ATI RN
RN ATI Capstone Proctored Comprehensive Assessment 2019 B
1. 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.
2. A client is being taught about which foods to include in a low fiber diet. Which statement indicates understanding?
- A. Choosing a fresh pear would be a good snack option
- B. I should make refried beans for supper
- C. Selecting white rice as a side dish is a good choice
- D. Opting for bran cereal would be a good breakfast choice
Correct answer: C
Rationale: The correct answer is C because white rice is a low-fiber food suitable for a low-fiber diet, making it an appropriate choice. Choices A, B, and D are incorrect because fresh pear, refried beans, and bran cereal are high-fiber foods and not suitable for a low-fiber diet.
3. What is a key characteristic of Illness Anxiety Disorder?
- A. Excessive focus on minor symptoms without medical evidence of illness
- B. The need for consistent reassurance from healthcare professionals
- C. Compulsive behavior to avoid physical illness
- D. Development of avoidance behaviors to reduce anxiety
Correct answer: A
Rationale: The correct answer is A: "Excessive focus on minor symptoms without medical evidence of illness." Illness Anxiety Disorder, formerly known as hypochondriasis, is characterized by a preoccupation with having a serious illness despite no medical evidence to support the presence of an illness. Individuals with this disorder often interpret normal bodily sensations as signs of severe illness. Choice B is incorrect because while individuals with Illness Anxiety Disorder may seek reassurance from healthcare professionals, the excessive focus on minor symptoms is the key characteristic. Choice C is incorrect as compulsive behaviors to avoid physical illness are more characteristic of illnesses like Obsessive-Compulsive Disorder. Choice D is incorrect as the development of avoidance behaviors to reduce anxiety is more commonly seen in conditions like specific phobias or social anxiety disorder.
4. A nurse caring for a client under airborne precautions notes that the client is scheduled for a nuclear scan. What is the appropriate action for the nurse to take?
- A. Planning to have the nuclear scan performed at the bedside
- B. Calling the nuclear medicine department and telling the technician that the test will have to be delayed until airborne precautions have been discontinued
- C. Asking the technicians in the nuclear scan department to wear masks
- D. Placing a surgical mask on the client for transport and for contact with other individuals
Correct answer: D
Rationale: The correct action for the nurse is to place a surgical mask on the client for transport and for contact with other individuals when a patient under airborne precautions requires movement. This helps prevent the spread of infectious agents. Planning to have the nuclear scan at the bedside (Choice A) may not be feasible or appropriate. Calling the nuclear medicine department to delay the test (Choice B) may inconvenience the client and disrupt the scheduled procedure. Asking technicians in the nuclear scan department to wear masks (Choice C) does not provide adequate protection for others who may come into contact with the client outside the department.
5. A healthcare professional is assessing a patient with pneumonia. Which finding is most concerning?
- A. Fever of 101°F.
- B. Blood pressure of 140/90 mmHg.
- C. Heart rate of 95 beats per minute.
- D. Crackles heard in the lung bases.
Correct answer: D
Rationale: Crackles heard in the lung bases are most concerning in a patient with pneumonia as they suggest fluid accumulation in the lungs, indicating possible severe infection or respiratory distress. Prompt intervention is required to prevent further complications.\n\nChoice A, fever of 101°F, is common in infections like pneumonia but may not be as immediately concerning as crackles indicating fluid in the lungs.\n\nChoice B, a blood pressure of 140/90 mmHg, is within normal limits and not directly indicative of pneumonia severity.\n\nChoice C, a heart rate of 95 beats per minute, is slightly elevated but not as critical as crackles suggesting fluid in the lungs.
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