PN ATI Capstone Proctored Comprehensive Assessment 2020 B with NGN

Correct Answer: A

Rationale: The nurse should assess the client with a fractured femur and sharp chest pain first. Sharp chest pain in this client may indicate a pulmonary embolism, a life-threatening condition requiring immediate attention. The other options describe important patient conditions but do not pose an immediate threat to life like a potential pulmonary embolism does.

Correct Answer: C

Rationale: The correct answer is C: Administer insulin glargine once daily at bedtime. Insulin glargine is a long-acting insulin that provides a basal level of insulin throughout the day. It should be given at the same time each day, usually at bedtime, to maintain a consistent blood sugar level. Choices A, B, and D are incorrect. Injecting insulin glargine before a meal (Choice A) is not necessary as it is a long-acting insulin. Shaking the insulin vial (Choice B) is not recommended as it may cause bubbles to form, affecting the accuracy of the dose. Taking insulin glargine with short-acting insulin (Choice D) is not a typical practice as insulin glargine is used for basal insulin coverage.

Correct Answer: A

Rationale: When administering hydrocodone, a healthcare professional should assess the respiratory rate first because hydrocodone is an opioid that can lead to respiratory depression. Monitoring the respiratory rate helps to detect any signs of respiratory distress or depression early on. Assessing blood pressure, pain level, or heart rate is also important but not the priority when administering hydrocodone, as the risk of respiratory depression is a more critical concern.

Correct Answer: C

Rationale: The correct answer is C: Acquired immunity. Acquired immunity occurs when an individual is given a vaccine or immunization to develop antibodies. This type of immunity is specific and develops after exposure to an antigen. Innate immunity (choice A) is the body's natural defense system present at birth. Passive immunity (choice B) is temporary immunity passed from one individual to another. Natural immunity (choice D) refers to immunity that is not gained through medical intervention or deliberate exposure.

Correct Answer: D

Rationale: Monitoring blood pressure, weight, and heart rhythm is crucial in clients with a history of heart disease as these parameters can indicate changes in the cardiovascular status. Changes in blood pressure can signify heart strain, weight fluctuations can be related to fluid retention or heart failure, and irregular heart rhythm can indicate arrhythmias or other cardiac issues. Monitoring all these parameters comprehensively allows for early detection of potential complications and timely intervention. Therefore, selecting 'All of the above' is the correct choice as it encompasses all the essential parameters for monitoring in clients with heart disease. Choices A, B, and C are incorrect as monitoring only one or two of these parameters may lead to missing important changes in the client's condition.