ATI RN
RN ATI Capstone Proctored Comprehensive Assessment Form A
1. A nurse manager is teaching a group of employees about standards for Quality and Safety Education for Nurses (QSEN). Which of the following statements by an employee should the nurse manager identify as an example of the QSEN concept of quality improvement?
- A. We should start tracking how soon clients are discharged after laparoscopic versus open surgery.
- B. We should involve our clients' partners in care planning as much as possible.
- C. We should be sure to log out of the computers immediately following documentation.
- D. We should provide change-of-shift report as a team, including the assistive personnel who assisted with care.
Correct answer: B
Rationale: Involving partners in care planning is a quality improvement strategy that aligns with QSEN principles. This choice reflects patient-centered care and collaboration, which are essential elements of quality improvement. Choices A, C, and D do not directly relate to quality improvement concepts. Tracking discharge times, logging out of computers, and providing change-of-shift reports are important practices but not specifically focused on quality improvement.
2. A client tests positive for alpha1-antitrypsin (AAT) deficiency and asks the nurse, What does this mean? How should the nurse respond?
- A. Your children may be at high risk for developing chronic obstructive pulmonary disease.
- B. I will arrange for a genetic counselor to discuss your condition.
- C. Your risk for chronic obstructive pulmonary disease is higher, particularly if you smoke.
- D. This is a recessive gene that should not affect your health.
Correct answer: C
Rationale: Alpha1-antitrypsin (AAT) deficiency is associated with a higher risk of chronic obstructive pulmonary disease (COPD), especially if the individual smokes. This condition is caused by a recessive gene. Individuals with one allele typically produce enough AAT to prevent COPD unless they smoke. However, those with two alleles are at high risk for COPD even without exposure to smoke or other irritants. Being a carrier of AAT deficiency does not guarantee that one's children will develop the disease; it depends on the AAT levels of the partner. While involving a genetic counselor may be beneficial in the long run, the immediate concern of the client's question should be addressed first.
3. A client is receiving heparin therapy. Which laboratory value should be monitored by the nurse to evaluate the effectiveness of the therapy?
- A. PT
- B. aPTT
- C. INR
- D. Platelet count
Correct answer: B
Rationale: The activated partial thromboplastin time (aPTT) is specifically used to monitor the effectiveness of heparin therapy. It should be maintained at 1.5 to 2 times the normal level. Monitoring aPTT helps ensure that the therapeutic range of heparin is achieved to prevent clot formation while minimizing the risk of bleeding complications. Choice A (PT) is incorrect as it is used to monitor warfarin therapy, not heparin. Choice C (INR) is also incorrect as it is primarily used to monitor warfarin therapy. Choice D (Platelet count) is not directly related to monitoring the effectiveness of heparin therapy.
4. Considering the statement that communication is most effective when barriers are first removed, which of the following is recognized as an inhibiting factor in communication?
- A. Avoidance of universally accepted abbreviations
- B. Usage of incorrect grammar
- C. Poor handwriting
- D. Advanced age of the client
Correct answer: D: Advanced age of the client
Rationale: The correct answer is 'D: Advanced age of the client.' Age can be a significant obstacle in communication due to factors such as hearing loss, cognitive decline, or memory issues, which all can hamper effective communication. Choices A, B, and C, while they may present challenges in communication, are not directly related to age and its influence on communication, making them incorrect. The issues presented by not using universally accepted abbreviations, incorrect grammar, and poor handwriting can be resolved through clarification, education, or the use of alternative communication methods, unlike the difficulties that can arise from advanced age.
5. A client prescribed Isosorbide Mononitrate for chronic stable Angina develops reflex tachycardia. Which of the following medications should the nurse expect to administer?
- A. Furosemide
- B. Captopril
- C. Ranolazine
- D. Metoprolol
Correct answer: D
Rationale: Metoprolol, a beta-adrenergic blocker, is commonly used to treat hypertension and stable angina pectoris. It is often prescribed to decrease heart rate in clients who develop tachycardia, such as in the case of reflex tachycardia induced by Isosorbide Mononitrate, making it the appropriate choice in this scenario. Furosemide (Choice A) is a loop diuretic used for conditions like heart failure and edema, not for reflex tachycardia. Captopril (Choice B) is an ACE inhibitor primarily used for hypertension and heart failure, not for reflex tachycardia. Ranolazine (Choice C) is used for chronic angina but does not specifically address reflex tachycardia.
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