2023 RN ATI CAPSTONE COMPREHENSIVE A
A nurse in a pediatric unit is preparing to insert an IV catheter for 7-year-old. Which of the following
actions should the nurse take?
A. (Unable to read)
B. Tell the child they will feel discomfort during the catheter insertion.
C. Use a mummy restraint to hold the child during the catheter insertion.
D. Require the parents to leave the room during the procedure.
A nurse is caring for a client who has arteriovenous fistula Which of thefollowing findings should the
nurse report?
A. Thrill upon palpation.
B.Absence of a bruit.
C. Distended blood vessels
D. Swishing sound upon auscultation.
A nurse is providing discharge teaching for a client who has an implantable cardioverter
defibrillator which of the following statementsdemonstrates understanding of the teaching?
A. “I will soak in the tub rather and showering”
B. “I will wear loose clothing around my ICD”
C. “I will stop using my microwave oven at home because of my ICD”
D. “I can hold my cellphone on the same side of my body as the ICD”
A nurse is caring for a client who is at 14 weeks gestation and reportsfeelings of ambivalence about
being pregnant. Which of the following responses should the nurse make?
A. “Describe your feelings to me about being pregnant”
B. “You should discuss your feelings about being pregnant with yourprovider”
C. “Have you discussed these feelings with your partner?”
D. “When did you start having these feelings?”
A nurse is planning care for a client who has a prescription for a bowel- training program following a spinal
cord injury. Which of the following actionsshould the nurse include in the plan of care?
A. Encourage a maximum fluid intake of 1,500 ml per day.
B. Increase the amount of refined grains in the client’s diet.
C. Provide the client with a cold drink prior to defecation.
, D. Administer a rectal suppository 30 minutes prior to scheduleddefecation times.
A nurse is caring for a client who is in active labor and requests painmanagement. Which of the
following actions should the nurse take?
A. Administer ondansetron.
B. Place the client in a warm shower.
C.Apply fundal pressure during contractions.
D. Assist the client to a supine position.
a nurse in an emergency department is performing triage for multiple clients following a disaster in the
community. To which of the following typesof injuries should the nurse assign the highest priority?
A. Below-the knee amputation
B. Fractured tibia
C. 95% full-thickness body burn
D. 10cm (4in) laceration to the forearm
a nurse manager is updating protocols for the use of belt restraints. Whichof the following guidelines
should the nurse include?
A. Remove the client’s restraint every 4hr
B. Document the client’s condition every 15 min
C.Attach the restrain to the bed’s side rails
D. Request a PRN restrain prescription for clients who are aggressive
A nurse is teaching an in-service about nursing leadership. Which of thefollowing information should
the nurse include about an effective leader?
A. Acts as an advocate for the nursing unit.
B. (Unable to read) for the unit
C. Priorities staff request over client needs.
D. Provides routine client care and documentation.
A nurse is reviewing the laboratory findings of a client who has diabetesmellitus and reports that she
has been following her (unable to read) care. The nurse should identify which of the following findings
indicates a need torevise the client’s plan of care.
A. Serum sodium 144 mEq/
B. (Unable to read)
C. Hba1c 10 %
, D. Random serum glucose 190 mg/dl.
A nurse in a provider’s office is reviewing the laboratory results of a group of clients. The nurse
should identify that which of the following sexually transmitted infections is a nationally notifiable
infectious diseasethat should be reported to the state health department?
A. Chlamydia
B. Human papillomavirus
C. Candidiasis
D. Herps simplex virus
A nurse is teaching a newly licensed nurse about therapeutic techniquesto use when leading a group on
a mental health unit. Which of the following group facilitation techniques should the nurse include in the
teaching?
A. Share personal opinions to help influence the group’s values
B. Measure the accomplishments of the group against a previous group
C. Yield in situations of conflicts to maintain group harmony
D. Use modeling to help the clients improve their interpersonal skills
A nurs e is p la nning for a client who practices Orthodox Juda is m. The client tells the nurse that
(Unable to read) Passover holiday. Which of thefollowing action should the nurse include in the plan of
care?
A. Provide chicken with cream sauce.
B.Avoid serving fish with fins and scales.
