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RN ATI capstone fundamentals exam

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Total Questions : 58

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Question 1:

The emergency department triage nurse receives notification there has been a mass shooting incident at a local shopping mall with several casualties injured. The hospital’s emergency response plan is initiated. Which client should the nurse prioritize for care?

A. Client with a sucking chest wound, conscious, blood pressure 88/58 mm Hg, heart rate 115/min, and red tag observed. B. Client with a significant penetrating head wound, unconscious with irregular breathing pattern, and black tag observed. C. Client with superficial lacerations to the left arm and left lower leg. D. Client with closed left lower leg injury, air cast in place, pain reported as 9 on a 0 to 10 numeric pain scale.

Answer and Explanation

Choice A:

A sucking chest wound compromises breathing, causes tension pneumothorax, and decreases cardiac output. Hypotension (88/58 mm Hg) and tachycardia (115/min) indicate shock, warranting immediate intervention. Red tag signifies life-threatening but potentially survivable injuries.

Choice B:

Penetrating head wounds with irregular breathing suggest brainstem injury, poor prognosis, and impending death. Black tag indicates un-survivable injuries, prioritizing resource allocation to others with a better survival potential.

Choice C:

Superficial lacerations involve minor soft tissue damage that does not compromise vital functions. These injuries are non-life-threatening and can wait for delayed medical care without significant risk to life or function.

Choice D:

Closed lower leg injuries cause localized pain but do not compromise airway, breathing, or circulation. Pain severity does not indicate life-threatening harm, allowing delayed care. Yellow tag signifies urgent but not immediate need for treatment.

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Question 2:

The nurse should identify that Client 1 requires priority care due to which of the following reasons?

A. The client has severe but survivable injuries. B. The client has minor injuries requiring immediate care. C. The client has non-life-threatening injuries but requires follow-up care. D. The client has injuries that do not require urgent attention.

Answer and Explanation

Choice A:

Severe but survivable injuries demand immediate care to stabilize critical functions like airway, breathing, and circulation. Prioritizing care ensures better survival outcomes, especially with red tag cases requiring prompt medical intervention.

Choice B:

Minor injuries do not threaten life or major functions, so they do not require immediate care. Patients with minor issues are generally green-tagged and can wait without significant adverse outcomes.

Choice C:

Non-life-threatening injuries needing follow-up care may have minimal short-term risks, making them less urgent. Such cases often align with yellow tag classifications for priority but non-immediate attention.

Choice D:

Injuries without urgent attention lack immediate risk to life or function. These cases can afford to wait without compromising patient outcomes, especially under mass casualty triage protocols.

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Question 3:

Which client should receive immediate intervention based on the following details?

A. Client with a sucking chest wound, conscious, blood pressure 88/58 mm Hg, heart rate 115/min, and red tag observed. B. Client with a significant penetrating head wound, unconscious with irregular breathing pattern, and black tag observed. C. Client with superficial lacerations to the left arm and left lower leg, occlusive dressing in place, tearful, blood pressure 118/78 mm Hg, and green tag observed. D. Client with closed left lower leg injury, air cast in place, pain reported as 9 on a 0 to 10 numeric pain scale, and yellow tag observed.

Answer and Explanation

Choice A:

Sucking chest wounds impair oxygenation, posing a direct threat to life. Signs of shock (88/58 mm Hg, heart rate 115/min) demand immediate intervention. Red tag classification reflects life-threatening but treatable conditions needing priority care.

Choice B:

Significant penetrating head wounds with irregular breathing indicate brainstem damage, which usually leads to poor outcomes. Black tag assignment denotes expectant management due to un-survivable injuries.

Choice C:

Superficial lacerations with stable vitals (118/78 mm Hg) and occlusive dressing in place ensure no life-threatening issues. Green tag indicates minimal care urgency, requiring no immediate intervention.

Choice D:

Closed lower leg injuries causing severe pain do not compromise airway, breathing, or circulation. Yellow tag classification reflects delayed medical needs, prioritizing resources for more critical cases.

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Question 4:

Which prescription should the nurse clarify with the provider prior to administration?

