ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment Form B
1. A patient with chronic kidney disease reports feeling light-headed after taking their medication. What should the nurse instruct the patient to do?
- A. Take the medication with food
- B. Take the medication at bedtime
- C. Stand up slowly to prevent dizziness
- D. Increase fluid intake
Correct answer: C
Rationale: Patients with chronic kidney disease are prone to orthostatic hypotension, which can cause dizziness. To prevent this, the nurse should instruct the patient to stand up slowly. Options A, B, and D do not directly address the issue of orthostatic hypotension and dizziness in this scenario.
2. While in the cafeteria, a nurse overhears two APs discussing a hospitalized patient. What action should the nurse take?
- A. Report the incident to the supervisor.
- B. Join the conversation to intervene.
- C. Quietly tell the APs that this is not appropriate.
- D. Ignore the conversation.
Correct answer: C
Rationale: The correct action for the nurse to take in this situation is to choose option C: 'Quietly tell the APs that this is not appropriate.' The nurse should immediately and discreetly address the situation, reminding the APs that discussing patient information in public areas violates confidentiality. Reporting the incident to the supervisor (option A) may be necessary if the behavior continues. Joining the conversation to intervene (option B) may escalate the situation and compromise patient confidentiality. Ignoring the conversation (option D) does not address the violation or prevent it from recurring.
3. A nurse is assessing a client who has schizophrenia and is experiencing negative symptoms. Which of the following findings should the nurse expect?
- A. Hallucinations
- B. Delusions
- C. Flat affect
- D. Paranoia
Correct answer: C
Rationale: The correct answer is C: Flat affect. Negative symptoms of schizophrenia involve deficits in normal emotional responses or other thought processes. These symptoms include a flat affect (reduced emotional expression), social withdrawal, and avolition (lack of motivation). Hallucinations and delusions are characteristic of positive symptoms, which involve the presence of abnormal behaviors or experiences. Paranoia is more associated with delusions rather than negative symptoms.
4. A nurse is planning care for an adolescent client with chronic renal failure. Which action should the nurse include?
- A. Encourage a diet high in calcium
- B. Provide a diet high in potassium
- C. Ensure increased fluid intake
- D. Restrict protein intake to the RDA
Correct answer: D
Rationale: In chronic renal failure, it is essential to restrict protein intake to the Recommended Dietary Allowance (RDA) to reduce the accumulation of waste products that the kidneys can no longer effectively eliminate. Choices A, B, and C are incorrect because in chronic renal failure, high calcium, high potassium, and increased fluid intake can further strain the kidneys and worsen the condition.
5. A nurse is reviewing the medication class, benzodiazepines. The nurse would use caution when administering benzodiazepines to which of the clients below?
- A. A client with glaucoma
- B. A client with renal failure
- C. A client with hypertension
- D. A client with insomnia
Correct answer: A
Rationale: Benzodiazepines can increase intraocular pressure, which is why they must be used cautiously in patients with glaucoma. In clients with this condition, benzodiazepines can potentially worsen symptoms and lead to further complications involving the eyes. Therefore, administering benzodiazepines to a client with glaucoma should be done with caution. Choices B, C, and D are not directly contraindicated with benzodiazepines, making them less likely to cause harm compared to administering to a client with glaucoma.
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