RN ATI CAPSTONE PROCTORED COMPREHENSIVE ASSESSMENT
TESTBANK FORM A & B EXAMS- ALL QUESTIONS AND CORRECT
VERIFIED
. If a client develops cor pulmonale (right-sided heart failure), the nurse would
expect to observe
1. increasing respiratory difficulty seen with exertion.
2. cough productive of a large amount of thick, yellow mucus.
3. peripheral edema and anorexia.
4. twitching of extremities. - CORRECT ANSWER3
. The nursing team includes two RNs, one LPN/LVN, and one nursing assistant.
The nurse should consider the assignments appropriate if the nursing assistant
is assigned to care for
1. a client with Alzheimer's requiring assistance with feeding.
2. a client with osteoporosis complaining of burning on urination.
3. a client with scleroderma receiving a tube feeding.
4. a client with cancer who has Cheyne-Stokes respirations. CORRECT CORRECT ANSWERWER1
A 23-year-old man is admitted with a subdural hematoma and cerebral edema
after a motorcycle accident. Which of the following symptoms should the
nurse expect to see INITIALLY?
1. Unequal and dilated pupils.
2. Decerebrate posturing.
3. Grand mal seizures.
4. Decreased level of consciousness. - CORRECT ANSWER4
A 23-year-old woman at 32-weeks gestation is seen in the outpatient clinic.
Which of the following findings, if assessed by the nurse, would indicate a
possible complication?
1. The client's urine test is positive for glucose and acetone.
2. The client has 1+ pedal edema in both feet at the end of the day.
3. The client complains of an increase in vaginal discharge.
4. The client says she feels pressure against her diaphragm when the baby moves. - CORRECT
ANSWER1
A 38-year-old woman is returned to her room after a subtotal thyroidectomy
for treatment of hyperthyroidism. Which of the following, if found by the
nurse at the patient's bedside, is nonessential?
1. Potassium chloride for IV administration.
2. Calcium gluconate for IV administration.
3. Tracheostomy set-up.
4. Suction equipment. - CORRECT ANSWER1
,A 59-year-old woman with bipolar disorder is receiving haloperidol (Haldol)
2 mg PO tid. She tells the nurse, "Milk is coming out of my breasts." Which
of the following responses by the nurse is BEST?
1. "You are seeing things that aren't real."
2. "Why don't we go make some fudge."
3. "You are experiencing a side effect of Haldol."
4. "I'll contact your physician to change your medication." - CORRECT ANSWER3
A 69-year-old client is undergoing his second exchange of
intermittent
peritoneal dialysis (IPD). Which of the following would require
an
intervention by the
nurse?
1. The client complains of pain during the inflow of the
dialysate.
2. The client complains of
constipation.
3. The dialysate outflow is
cloudy.
4. There is blood-tinged fluid around the intra-abdominal catheter. -
CORRECT ANSWER3
A charge nurse is discussing the responsibility of nurses carig for clients who have C. difficile. Which of
the following information should the nurse include in the teaching?
a) Assign the client to a room with a negative air-flow system
b) Use alcohol-based hand sanitizer when leaving the clients room
c) clean contaminated surfaces in the clients room with a phenol solution
d) have family members wear a gown and gloves when visiting - CORRECT ANSWERD
A client diagnosed with dementia wanders the halls of the locked nursing unit during the day. To ensure
the client's safety while walking in the halls, the nurse should do which of the following?
1. Administer PRN haloperidol (Haldol) to decrease the need to walk.
2. Assess the client's gait for steadiness.
3. Restrain the client in a geriatric chair.
4. Administer PRN lorazepam (Ativan) to provide sedation. - CORRECT ANSWER2
A client has a history of oliguria, hypertension, and peripheral edema. Current
lab values are: BUN -25, K+ -4.0 mEq/L. Which nutrient should be restricted
in the client's diet?
