ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A nurse is providing teaching for a child who is prescribed ferrous sulfate. Which of the following instructions should the nurse include?
- A. Take the medication with milk
- B. Take with a glass of orange juice
- C. Take at bedtime
- D. Take with meals
Correct answer: B
Rationale: The correct answer is B: 'Take with a glass of orange juice.' Ferrous sulfate should be taken with orange juice (vitamin C) to enhance the absorption of iron. Taking it with milk (choice A) is not recommended as calcium can interfere with iron absorption. Taking it at bedtime (choice C) or with meals (choice D) may lead to decreased absorption due to interactions with other food or medications.
2. A nurse is caring for a client with a prescription for ferrous sulfate. What instruction should the nurse provide?
- A. Avoid strawberries and citrus fruits
- B. Take with fluids other than coffee or tea
- C. Take on a full stomach
- D. Double the dose if you miss a dose
Correct answer: B
Rationale: The correct instruction for a client prescribed ferrous sulfate is to take it with fluids other than coffee or tea. Coffee and tea can hinder iron absorption, so it's important to take the medication with other types of fluids. Choice A is incorrect because strawberries and citrus fruits are sources of vitamin C, which actually enhance iron absorption. Choice C is incorrect because ferrous sulfate is usually recommended to be taken on an empty stomach for better absorption. Choice D is incorrect as doubling the dose of ferrous sulfate can lead to an overdose and severe side effects.
3. A nurse is preparing to administer a dose of digoxin. Which of the following should the nurse do first?
- A. Assess blood pressure
- B. Check heart rate
- C. Monitor potassium levels
- D. Review the medication order
Correct answer: B
Rationale: The correct answer is to check the heart rate first before administering digoxin. Digoxin is a medication that directly affects the heart, so it is crucial to ensure that the heart rate is within the appropriate range before giving the dose. If the heart rate is below 60 bpm, administering digoxin could lead to toxicity. Assessing blood pressure (Choice A) is important but not the first priority when preparing to administer digoxin. Monitoring potassium levels (Choice C) is also crucial for patients on digoxin, but it is not the initial step. Reviewing the medication order (Choice D) is necessary but can be done after checking the heart rate.
4. A nurse is caring for a client who has dehydration. The client has a peripheral IV and has a prescription for an infusion of 0.9% sodium chloride 1,000 mL with 40 mEq potassium chloride to infuse over 1 hr. Which of the following actions should the nurse take first?
- A. Teach the client to report findings of IV extravasation
- B. Evaluate the patency of the IV
- C. Consult with the pharmacist about the prescription
- D. Verify the prescription with the provider
Correct answer: D
Rationale: The priority action is to verify the prescription with the provider. Verifying the prescription ensures patient safety by preventing fluid volume overload and dysrhythmias, which can result from infusing potassium too rapidly. Teaching the client about IV extravasation, evaluating IV patency, and consulting with the pharmacist are important but should come after verifying the prescription to ensure the ordered treatment is appropriate and safe for the client's condition.
5. A nurse is caring for a client prescribed clopidogrel. Which of the following should the nurse monitor?
- A. Liver function tests
- B. Blood pressure
- C. Potassium levels
- D. Respiratory rate
Correct answer: A
Rationale: Corrected Rationale: Clopidogrel is an antiplatelet medication, so the nurse should monitor for signs of bleeding and liver function tests due to potential liver effects. Monitoring liver function tests is essential to detect any adverse effects on the liver because clopidogrel can cause hepatotoxicity. While monitoring blood pressure, potassium levels, and respiratory rate are important in general patient care, they are not the priority assessments specifically related to clopidogrel use.
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