ATI RN
RN ATI Capstone Proctored Comprehensive Assessment Form A
1. A client scheduled for a CT scan of the head with contrast is being taught by a nurse. Which of the following statements by the client indicates a need for further teaching?
- A. I will not eat or drink for 4 hours before the procedure
- B. I will keep my head still throughout the procedure
- C. I will experience a warm sensation when the dye is injected
- D. I can take my morning dose of metformin
Correct answer: D
Rationale: The correct answer is D because metformin should be held before a contrast CT scan to prevent the risk of kidney damage. Choices A, B, and C are all correct statements regarding the preparation and experience of a CT scan with contrast. It is important to fast before the procedure, keep the head still during the scan, and expect a warm sensation when the dye is injected.
2. A healthcare professional in a clinic sees a client who has an acute asthma exacerbation. Which of the following medications should reduce the symptoms?
- A. Cromolyn via metered dose inhaler
- B. Budesonide via dry powder inhaler
- C. Montelukast orally
- D. Albuterol via jet nebulizer
Correct answer: D
Rationale: Albuterol via jet nebulizer is the correct choice in this scenario as it is a short-acting bronchodilator that quickly relieves bronchospasm during an asthma exacerbation. Cromolyn (Choice A) is a mast cell stabilizer used for prevention, not quick relief. Budesonide (Choice B) is an inhaled corticosteroid used for long-term control, not for acute symptom relief. Montelukast (Choice C) is a leukotriene receptor antagonist used for maintenance therapy, not for immediate symptom relief during an exacerbation.
3. A nurse is assessing a client's wound dressing and observes a watery red drainage. The nurse should document this drainage as which of the following?
- A. Purulent
- B. Serous
- C. Sanguineous
- D. Serosanguineous
Correct answer: D
Rationale: The correct answer is D, serosanguineous. Serosanguineous drainage is thin, watery, and pale red, indicating a mixture of serous fluid and blood. Choice A (purulent) refers to thick, yellow or green drainage indicating infection. Choice B (serous) is thin, clear drainage. Choice C (sanguineous) is bright red, indicating fresh bleeding.
4. A healthcare professional is assessing a patient with pneumonia. Which finding is most concerning?
- A. Fever of 101°F.
- B. Blood pressure of 140/90 mmHg.
- C. Heart rate of 95 beats per minute.
- D. Crackles heard in the lung bases.
Correct answer: D
Rationale: Crackles heard in the lung bases are most concerning in a patient with pneumonia as they suggest fluid accumulation in the lungs, indicating possible severe infection or respiratory distress. Prompt intervention is required to prevent further complications.\n\nChoice A, fever of 101°F, is common in infections like pneumonia but may not be as immediately concerning as crackles indicating fluid in the lungs.\n\nChoice B, a blood pressure of 140/90 mmHg, is within normal limits and not directly indicative of pneumonia severity.\n\nChoice C, a heart rate of 95 beats per minute, is slightly elevated but not as critical as crackles suggesting fluid in the lungs.
5. A client with cirrhosis and ascites requires a care plan. Which intervention should the nurse include?
- A. Increase the client's sodium intake
- B. Increase the client's saturated fat intake
- C. Decrease the client's carbohydrate intake
- D. Decrease the client's fluid intake
Correct answer: D
Rationale: In cirrhosis with ascites, decreasing fluid intake is crucial to manage the condition. This helps prevent further fluid accumulation in the abdomen. Increasing sodium intake (Choice A) can worsen fluid retention and edema. Increasing saturated fat intake (Choice B) is not recommended as it can contribute to liver damage. Decreasing carbohydrate intake (Choice C) is not directly related to managing ascites in cirrhosis.
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