ATI RN
RN ATI Capstone Proctored Comprehensive Assessment Form A
1. A school nurse is providing care for students in an elementary education facility. Which of the following interventions by the nurse addresses the primary level of prevention?
- A. Design interventions for a student's individual education plan (IEP).
- B. Teach students about healthy food choices.
- C. Perform first aid for minor injuries.
- D. Perform scoliosis screenings for students.
Correct answer: B
Rationale: The correct answer is B because teaching students about healthy food choices is a primary prevention strategy that aims to prevent future health issues by promoting healthy behaviors. Choice A, designing interventions for an individual education plan (IEP), is more related to addressing specific educational needs rather than preventing health issues. Choice C, performing first aid for minor injuries, is a form of secondary prevention aimed at reducing the impact of existing health problems. Choice D, performing scoliosis screenings for students, falls under secondary prevention by detecting health issues early rather than preventing them.
2. The nurse asks a client who is about to have a cardiac catheterization about any allergies. The client states, 'I always get a rash when I eat shellfish.' Which of the following is the priority nursing action?
- A. Attach a wristband indicating the client's allergy
- B. Ask the client if any other foods cause such a reaction
- C. Notify the dietary department of the client's allergy
- D. Notify the provider of the client's allergy
Correct answer: D
Rationale: Notifying the provider of the client's shellfish allergy is crucial to prevent a potential reaction from the contrast dye. While attaching a wristband indicating the allergy may be necessary, the priority is to inform the provider. Asking the client about other foods causing a similar reaction or notifying the dietary department, although important, are not the priority in this situation.
3. A client is experiencing chest pain. Which action should the nurse take first?
- A. Administer aspirin
- B. Provide oxygen
- C. Perform an ECG
- D. Administer nitroglycerin
Correct answer: D
Rationale: Administering nitroglycerin is the priority action when a client is experiencing chest pain as it helps alleviate the pain caused by reduced blood flow to the heart. Oxygen can be beneficial, but nitroglycerin takes precedence in this situation. Aspirin can also be given, but nitroglycerin is the priority. Performing an ECG can provide valuable information but is not the first action to take in this scenario.
4. A patient is at risk for impaired skin integrity. What is the priority intervention for the nurse?
- A. Turn and reposition the patient every 2 hours.
- B. Apply a moisture barrier to the patient's skin.
- C. Massage the patient's skin to promote circulation.
- D. Apply a heating pad to the patient's skin to increase blood flow.
Correct answer: A
Rationale: The correct answer is to turn and reposition the patient every 2 hours. This intervention is crucial in preventing pressure ulcers and maintaining skin integrity by relieving pressure on bony prominences. Applying a moisture barrier (Choice B) is important for moisture-associated skin damage but is not the priority in this case. Massaging the patient's skin (Choice C) can potentially cause friction and shear, increasing the risk of skin breakdown. Applying a heating pad (Choice D) can lead to burns or thermal injuries, exacerbating skin integrity issues.
5. A nurse is preparing to administer furosemide 40 mg IV. Available is furosemide 10 mg/1 mL. How many mL should the nurse administer per dose?
- A. 2
- B. 3
- C. 4
- D. 5
Correct answer: C
Rationale: To calculate the mL needed, divide the total dose by the dose per mL. In this case, 40 mg divided by 10 mg/mL equals 4 mL. Therefore, the nurse should administer 4 mL per dose. Choice A, 2 mL, is incorrect because it would only deliver 20 mg of furosemide, which is half the required dose. Choices B and D are also incorrect as they do not provide the accurate amount needed to achieve the 40 mg dosage.
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