ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B with NGN
1. How should a healthcare professional respond to a patient experiencing hypoglycemia?
- A. Rechecking the blood glucose level in 15 minutes
- B. Encouraging the patient to eat a high-protein snack
- C. Administering 15g of fast-acting carbohydrates
- D. Administering glucagon if the patient is unconscious
Correct answer: C
Rationale: The correct response to a patient experiencing hypoglycemia is to administer 15g of fast-acting carbohydrates. This helps quickly increase the blood glucose levels in the patient, addressing the low blood sugar. Rechecking the blood glucose level in 15 minutes (Choice A) may delay necessary intervention, encouraging a high-protein snack (Choice B) is not recommended as it does not rapidly increase blood sugar levels, and administering glucagon if the patient is unconscious (Choice D) is typically done in severe cases of hypoglycemia when the patient is unable to eat or drink.
2. A nurse is evaluating a client receiving hemodialysis. Which of the following lab values requires immediate intervention?
- A. Sodium 135 mEq/L
- B. Potassium 6.5 mEq/L
- C. Calcium 9 mg/dL
- D. Chloride 98 mEq/L
Correct answer: B
Rationale: The correct answer is B. Potassium levels above 5.0 mEq/L can lead to cardiac issues, and a level of 6.5 mEq/L requires immediate intervention. Hyperkalemia can cause life-threatening cardiac arrhythmias. Choices A, C, and D are within normal ranges and do not require immediate intervention in the context of hemodialysis monitoring.
3. A client has a new prescription for guaifenesin. What information regarding the action of guaifenesin should the nurse include in the teaching?
- A. Decreases mucus production
- B. Reduces nasal congestion
- C. Increases cough production
- D. Reduces fever
Correct answer: C
Rationale: The correct answer is C: 'Increases cough production.' Guaifenesin is an expectorant that works by increasing cough production to help clear secretions from the airways. Option A is incorrect because guaifenesin does not decrease mucus production but rather helps to make the mucus easier to cough up. Option B is incorrect as guaifenesin does not reduce nasal congestion. Option D is incorrect because guaifenesin does not have any effect on reducing fever.
4. The nurse is performing hand hygiene before assisting a healthcare provider with insertion of a chest tube. While washing hands, the nurse touches the sink. Which action will the nurse take next?
- A. Repeat handwashing using antiseptic soap.
- B. Inform the healthcare provider and recruit another nurse to assist.
- C. Extend the handwashing procedure to 5 minutes.
- D. Rinse and dry hands and begin assisting the healthcare provider.
Correct answer: A
Rationale: The correct answer is A. The sink is considered a contaminated area. When hand hygiene is compromised during the process, it is essential to repeat handwashing using antiseptic soap to ensure proper hygiene. Choice B is incorrect because the situation can be managed by proper handwashing. Choice C is incorrect as extending the handwashing procedure to 5 minutes is not necessary in this scenario. Choice D is incorrect as the hands need to be properly cleaned before assisting the healthcare provider.
5. A nurse is planning care for a client who has dehydration and is receiving a continuous IV infusion of 0.9% sodium chloride. Which of the following interventions should the nurse include in the plan of care?
- A. Monitor the client's intake and output every 6 hours
- B. Administer furosemide to the client
- C. Check the client's IV infusion every 8 hours
- D. Offer the client 240 ml (8 oz) of oral fluids every 4 hours
Correct answer: D
Rationale: Offering the client 240 ml (8 oz) of oral fluids every 4 hours is essential to maintain hydration in a client with dehydration who is receiving continuous IV infusion. This intervention helps ensure an adequate fluid balance. Monitoring the client's intake and output every 6 hours is necessary to assess hydration status and response to treatment. Administering furosemide to the client, choice B, is contraindicated in dehydration as it can further deplete fluid volume. Checking the IV infusion every 8 hours, as in choice C, is important but not as critical as ensuring oral fluid intake to promote hydration.
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