ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B
1. A nurse is providing discharge teaching to a client following a myocardial infarction (MI). Which of the following activities should the client avoid?
- A. Swimming in a pool
- B. Driving a car
- C. Light housework
- D. Walking on flat ground
Correct answer: B
Rationale: The correct answer is B: Driving a car. Driving a car can be physically and emotionally taxing, increasing the risk of complications soon after a myocardial infarction. It requires quick reflexes and decision-making abilities, which may be impaired during the recovery period. Swimming in a pool, light housework, and walking on flat ground are generally safe and beneficial activities for clients following a myocardial infarction as they promote circulation, muscle strength, and overall well-being.
2. The nurse is caring for a group of medical-surgical patients. A fire has been reported in an adjacent wing of the hospital. What should the nurse do to ensure the patients' safety?
- A. Wait until the fire department arrives before taking action.
- B. Close all doors.
- C. Identify evacuation routes.
- D. Move bedridden patients in their beds.
Correct answer: B
Rationale: During a fire emergency, it is crucial to close all doors to contain smoke and fire, helping to protect the patients. This action can prevent the spread of fire and smoke to the area where patients are located. Identifying evacuation routes is also important for a timely and orderly evacuation if necessary. Waiting for the fire department to arrive before taking action (Choice A) can waste valuable time and put patients at risk. Moving bedridden patients in their beds (Choice D) can be dangerous during a fire and should be avoided as it can expose patients and staff to more risks.
3. A nurse is providing discharge teaching for a client prescribed warfarin. What should be included in the teaching?
- A. Avoid foods rich in vitamin K
- B. Take warfarin with meals
- C. Take aspirin for pain relief
- D. Report unusual bleeding or bruising
Correct answer: D
Rationale: The correct answer is D. When a client is prescribed warfarin, they should be educated to report any unusual bleeding or bruising promptly. Choices A, B, and C are incorrect. Avoiding foods rich in vitamin K is not necessary when taking warfarin, as long as intake remains consistent. Warfarin does not need to be taken with meals, and aspirin should not be taken for pain relief due to its blood-thinning effects, which can increase the risk of bleeding when combined with warfarin.
4. A client reports pain and swelling at the IV site. What should the nurse do first?
- A. Flush the IV line and continue the infusion.
- B. Stop the infusion and notify the healthcare provider.
- C. Increase the IV infusion rate to reduce discomfort.
- D. Apply a warm compress to the IV site and continue monitoring.
Correct answer: B
Rationale: The correct answer is B: Stop the infusion and notify the healthcare provider. Pain and swelling at an IV site can indicate infiltration or infection, which are serious complications. Stopping the infusion helps prevent further harm to the client, and notifying the healthcare provider promptly allows for appropriate assessment and intervention. Choice A is incorrect because flushing the IV line and continuing the infusion could exacerbate the issue. Choice C is incorrect as increasing the IV infusion rate is not the appropriate action for pain and swelling at the site. Choice D is incorrect because applying a warm compress may not address the underlying issue of infiltration or infection; it's crucial to stop the infusion and seek further guidance.
5. The emergency department has been notified of a potential bioterrorism attack. Which action by the nurse is priority?
- A. Prepare for potential posttraumatic stress related to this bioterrorism attack.
- B. Transport patients quickly and efficiently through the elevators.
- C. Monitor for specific symptoms related to the bioterrorism attack.
- D. Manage all patients using standard precautions.
Correct answer: D
Rationale: During a potential bioterrorism attack, the priority for the nurse is to manage all patients using standard precautions. This approach ensures the safety of both patients and healthcare providers by preventing the spread of potential bioterrorism-related illnesses. Option A is incorrect because managing patient care and safety through standard precautions takes precedence. Option B is incorrect as patient transport should also be done while adhering to infection control measures. Option C is incorrect as monitoring for specific symptoms is important but not the priority when all patients need to be managed with standard precautions.
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