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RN ATI Capstone Proctored Comprehensive Assessment Form B

What are the common side effects of opioid analgesics, and how should they be managed?

    A. Drowsiness and dizziness, ensuring safety precautions

    B. Respiratory depression, ensuring adequate ventilation

    C. Constipation and nausea, managed with stool softeners

    D. Nausea and vomiting, managing with antiemetics

Correct Answer: A
Rationale: The correct answer is A. Common side effects of opioid analgesics include drowsiness and dizziness. These side effects can impair a person's ability to operate machinery or drive safely. To manage these side effects, it is essential to advise patients to avoid activities that require alertness until they know how the medication affects them. Choices B, C, and D are incorrect because respiratory depression, constipation, and nausea are also common side effects of opioids, but they are not the primary side effects being asked for in this question.

A healthcare provider is reviewing a client's lab results. Which of the following lab values should the provider report?

  • A. Magnesium 1.9 mEq/L
  • B. Potassium 3.6 mEq/L
  • C. Sodium 126 mEq/L
  • D. Chloride 99 mEq/L

Correct Answer: C
Rationale: The correct answer is C: Sodium 126 mEq/L. A sodium level of 126 mEq/L is below the normal range, indicating hyponatremia, which can have serious health implications and should be reported to the healthcare provider for further evaluation and intervention. Choices A, B, and D are within or close to the normal ranges for magnesium, potassium, and chloride, respectively, and do not require immediate reporting as they are not significantly abnormal.

A nurse is caring for a client who is postoperative following a cholecystectomy and reports pain. Which of the following actions should the nurse take? (SATA)

  • A. Change the client's position
  • B. Identify the client's pain level
  • C. Remind the client to use incisional splinting
  • D. Offer the client a back rub

Correct Answer: A
Rationale: The correct actions the nurse should take when caring for a client postoperative following a cholecystectomy and reporting pain include changing the client's position. This can help relieve postoperative pain by reducing pressure on the surgical site. Identifying the client's pain level is important but not specific to alleviating postoperative pain. While reminding the client to use incisional splinting can be beneficial, it may not directly address the immediate pain concern. Offering the client a back rub is not typically indicated for postoperative pain relief after a cholecystectomy.

A nurse is caring for a newborn in the nursery following a circumcision. The newborn's grandparent, who does not have an identification bracelet, requests to take the newborn to his parents' room. Which of the following actions should the nurse take?

  • A. Check the newborn's identification bracelet against the chart
  • B. Obtain permission from the newborn's parents
  • C. Respectfully deny the grandparent's request
  • D. Review the newborn's footprints record

Correct Answer: C
Rationale: In this scenario, where the grandparent lacks proper identification, the nurse should respectfully deny the request to take the newborn. It is crucial to prioritize the newborn's safety and security by following hospital policies and procedures. Checking the newborn's identification bracelet against the chart (Choice A) may not be sufficient to address the situation at hand, as the grandparent's lack of identification is the primary concern. While obtaining permission from the newborn's parents (Choice B) is important, the lack of proper identification from the grandparent takes precedence. Reviewing the newborn's footprints record (Choice D) is not necessary in this situation, as the immediate concern is ensuring proper identification and security before allowing the newborn to leave the nursery.

A patient with a history of hypertension is admitted for chest pain. What is the most appropriate action for the nurse to take first?

  • A. Obtain a detailed medical history
  • B. Administer nitroglycerin
  • C. Conduct an ECG
  • D. Administer morphine sulfate

Correct Answer: B
Rationale: The correct answer is to administer nitroglycerin. Nitroglycerin is the priority intervention for a patient presenting with chest pain as it helps dilate blood vessels, reduce chest pain, and improve oxygen supply to the heart. Obtaining a detailed medical history, conducting an ECG, or administering morphine sulfate are important steps in the assessment and treatment process but are secondary to the immediate need to address chest pain and potential cardiac ischemia.

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