ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B
1. When providing education on the use of insulin, what should be included?
- A. Insulin can be stored at room temperature indefinitely
- B. Monitor blood glucose levels before administration
- C. Insulin is a long-acting medication
- D. Insulin has no side effects
Correct answer: B
Rationale: The correct answer is to monitor blood glucose levels before administration. This step is crucial to ensure the correct dose of insulin is administered based on the current blood glucose level. Choice A is incorrect as insulin usually needs to be stored in the refrigerator and has an expiration date. Choice C is incorrect because insulin can be short-acting, rapid-acting, intermediate-acting, or long-acting. Choice D is also incorrect as insulin can have side effects such as hypoglycemia if the dose is too high.
2. A client is taking levothyroxine. Which of the following findings should indicate that the medication is effective?
- A. Weight loss
- B. Decreased blood pressure
- C. Absence of seizures
- D. Decreased inflammation
Correct answer: A
Rationale: The correct answer is A: Weight loss. Levothyroxine is used to treat hypothyroidism, which is characterized by symptoms such as weight gain. Therefore, weight loss in a client taking levothyroxine indicates that the medication is effective in managing hypothyroidism. Choices B, C, and D are incorrect because levothyroxine primarily affects thyroid function and metabolism, not blood pressure, seizures, or inflammation.
3. A nurse is caring for a client prescribed hydromorphone for severe pain. The client's respiratory rate has decreased from 16 breaths per minute to 6. Which of the following medications should the nurse prepare to administer?
- A. Naloxone
- B. Flumazenil
- C. Activated charcoal
- D. Aluminum hydroxide
Correct answer: A
Rationale: Naloxone is the correct answer. Naloxone is the antidote for opioid overdose, including hydromorphone. Opioids can cause respiratory depression, and a significant decrease in respiratory rate from 16 to 6 breaths per minute indicates respiratory compromise. Naloxone should be administered promptly to reverse the effects of the opioid and restore normal respiratory function. Flumazenil (Choice B) is used to reverse the effects of benzodiazepines, not opioids. Activated charcoal (Choice C) is used for gastrointestinal decontamination in cases of overdose with certain substances, but it is not the appropriate intervention for opioid-induced respiratory depression. Aluminum hydroxide (Choice D) is an antacid and has no role in managing opioid overdose or respiratory depression.
4. A client has developed a pulmonary embolism. Which of the following interventions should the nurse implement first?
- A. Administer oxygen
- B. Prepare the client for a thoracentesis
- C. Elevate the client’s lower extremities
- D. Administer anticoagulant therapy
Correct answer: A
Rationale: Administering oxygen is the priority intervention for a client with a pulmonary embolism. Pulmonary embolism can lead to impaired gas exchange, causing hypoxemia. Administering oxygen helps to maintain adequate oxygenation levels. Thoracentesis is not indicated for a pulmonary embolism, as it is a procedure to remove fluid or air from the pleural space, not a treatment for embolism. Elevating the client's lower extremities is not a priority in the management of a pulmonary embolism. Administering anticoagulant therapy is important in the treatment of pulmonary embolism to prevent further clot formation, but it is not the first intervention. Oxygen administration takes precedence to address the immediate oxygenation needs of the client.
5. A client with Ménière’s disease is experiencing episodes of vertigo. Which of the following interventions should the nurse include in the plan?
- A. Encourage bed rest
- B. Restrict fluid intake to the morning hours
- C. Administer aspirin
- D. Provide a low sodium diet
Correct answer: D
Rationale: The correct intervention for a client with Ménière’s disease experiencing vertigo is to provide a low sodium diet. Limiting sodium helps to reduce fluid retention, which in turn decreases the manifestations of Ménière’s disease. Encouraging bed rest (Choice A) may be necessary during acute episodes but is not a long-term solution. Restricting fluid intake (Choice B) to the morning hours does not specifically address the underlying issue of fluid retention associated with Ménière’s disease. Administering aspirin (Choice C) is not recommended for Ménière’s disease as it can worsen symptoms.
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