ATI LPN
PN ATI Capstone Proctored Comprehensive Assessment 2020 B with NGN
1. A school nurse is providing care for students in an elementary education facility. What intervention by the nurse addresses the primary level of prevention?
- A. Monitor for signs of illness.
- B. Teach students about healthy food choices.
- C. Administer medication to students with chronic conditions.
- D. Monitor immunization compliance.
Correct answer: B
Rationale: The correct answer is B: Teach students about healthy food choices. Teaching healthy habits like proper nutrition is an example of primary prevention because it aims to prevent disease before it occurs. Choice A, monitoring for signs of illness, is more related to secondary prevention (early detection and treatment). Choice C, administering medication to students with chronic conditions, is a form of tertiary prevention (managing existing conditions to prevent complications). Choice D, monitoring immunization compliance, is also a form of primary prevention but focuses on preventing specific infectious diseases through immunization rather than general health promotion.
2. A healthcare professional is assessing a client for signs of dehydration. Which of the following should the healthcare professional look for?
- A. Bradycardia
- B. Dry mucous membranes
- C. Decreased urination
- D. Both B and C
Correct answer: D
Rationale: Corrected Rationale: Signs of dehydration include dry mucous membranes and decreased urination, among other symptoms. Bradycardia is not a typical sign of dehydration; instead, tachycardia (increased heart rate) is more commonly associated with dehydration. Therefore, option A is incorrect. While dry mucous membranes and decreased urination are indicative of dehydration, selecting only one of these symptoms would not provide a comprehensive assessment. Hence, option D, which includes both dry mucous membranes and decreased urination, is the correct choice.
3. A nurse is assessing a client with a history of heart failure. Which of the following findings should the nurse monitor?
- A. Increased energy
- B. Peripheral edema
- C. Elevated heart rate
- D. Improved lung sounds
Correct answer: B
Rationale: The correct answer is B: Peripheral edema. In heart failure, the heart's inability to pump effectively can lead to fluid backup, causing swelling in the extremities, known as peripheral edema. Monitoring for peripheral edema is crucial as it is a common sign of worsening heart failure. Choices A, C, and D are incorrect because increased energy, elevated heart rate, and improved lung sounds are not typical findings in heart failure. Increased energy is not usually associated with heart failure, an elevated heart rate may occur as a compensatory mechanism but is not a direct sign of heart failure, and improved lung sounds are not expected in heart failure which often presents with crackles or wheezes due to pulmonary congestion.
4. A nurse is caring for a client who is receiving magnesium sulfate for preeclampsia. Which of the following findings should the nurse report to the healthcare provider?
- A. Urinary output of 40 mL/hr
- B. Respiratory rate of 10 breaths per minute
- C. Absent deep tendon reflexes
- D. Blood pressure of 150/90 mm Hg
Correct answer: B
Rationale: Magnesium sulfate can depress the central nervous system, leading to respiratory depression. A respiratory rate of 10 breaths per minute is below the normal range and requires immediate intervention. Urinary output of 40 mL/hr (Choice A) is within the normal range for a client receiving magnesium sulfate. Absent deep tendon reflexes (Choice C) are an expected finding due to the medication's effect on neuromuscular excitability. A blood pressure of 150/90 mm Hg (Choice D) is slightly elevated but not a priority concern compared to severe respiratory depression.
5. A client with a history of renal failure is being cared for by a nurse. Which of the following should the nurse monitor?
- A. Fluid intake
- B. Electrolyte levels
- C. Blood pressure
- D. Both B and C
Correct answer: D
Rationale: Clients with renal failure are at risk for electrolyte imbalances and hypertension. Monitoring electrolyte levels is crucial because renal failure can lead to imbalances in sodium, potassium, and other electrolytes. Blood pressure monitoring is essential as hypertension is a common complication of renal failure. Therefore, both electrolyte levels and blood pressure should be closely monitored to detect and manage any abnormalities. Fluid intake, while important, is not specific to renal failure monitoring and is not the priority in this case.
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