ATI RN
RN ATI Capstone Proctored Comprehensive Assessment A
1. Which principle is most important for maintaining medical asepsis in a healthcare setting?
- A. Sterilize instruments only when visibly contaminated.
- B. Use sterile gloves for all patient interactions.
- C. Disinfect patient areas only at the end of the day.
- D. Clean hands thoroughly before and after patient contact.
Correct answer: D
Rationale: The correct answer is D: Clean hands thoroughly before and after patient contact. Hand hygiene is crucial for maintaining medical asepsis in a healthcare setting as it helps prevent the spread of infections between patients and healthcare workers. Choice A is incorrect because instruments should be sterilized regularly, not just when visibly contaminated. Choice B is incorrect as sterile gloves are not required for all patient interactions, only for specific procedures. Choice C is incorrect because patient areas should be disinfected regularly throughout the day, not just at the end of the day.
2. Which of the following is a primary focus of tertiary prevention in mental health?
- A. Identifying early signs of mental illness
- B. Preventing the occurrence of mental health problems
- C. Rehabilitation and prevention of further deterioration
- D. Providing a safe environment to prevent harm
Correct answer: C
Rationale: The correct answer is C: Rehabilitation and prevention of further deterioration. Tertiary prevention in mental health aims to provide interventions and support to individuals who already have a mental illness to prevent further deterioration and promote recovery. Choice A, identifying early signs of mental illness, is more aligned with primary prevention which focuses on preventing the onset of mental health problems. Choice B, preventing the occurrence of mental health problems, pertains to secondary prevention which involves early detection and intervention to prevent the progression of mental health issues. Choice D, providing a safe environment to prevent harm, is important but it is not the primary focus of tertiary prevention which is more centered on rehabilitation and improving the quality of life for individuals with existing mental health conditions.
3. Which intervention is most effective in preventing deep vein thrombosis (DVT) in a postoperative patient?
- A. Encourage the patient to drink plenty of fluids.
- B. Encourage early ambulation and leg exercises.
- C. Administer anticoagulants as prescribed.
- D. Apply compression stockings to the patient's legs.
Correct answer: B
Rationale: The most effective intervention in preventing deep vein thrombosis (DVT) in a postoperative patient is to encourage early ambulation and leg exercises. Early ambulation helps promote circulation, preventing stasis and reducing the risk of blood clot formation. Encouraging the patient to drink plenty of fluids (choice A) is important for overall health but is not the most effective intervention for preventing DVT. Administering anticoagulants (choice C) is a valuable intervention in some cases, but it may not be suitable for all postoperative patients. Applying compression stockings (choice D) can help prevent DVT but is generally not as effective as early ambulation and leg exercises in postoperative patients.
4. A nurse at a provider's office is providing teaching to a client who is taking chemotherapy and losing weight. Which of the following should the nurse recommend to increase calorie and protein intake? (SATA)
- A. Top fruits with yogurt
- B. Add cream to soups
- C. Increase fluids during meals
- D. Use milk instead of water in recipes
Correct answer: A
Rationale: Topping fruits with yogurt is the correct recommendation to increase calorie and protein intake for a client on chemotherapy who is losing weight. Yogurt is a good source of protein and adding it to fruits can provide additional calories as well. Choice B, adding cream to soups, may increase calorie intake but does not specifically address protein needs. Choice C, increasing fluids during meals, is important for hydration but does not directly address calorie and protein intake. Choice D, using milk instead of water in recipes, may increase calorie content but does not focus on increasing protein intake, which is essential for clients on chemotherapy.
5. A client just had a flexible bronchoscopy. Which of the following nursing actions is appropriate?
- A. Irrigate the client's throat every 4 hours
- B. Withhold food and liquids until the client's gag reflex returns
- C. Suction the client's oropharynx frequently
- D. Have the client refrain from talking for 24 hours
Correct answer: B
Rationale: After a flexible bronchoscopy, it is essential to withhold food and liquids until the client's gag reflex returns. This precaution helps prevent aspiration, as the gag reflex protects the airway from foreign material. Irrigating the client's throat every 4 hours (Choice A) is unnecessary and may increase the risk of aspiration. Suctioning the client's oropharynx frequently (Choice C) can cause trauma and is not indicated unless there is a specific medical reason for it. Having the client refrain from talking for 24 hours (Choice D) is not necessary after a flexible bronchoscopy.
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