1. Protein.
2. Fats.
3. Carbohydrates.
4. Magnesium. - CORRECT ANSWER1
,a client has a new prescription for spironilactone ( aldactone ) which of the following laboratory value
should the nurse recognized as a reason to withhold the morning dose of the medication and notify the
provider - CORRECT ANSWERserum potassium 5.2
a client has prescription for valproic ( Depakote) which of the following laboratory value should the nurse
anticipate monitor for the client taking this medication - CORRECT ANSWERthrombocytes,
amylase count and liver
function
test
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse
would expect to find rebound tenderness at which location? a) Left lower quadrant
b) Left upper quadrant
c) Right upper quadrant
d) Right lower quadrant - CORRECT ANSWERD
A client is being discharged with sublingual nitroglycerin (Nitrostat).
The client should be cautioned by the nurse to
1. take the medication five minutes after the pain has started.
2. stop taking the medication if a stinging sensation is absent.
3. take the medication on an empty stomach.
4. avoid abrupt changes in posture. - CORRECT ANSWER4
A client is given morphine 6 mg IV push for postoperative pain. Following
administration of this drug, the nurse observes the following: pulse 68,
respirations 8, BP 100/68, client sleeping quietly. Which of the following
nursing actions is MOST appropriate?
1. Allow the client to sleep undisturbed.
2. Administer oxygen via facemask or nasal prongs.
3. Administer naloxone (Narcan).
4. Place epinephrine 1:1,000 at the bedside. - CORRECT ANSWER3
A client is receiving total parenteral nutrition (TPN). To determine the client's
tolerance of this treatment, the nurse should assess for which of the
following?
1. A significant increase in pulse rate.
2. A decrease in diastolic blood pressure.
3. Temperature in excess of 98.6°F (37°C).
4. Urine output of at least 30 cc per hour. - CORRECT ANSWER4
A client is scheduled for a left lower lobectomy. The physician has ordered
diazepam (Valium) 2 mg IM for anxiety. The nurse would determine that the
medication is appropriate if the client displays which of the following
symptoms?
1. Agitation and decreased level of consciousness.
2. Lethargy and decreased respiratory rate.
3. Restlessness and increased heart rate.
, 4. Hostility and increased blood pressure. - CORRECT ANSWER3
A client returns to his room following a myelogram. The nursing care
plan should include which of the following?
1. Encourage oral fluid
intake.
2. Maintain the prone position for 12
hours.
3. Encourage the client to ambulate after the procedure.
4. Evaluate the client's distal pulses on the affected side. -
CORRECT ANSWER1
a client should receive a dose of flumazenil ( romazicon) to treat symptoms of - CORRECT
ANSWERbenzodiazepine
overdose
a client who has parkinson's disease is prescribed levodopa/carbidopa ( sinemet) and pramipexole
( Mirapex) for which of the following should the nurse monitor this client - CORRECT ANSWERorthostatic
hypotension
a client who is start taking lithium carbonate month ago tell the nurse she has just begun taking multiply
daily doses of ibuprofen ( motrin) for tension headache. should the client avoid ibuprofen. why or why
not ? - CORRECT ANSWERwhat , if any is the appropriate action for the nurse to take NSAIDS such as
ibuprofen increase the renal reabsorption of lithium carbonate , possibly leading to lithium carbonate
toxicity . therefor this client would avoid NSAIDS . the nurse should notify the provider of client headache
and ibuprofen us
A client with a peptic ulcer had a partial gastrectomy and vagotomy (Billroth
I). In planning the discharge teaching, the client should be cautioned by the
nurse about which of the following?
1. Sit up for at least 30 minutes after eating.
2. Avoid fluids between meals.
3. Increase the intake of high-carbohydrate foods.
4. Avoid eating large meals that are high in simple sugars and liquids. -
CORRECT ANSWER4
A client with newly diagnosed type I diabetes mellitus is being seen by the
home health nurse. The physician orders include: 1,200-calorie ADA diet,
15 units of NPH insulin before breakfast, and check blood sugar qid. When
the nurse visits the client at 5 PM, the nurse observes the man performing
a blood sugar analysis. The result is 50 mg/dL. The nurse would expect the
client to be
1. confused with cold, clammy skin and a pulse of 110.
2. lethargic with hot, dry skin and rapid, deep respirations.
3. alert and cooperative with a BP of 130/80 and respirations of 12.
4. short of breath, with distended neck veins and a bounding pulse of 96. - CORRECT ANSWER1
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