C. Provide unleavened bread.
D. Avoid serving foods containing lamb.
A nurse is caring for a client who has a pulmonary embolism. The nurseshould identify the
effectiveness of the treatment
A. A chest x-ray reveals increased density in all fields.
B. The client reports feeling less anxious.
C. Diminished breath sounds are auscultated bilaterally
D.ABG results include Ph 7.48 PaO2 77 mm Hg and PaCO2 47 mm Hg.
A nurse in an emergency department is assessing a client who reportsingesting thirty diazepam
tablets (Unable to read) a respiratory rate of 10/min. After securing the client’s airway and initiating an IV,
which of thefollowing actions should the nurse do next.
A. Monitor the client’s IV site for thrombophlebitis.
, B.Administer flumazenil to the client.
C. Evaluate the client for further suicidal behavior.
D. Initiate seizure precautions for the client.
A nurse in an emergency department is caring for a client who reportscocaine use 1hr ago. Which of
the following findings should the nurse expect?
A. Hypotension
B. Memory loss
C. Slurred speech
D. Elevated temperature
A nurse is assessing a newborn who has a blood glucose level of 30mg/dl. Which of the
following manifestations should the nurse expect?
A. Loose stools
B. Jitterine ss
C. Hypertonia
D. Abdominal distention
A nurse in a pediatric clinic is reviewing the laboratory test results of a school age child. Which of the
following findings should the nurse report to the provider?
A. Hgb 12.5 g/dl
B. Platelets 250,000/mm3
C. Hct 40%
D. WBC 14,000/mm3
A charge nurse is teaching a newly licensed nurse about clients designating a health care proxy in
situations that require a durable power of attorney for heal care (DPSHC). Which of the following information
should thecharge nurse include?
A. “The proxy should make health care decisions for the client regardlessof the client’s ability to do so.”
B. “The proxy can make financial decisions if the need arises.”
C. “The proxy can make treatment decisions if the client is underanesthesia.”
D. “The proxy should manage legal issues for the client.”
A nurse in the PACU is caring for a client who reports nausea. Which of the following actions should
the nurse take first?
A nurse in a pediatric unit is preparing to insert an IV catheter for 7-year-old. Which of the following
actions should the nurse take?
A. (Unable to read)
B. Tell the child they will feel discomfort during the catheter insertion.
C. Use a mummy restraint to hold the child during the catheter insertion.
D. Require the parents to leave the room during the procedure.
A nurse is caring for a client who has arteriovenous fistula Which of thefollowing findings should the
nurse report?
A. Thrill upon palpation.
B.Absence of a bruit.
C. Distended blood vessels
D. Swishing sound upon auscultation.
A nurse is providing discharge teaching for a client who has an implantable cardioverter
defibrillator which of the following statementsdemonstrates understanding of the teaching?
A. “I will soak in the tub rather and showering”
B. “I will wear loose clothing around my ICD”
C. “I will stop using my microwave oven at home because of my ICD”
D. “I can hold my cellphone on the same side of my body as the ICD”
A nurse is caring for a client who is at 14 weeks gestation and reportsfeelings of ambivalence about
being pregnant. Which of the following responses should the nurse make?
A. “Describe your feelings to me about being pregnant”
B. “You should discuss your feelings about being pregnant with yourprovider”
C. “Have you discussed these feelings with your partner?”
D. “When did you start having these feelings?”
A nurse is planning care for a client who has a prescription for a bowel- training program following a spinal
cord injury. Which of the following actionsshould the nurse include in the plan of care?
A. Encourage a maximum fluid intake of 1,500 ml per day.
B. Increase the amount of refined grains in the client’s diet.
C. Provide the client with a cold drink prior to defecation.
, D. Administer a rectal suppository 30 minutes prior to scheduleddefecation times.
A nurse is caring for a client who is in active labor and requests painmanagement. Which of the
following actions should the nurse take?
A. Administer ondansetron.
B. Place the client in a warm shower.
C.Apply fundal pressure during contractions.
D. Assist the client to a supine position.
a nurse in an emergency department is performing triage for multiple clients following a disaster in the
community. To which of the following typesof injuries should the nurse assign the highest priority?
