ATI RN
RN ATI Capstone Proctored Comprehensive Assessment Form A
1. An occupational health nurse in a factory is planning interventions to reduce environmental stressors for employees. Which of the following interventions should the nurse use to affect physical agents in the environment?
- A. Teach workers to choose personal strategies to cope with work stress
- B. Limit the amount of time workers spend in temperatures over 43.3°C (110°F)
- C. Provide ear plugs for use at workstations throughout the factory
- D. Obtain dosimeters for employees to wear when using new machinery that emits radiation
Correct answer: B
Rationale: Limiting exposure to extreme temperatures is important to protect workers from heat-related illnesses.
2. A patient is receiving a blood transfusion and develops chills, a headache, and low back pain. What is the nurse’s priority action?
- A. Administer acetaminophen
- B. Stop the transfusion
- C. Slow the transfusion rate
- D. Administer antihistamines
Correct answer: B
Rationale: The correct answer is to stop the transfusion (Choice B). The symptoms described - chills, headache, and low back pain - are indicative of a transfusion reaction. The priority action is to immediately stop the transfusion to prevent further complications such as more severe reactions like hemolytic reactions or anaphylaxis. Administering acetaminophen (Choice A) may help with symptoms but does not address the underlying cause. Slowing the transfusion rate (Choice C) may not be sufficient if a serious transfusion reaction is occurring. Administering antihistamines (Choice D) is not the priority in this situation; stopping the transfusion takes precedence to ensure patient safety.
3. In a disaster where a building has collapsed, which victim should a nurse attend to first?
- A. A victim who has died of multiple serious injuries
- B. A victim with a partial amputation of a leg who is bleeding profusely
- C. An alert victim who has numerous bruises on the arms and legs
- D. A hysterical victim who has sustained a head injury
Correct answer: B
Rationale: In a disaster situation like a building collapse, the nurse should attend to the victim with a partial amputation of a leg who is bleeding profusely first. This victim is at immediate risk of severe blood loss, which can be life-threatening. It is crucial to address life-threatening injuries like severe bleeding before attending to other less urgent cases. The victim with the amputation requires immediate intervention to control bleeding and stabilize their condition. Victims who are already deceased or have less urgent injuries can be attended to after addressing the critical cases.
4. A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. After securing a safe environment, which of the following actions should the nurse take next?
- A. Check for orthostatic hypotension
- B. Use a gait belt
- C. Position the chair on the strong side
- D. Ask for assistance
Correct answer: A
Rationale: The correct next action for the nurse to take is to check for orthostatic hypotension. This step is crucial as it ensures the client's safety during the transfer process. Orthostatic hypotension is a drop in blood pressure that can occur when a person moves from a lying down position to a sitting or standing position. By checking for orthostatic hypotension before transferring the client, the nurse can prevent potential complications such as dizziness, lightheadedness, or falls. Choices B, C, and D are incorrect in this scenario as they do not address the immediate safety concern of assessing for orthostatic hypotension.
5. How should a healthcare professional manage a patient with a chest tube?
- A. Ensuring the chest tube is secured properly and functioning
- B. Checking for air leaks and ensuring drainage is working
- C. Ensuring chest tube drainage is below chest level
- D. Ensuring proper documentation of chest tube output
Correct answer: D
Rationale: Proper documentation of chest tube output is crucial in the care of a patient with a chest tube. While ensuring the chest tube is secured and functioning, checking for air leaks, and maintaining drainage below chest level are important aspects of care, documentation of output is essential for monitoring the patient's condition, assessing the effectiveness of treatment, and ensuring appropriate interventions if needed.
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