ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B with NGN
1. A nurse on a rehab unit is creating a plan of care for a newly admitted patient who has difficulty swallowing following a stroke. Which interprofessional team members should the nurse anticipate consulting?
- A. Physical therapist
- B. Speech-language pathologist
- C. Social worker
- D. Respiratory therapist
Correct answer: B
Rationale: The correct answer is B: Speech-language pathologist. A speech-language pathologist specializes in assessing and treating swallowing disorders, making them the most appropriate consultant for a patient with difficulty swallowing following a stroke. While other interprofessional team members such as a physical therapist (choice A), social worker (choice C), and respiratory therapist (choice D) may play important roles in the patient's care, the primary focus for swallowing difficulties would be the speech-language pathologist.
2. A nurse is assessing a client who reports a possible exposure to HIV. Which of the following findings should the nurse identify as an early manifestation of HIV infection?
- A. Stomatitis
- B. Fatigue
- C. Wasting syndrome
- D. Lipodystrophy
Correct answer: B
Rationale: The correct answer is B: Fatigue. A client with early HIV infection can be asymptomatic or experience symptoms like viral infections, such as fever, rash, and fatigue. Fatigue is a common early manifestation of HIV infection due to the body's immune response. Stomatitis (choice A) is more commonly associated with oral health issues or infections. Wasting syndrome (choice C) and lipodystrophy (choice D) are more advanced manifestations seen in later stages of HIV infection, characterized by severe weight loss and changes in body fat distribution, respectively.
3. A nurse is preparing to administer IV furosemide. Which of the following should the nurse monitor for during the infusion?
- A. Increased urinary output
- B. Ototoxicity
- C. Hypokalemia
- D. Hypoglycemia
Correct answer: C
Rationale: The correct answer is C: Hypokalemia. Furosemide is a loop diuretic that works by increasing the excretion of water and electrolytes, particularly potassium. Therefore, the nurse should monitor for hypokalemia, as low potassium levels can lead to various complications such as cardiac dysrhythmias. Choice A, increased urinary output, is an expected effect of furosemide due to its diuretic action but is not a side effect needing monitoring. Ototoxicity (Choice B) is a potential adverse effect of other medications like aminoglycoside antibiotics, not furosemide. Hypoglycemia (Choice D) is not a common side effect associated with furosemide administration.
4. A healthcare professional is preparing to administer a dose of warfarin. Which of the following actions should the healthcare professional take?
- A. Verify INR levels
- B. Administer with food
- C. Monitor blood glucose levels
- D. Assess liver function
Correct answer: A
Rationale: Corrected Rationale: When administering warfarin, it is crucial to verify the patient's INR levels. INR monitoring is essential to ensure that the patient is receiving the correct dose of warfarin for their condition and to minimize the risk of bleeding. Choices B, C, and D are incorrect because administering warfarin with food, monitoring blood glucose levels, and assessing liver function are not directly related to the safe administration and monitoring of warfarin therapy.
5. A nurse is performing a focused assessment for a client who has dysrhythmias. What indicates ineffective cardiac contractions?
- A. Increased blood pressure
- B. Pulse deficit
- C. Normal heart rate
- D. Elevated oxygen saturation
Correct answer: B
Rationale: The correct answer is B: Pulse deficit. A pulse deficit is a significant finding in clients with dysrhythmias, indicating ineffective cardiac contractions. Pulse deficit occurs when there is a difference between the apical and radial pulses, suggesting that not all heart contractions are strong enough to produce a pulse that can be felt peripherally. Increased blood pressure (choice A) may occur due to various factors and is not a direct indicator of ineffective cardiac contractions. Similarly, a normal heart rate (choice C) and elevated oxygen saturation (choice D) do not specifically point towards ineffective cardiac contractions; they can be present in individuals with dysrhythmias but do not directly indicate ineffective cardiac contractions.
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