A. Below-the knee amputation
B. Fractured tibia
C. 95% full-thickness body burn
D. 10cm (4in) laceration to the forearm
a nurse manager is updating protocols for the use of belt restraints. Whichof the following guidelines
should the nurse include?
A. Remove the client’s restraint every 4hr
B. Document the client’s condition every 15 min
C.Attach the restrain to the bed’s side rails
D. Request a PRN restrain prescription for clients who are aggressive
A nurse is teaching an in-service about nursing leadership. Which of thefollowing information should
the nurse include about an effective leader?
A. Acts as an advocate for the nursing unit.
B. (Unable to read) for the unit
C. Priorities staff request over client needs.
D. Provides routine client care and documentation.
A nurse is reviewing the laboratory findings of a client who has diabetesmellitus and reports that she
has been following her (unable to read) care. The nurse should identify which of the following findings
indicates a need torevise the client’s plan of care.
A. Serum sodium 144 mEq/
B. (Unable to read)
C. Hba1c 10 %
, D. Random serum glucose 190 mg/dl.
A nurse in a provider’s office is reviewing the laboratory results of a group of clients. The nurse
should identify that which of the following sexually transmitted infections is a nationally notifiable
infectious diseasethat should be reported to the state health department?
A. Chlamydia
B. Human papillomavirus
C. Candidiasis
D. Herps simplex virus
A nurse is teaching a newly licensed nurse about therapeutic techniquesto use when leading a group on
a mental health unit. Which of the following group facilitation techniques should the nurse include in the
teaching?
A. Share personal opinions to help influence the group’s values
B. Measure the accomplishments of the group against a previous group
C. Yield in situations of conflicts to maintain group harmony
D. Use modeling to help the clients improve their interpersonal skills
A nurs e is p la nning for a client who practices Orthodox Juda is m. The client tells the nurse that
(Unable to read) Passover holiday. Which of thefollowing action should the nurse include in the plan of
care?
A. Provide chicken with cream sauce.
B.Avoid serving fish with fins and scales.
C. Provide unleavened bread.
D. Avoid serving foods containing lamb.
A nurse is caring for a client who has a pulmonary embolism. The nurseshould identify the
effectiveness of the treatment
A. A chest x-ray reveals increased density in all fields.
B. The client reports feeling less anxious.
C. Diminished breath sounds are auscultated bilaterally
D.ABG results include Ph 7.48 PaO2 77 mm Hg and PaCO2 47 mm Hg.
A nurse in an emergency department is assessing a client who reportsingesting thirty diazepam
tablets (Unable to read) a respiratory rate of 10/min. After securing the client’s airway and initiating an IV,
which of thefollowing actions should the nurse do next.
A. Monitor the client’s IV site for thrombophlebitis.
, B.Administer flumazenil to the client.
C. Evaluate the client for further suicidal behavior.
D. Initiate seizure precautions for the client.
A nurse in an emergency department is caring for a client who reportscocaine use 1hr ago. Which of
the following findings should the nurse expect?
A. Hypotension
B. Memory loss
C. Slurred speech
D. Elevated temperature
A nurse is assessing a newborn who has a blood glucose level of 30mg/dl. Which of the
following manifestations should the nurse expect?
A. Loose stools
B. Jitterine ss
C. Hypertonia
D. Abdominal distention
A nurse in a pediatric clinic is reviewing the laboratory test results of a school age child. Which of the
following findings should the nurse report to the provider?
A. Hgb 12.5 g/dl
B. Platelets 250,000/mm3
C. Hct 40%
D. WBC 14,000/mm3
A charge nurse is teaching a newly licensed nurse about clients designating a health care proxy in
situations that require a durable power of attorney for heal care (DPSHC). Which of the following information
should thecharge nurse include?
A. “The proxy should make health care decisions for the client regardlessof the client’s ability to do so.”
B. “The proxy can make financial decisions if the need arises.”
C. “The proxy can make treatment decisions if the client is underanesthesia.”
D. “The proxy should manage legal issues for the client.”
A nurse in the PACU is caring for a client who reports nausea. Which of the following actions should
the nurse take first?