A. Potassium Chloride 20 mEq PO daily. B. HCTZ 25 mg PO daily. C. Amlodipine 10 mg PO daily. D. Clonidine 1 mg PO TID PRN for systolic blood pressure of 180.

Answer and Explanation

Choice A:

Potassium chloride 20 mEq daily is a common dose for hypokalemia prevention or treatment. Normal serum potassium is 3.5–5.0 mEq/L. This dose is unlikely to cause adverse effects without significant hyperkalemia.

Choice B:

Hydrochlorothiazide 25 mg daily effectively manages hypertension by reducing fluid retention. It can cause hypokalemia; thus, monitoring serum potassium is crucial. Normal serum potassium range is 3.5–5.0 mEq/L.

Choice C:

Amlodipine 10 mg daily is a standard antihypertensive dose. It is a calcium channel blocker that dilates blood vessels, lowering blood pressure without significant adverse effects in most patients.

Choice D:

Clonidine 1 mg TID PRN for systolic blood pressure above 180 is excessive. Normal doses are 0.1–0.3 mg. High doses risk severe hypotension, bradycardia, and withdrawal symptoms. This requires clarification.

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Question 5:

A nurse is caring for a client in the emergency department. Which action should the nurse take based on the client’s medication administration record at 1130?

A. Administer Albuterol nebulizer 2.5 mg stat. B. Administer Methylprednisolone 50 mg IV stat. C. Reassess the client’s vital signs before administering medications. D. Notify the provider if the client has worsening symptoms after administration.

Answer and Explanation

Choice A:

Administering Albuterol nebulizer 2.5 mg stat is appropriate for acute bronchospasm. Albuterol is a beta-agonist that relaxes airway smooth muscles, improving oxygenation. It is only administered when clinically indicated.

Choice B:

Methylprednisolone 50 mg IV is used for severe inflammation. It suppresses immune responses and reduces cytokine activity, but it does not directly address acute symptoms needing immediate intervention.

Choice C:

Reassessing vital signs ensures the patient’s stability before administering medications. This is vital in emergencies to evaluate therapy needs and prevent further clinical deterioration.

Choice D:

Notifying the provider about worsening symptoms after administration ensures timely interventions. However, preemptive measures, like reassessing stability, take priority before escalation.

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Question 6:

Based on the physical exam findings, which assessment indicates the client’s condition is worsening?

A. Cyanotic mucous membranes and oxygen saturation of 84% on 3 L nasal cannula. B. Diffuse wheezing auscultated throughout lung fields and hand tremor present. C. Blood pressure of 168/90 mm Hg and heart rate of 98/min. D. Clear rhinorrhea visible and skin warm and dry.

Answer and Explanation

Choice A:

Cyanotic mucous membranes and oxygen saturation of 84% indicate severe hypoxemia. Normal oxygen saturation is 95–100%. The cyanosis suggests inadequate tissue oxygenation, requiring immediate intervention to prevent respiratory failure.

Choice B:

Diffuse wheezing and tremors may signify severe airway obstruction or beta-agonist overuse. While concerning, these findings are not as immediately life-threatening as hypoxemia and cyanosis.

Choice C:

Elevated blood pressure (168/90 mm Hg) and heart rate (98/min) may indicate stress or pain but do not reflect acute life-threatening changes compared to severe hypoxemia.

Choice D:

Clear rhinorrhea and warm, dry skin may suggest mild upper respiratory infection. These findings do not indicate imminent danger or severe respiratory compromise compared to hypoxemia and cyanosis.

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Question 7:

A nurse is caring for a client on a medical-surgical unit. Which intervention should the nurse prioritize?

A. Monitoring blood pressure trends after administering antihypertensive medication. B. Administering prescribed Potassium Chloride 20 mEq PO STAT. C. Reassessing the client for additional medication needs at 1300. D. Educating the client about the importance of maintaining stable blood pressure levels.

Answer and Explanation

Choice A:

Monitoring blood pressure trends ensures early detection of medication effectiveness, yet is secondary to addressing critical hypokalemia. Normal blood pressure is 120/80 mmHg; deviations warrant monitoring, but this is not the priority intervention.

