ATI RN
ATI Capstone Comprehensive Assessment B
1. The patient experienced a surgical procedure, and Betadine was utilized as the surgical prep. Two days postoperatively, the nurse's assessment indicates that the incision is red and has a small amount of purulent drainage. The patient reports tenderness at the incision site. The patient's temperature is 100.5°F, and the WBC is 10,500/mm³. Which action should the nurse take first?
- A. Reevaluate the temperature and white blood cell count in 4 hours.
- B. Check which solution was used for skin preparation in surgery.
- C. Plan to change the surgical dressing during the shift.
- D. Utilize SBAR to notify the primary health care provider.
Correct answer: D
Rationale: The patient is showing signs of a possible surgical site infection, including redness, purulent drainage, tenderness, elevated temperature, and increased white blood cell count. These symptoms suggest the need for immediate action to address a potential complication. Utilizing SBAR to notify the primary health care provider is crucial as it allows for effective communication of the patient's condition and the need for further assessment and intervention. Reevaluating the temperature and white blood cell count later, checking the solution used for skin preparation, or planning to change the dressing do not address the urgent need for intervention and communication with the healthcare provider.
2. A nursing student learns about modifiable risk factors for coronary artery disease. Which factors does this include? (SATA)
- A. Age
- B. Hypertension
- C. Obesity
- D. Smoking
Correct answer: B
Rationale: Hypertension, obesity, smoking, and excessive stress are all modifiable risk factors for coronary artery disease. Age is a nonmodifiable risk factor as it is a natural process of life.
3. What is the combat health support system in the field designed to do?
- A. Provide evacuation to the far rear for treatment and delay return to duty
- B. Project, sustain, and protect the health of the soldier in war and operations other than war
- C. Provide rearward evacuation and reassignment
- D. Provide far rear area care and delayed return to duty
Correct answer: B
Rationale: The correct answer is B. The combat health support system in the field is designed to project, sustain, and protect the health of soldiers in both war and operations other than war. Choice A is incorrect because the system is not primarily focused on providing evacuation to the far rear for treatment, but rather on overall health support. Choice C is incorrect as it only mentions rearward evacuation and reassignment, which is a limited scope compared to the comprehensive support provided by the system. Choice D is incorrect as it narrowly focuses on far rear area care and delayed return to duty, missing the broader aspects of health support and protection.
4. What is the main function of the digestive system?
- A. Formation of cells
- B. Movement of body parts
- C. Absorption of nutrients
- D. Providing oxygen for the extraction of energy from nutrients
Correct answer: C
Rationale: The correct answer is C: Absorption of nutrients. The main function of the digestive system is to break down food into nutrients that can be absorbed by the body to provide energy and support bodily functions. Choice A, 'Formation of cells,' is incorrect as cell formation is not the primary function of the digestive system; it is more related to processes like cell division and growth. Choice B, 'Movement of body parts,' is incorrect as this is more related to the muscular system, which controls body movements. Choice D, 'Providing oxygen for the extraction of energy from nutrients,' is incorrect because providing oxygen is primarily the function of the respiratory system, which is responsible for breathing and oxygen exchange in the body, not the digestive system.
5. A male patient with hypogonadism is receiving testosterone therapy. What is the most serious adverse effect the nurse should monitor for?
- A. Increased risk of breast cancer
- B. Increased risk of cardiovascular events
- C. Increased risk of liver dysfunction
- D. Increased risk of prostate cancer
Correct answer: B
Rationale: The correct answer is B: Increased risk of cardiovascular events. Testosterone therapy can lead to an increased risk of cardiovascular events such as heart attacks and strokes, especially in older patients. Monitoring for signs and symptoms of cardiovascular issues is crucial when administering testosterone therapy. Choices A, C, and D are incorrect because testosterone therapy does not typically lead to an increased risk of breast cancer, liver dysfunction, or prostate cancer.
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