ATI Capstone- Fundamentals
Pre-Assessment
A menopausal client is having difficulty getting to sleep and asks what actions she should
incorporate in her daily routine to promote sleep. The nurse would encourage which of the
below measures to promote sleep?
A. Consume a warm drink at bedtime.
B. Take an evening walk before bedtime.
C. Take an afternoon nap.
D. Limit alcohol and nicotine prior to bedtime. - ANS-D. Limit alcohol and nicotine prior to
bedtime.
Rationale: Limit alcohol, caffeine (stimulant), and nicotine (stimulant) at least 4 hr before
bedtime. Exercise regularly; limit exercise at least 2 hr before bedtime. Limit fluids 2 to 4 hr
before bedtime.
\A nurse is assisting a client with his meal that is at risk for aspiration due to a stroke. What
interventions should the nurse take to prevent aspiration? Select all that apply.
A. Position the client in Fowler's position.
B. Instruct the client to tuck his chin when swallowing.
C. Provide oral hygiene before meals.
D. Position the client in Trendelenburg position.
E. Support the client's upper back, neck and head during feedings. - ANS-A, B, and E.
Rationale: To decrease the risk of aspiration for a stroke client, ensure the clients position is
upright, that the upper back and head are supported during meals. Remind the client to tuck
their chin while swallowing, to guide the food's path. Avoid lowering the head of bed during
feedings. Oral care can improve the client's well-being and increase the interest for eating, but
does not help prevent the potential for aspiration.
\A nurse is caring for a client who has been prescribed furosemide. Which of the following foods
should the nurse encourage to include in his diet?
A. Table salt
B. Egg yolks
C. White wine
D. Oranges - ANS-D. Oranges
Rationale: Client prescribed potassium-wasting diuretics should be encouraged to eat foods
high in potassium. Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, and
bananas are all good sources of potassium. Table salt is not a good source of potassium.
\A nurse is caring for a client with encephalopathy secondary to liver failure. The client has been
prescribed a high calorie, low protein diet. Which of the following meal selections is appropriate
for this client?
A. Scrambled eggs, bacon and pancakes.
B. Grilled cheese sandwich, potato chips, chocolate pudding.
C. Steak, french fried, corn.
Pre-Assessment
A menopausal client is having difficulty getting to sleep and asks what actions she should
incorporate in her daily routine to promote sleep. The nurse would encourage which of the
below measures to promote sleep?
A. Consume a warm drink at bedtime.
B. Take an evening walk before bedtime.
C. Take an afternoon nap.
D. Limit alcohol and nicotine prior to bedtime. - ANS-D. Limit alcohol and nicotine prior to
bedtime.
Rationale: Limit alcohol, caffeine (stimulant), and nicotine (stimulant) at least 4 hr before
bedtime. Exercise regularly; limit exercise at least 2 hr before bedtime. Limit fluids 2 to 4 hr
before bedtime.
\A nurse is assisting a client with his meal that is at risk for aspiration due to a stroke. What
interventions should the nurse take to prevent aspiration? Select all that apply.
A. Position the client in Fowler's position.
B. Instruct the client to tuck his chin when swallowing.
C. Provide oral hygiene before meals.
D. Position the client in Trendelenburg position.
E. Support the client's upper back, neck and head during feedings. - ANS-A, B, and E.
Rationale: To decrease the risk of aspiration for a stroke client, ensure the clients position is
upright, that the upper back and head are supported during meals. Remind the client to tuck
their chin while swallowing, to guide the food's path. Avoid lowering the head of bed during
feedings. Oral care can improve the client's well-being and increase the interest for eating, but
does not help prevent the potential for aspiration.
\A nurse is caring for a client who has been prescribed furosemide. Which of the following foods
should the nurse encourage to include in his diet?
A. Table salt
B. Egg yolks
C. White wine
D. Oranges - ANS-D. Oranges
Rationale: Client prescribed potassium-wasting diuretics should be encouraged to eat foods
high in potassium. Oranges, dried fruits, tomatoes, avocados, dried peas, meats, broccoli, and
bananas are all good sources of potassium. Table salt is not a good source of potassium.
\A nurse is caring for a client with encephalopathy secondary to liver failure. The client has been
prescribed a high calorie, low protein diet. Which of the following meal selections is appropriate
for this client?
A. Scrambled eggs, bacon and pancakes.
B. Grilled cheese sandwich, potato chips, chocolate pudding.
C. Steak, french fried, corn.
