of aspiration. Crushing medications and mixing them together (Choice B) can alter the medication's effectiveness or cause adverse effects. Mixing medications with applesauce (Choice D) may also present a choking hazard for clients with dysphagia.
3. 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.
4. A nurse is assessing a client who is at risk for pressure injuries. Which intervention should the nurse include in the plan of care?
- A. Reposition the client every 4 hours
- B. Use a special mattress for the client
- C. Keep the client on bedrest
- D. Encourage the client to remain in one position
Correct answer: B
Rationale: The correct answer is B: 'Use a special mattress for the client.' Using a special mattress reduces pressure on bony prominences and helps prevent pressure injuries. Repositioning the client every 4 hours (choice A) is important but using a special mattress is more effective. Keeping the client on bedrest (choice C) can increase the risk of pressure injuries due to prolonged immobility. Encouraging the client to remain in one position (choice D) is incorrect as it can lead to pressure injuries by exerting pressure on the same areas for an extended period.
5. A nurse is monitoring a client receiving intermittent enteral feedings. What should the nurse identify as a sign of intolerance to the feeding?
- A. Decreased heart rate
- B. Nausea
- C. Fever
- D. Weight gain
Correct answer: B
Rationale: Nausea is a common sign of intolerance to enteral feedings and should be addressed promptly. Nausea can indicate various issues such as feeding intolerance, formula composition problems, or underlying medical conditions. Decreased heart rate, fever, and weight gain are not typical signs of feeding intolerance. Decreased heart rate and fever may indicate other medical conditions, while weight gain is not an immediate sign of intolerance to enteral feedings.
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