Choice B:

Administering potassium chloride STAT addresses potential hypokalemia, which risks arrhythmias and muscle weakness. Normal potassium levels range between 3.5-5.0 mEq/L, highlighting urgency when potassium is below normal.

Choice C:

Reassessing additional medication needs at a set time ensures comprehensive care but does not address immediate life-threatening conditions like hypokalemia, which requires urgent correction to prevent cardiac dysfunction.

Choice D:

Educating about blood pressure maintenance is crucial for long-term management but does not address the immediate physiological imbalance or risk of arrhythmias due to electrolyte disturbance, making it a lower priority.

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Question 8:

A nurse should wash hands with soap and warm water for at least 15 seconds and then dry hands with a clean paper towel.

A. Wash hands with cold water for at least 15 seconds and dry with a towel. B. Wash hands with soap and warm water for at least 10 seconds and air dry. C. Wash hands with soap and warm water for at least 15 seconds and then dry hands with a clean paper towel. D. Wash hands with only water and dry with a clean paper towel.

Answer and Explanation

Choice A:

Washing hands with cold water is less effective for removing pathogens compared to warm water. Warm water opens pores and enhances soap’s efficacy in breaking down oils and debris. Duration is also insufficient.

Choice B:

Washing for 10 seconds does not provide sufficient time for thorough microbial removal as evidence supports 15-20 seconds for optimal hand hygiene. Air drying increases the risk of recontamination and bacterial persistence.

Choice C:

Using soap and warm water for at least 15 seconds effectively removes microorganisms, reducing cross-infection. Drying with clean paper towels prevents bacterial growth and contamination compared to air drying or reused cloths.

Choice D:

Washing with water alone lacks the surfactant action of soap, which emulsifies oils and debris carrying bacteria. Drying with a clean towel prevents contamination but cannot compensate for soap absence.

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Question 9:

A nurse is providing teaching about measures to promote sleep with a client who has insomnia. Which of the following client statements indicates an understanding of the teaching?

A. “I can exercise as late as 1 hour before bedtime.”. B. “I should reduce my fluid intake 2 hours before bedtime.”. C. “I should take an hour nap each day.”. D. “I can eat a large meal as late as 1 hour before bedtime.”.

Answer and Explanation

Choice A:

Exercising close to bedtime increases adrenaline and body temperature, which interfere with sleep initiation. Studies recommend ceasing vigorous activity at least 3-4 hours before bedtime to optimize sleep quality.

Choice B:

Reducing fluid intake before bed minimizes nocturia, a common sleep disturbance. This aligns with promoting uninterrupted sleep and improving overall sleep hygiene and quality for individuals with insomnia.

Choice C:

Taking daytime naps, especially longer than 30 minutes, disrupts circadian rhythms and sleep drive, contributing to difficulty initiating and maintaining sleep during regular hours.

Choice D:

Eating a large meal before bedtime delays gastric emptying and may cause discomfort or reflux, both of which interfere with falling asleep. Light snacks are recommended if needed, but not heavy meals.

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Question 10:

A nurse is documenting client care. Which of the following entries should the nurse identify as an example of implementation of client care?

A. “Vomited 120 mL of clear yellow emesis.”. B. “Reports stomach pain as 3 on pain scale.”. C. “Denies further nausea or vomiting since antiemetic administration.”. D. “Contacted the provider to report client findings.”.

Answer and Explanation

Choice A:

Documenting emesis describes an observed occurrence but does not involve actively performing an intervention, thus representing assessment rather than implementation in client care.

Choice B:

Reporting pain as a numeric scale is part of assessment and data collection, not active implementation of nursing interventions aimed at client care.

Choice C:

Reporting the absence of nausea or vomiting indicates evaluation of an intervention's effectiveness, which occurs after implementation rather than during it.

Choice D:

Contacting the provider actively initiates communication and implementation of interventions, addressing client needs and collaborating with the healthcare team for enhanced care delivery.

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