a client with hearing loss has been fitted for a hearing aid which of the following teaching points are important for the nurse to discuss with the cl
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Nursing Elites

ATI LPN

PN ATI Capstone Proctored Comprehensive Assessment 2020 B

1. What teaching points are important for the nurse to discuss with a client with hearing loss who has been fitted for a hearing aid?

Correct answer: B

Rationale: The correct teaching point for a client with hearing loss who has been fitted for a hearing aid is to use mild soap and water to clean the ear mold. It is important to keep the ear mold clean to prevent infections and maintain proper functioning. Choice A is incorrect because using the highest setting can lead to discomfort and may not be necessary for all situations. Choice C is incorrect as the hearing aid should generally be turned off when not in use, not just during sleep, to conserve battery life. Choice D is incorrect as immersing the hearing aid in saline solution can damage the device; it should be kept dry to prevent malfunction.

2. A nurse is preparing to administer total parenteral nutrition (TPN) to a client. Which of the following findings indicates a need to obtain a new bag of TPN before administering?

Correct answer: A

Rationale: A TPN solution with an oily appearance and a layer of fat on top indicates that the solution is 'cracked' and should not be used as it may have separated or deteriorated. This finding suggests a need to obtain a new bag of TPN before administering. Options B, C, and D are normal aspects of TPN administration. Option B confirms the presence of essential components in the TPN solution, option C provides information about the preparation time, and option D ensures proper identification and matching of the TPN with the correct client.

3. During a change-of-shift assessment, a nurse is evaluating four clients. Which finding should the nurse report to the provider first?

Correct answer: B

Rationale: Lethargy and confusion in a client with gastroenteritis are concerning findings that may indicate severe dehydration or electrolyte imbalance, requiring immediate intervention. While the other options are important, they do not pose an immediate life-threatening risk compared to the altered mental status in a client with gastroenteritis.

4. A nurse is assessing a client who has pericarditis. Which of the following findings is the priority?

Correct answer: A

Rationale: The correct answer is A: Paradoxical pulse. Paradoxical pulse, which is a significant drop in systolic blood pressure during inspiration, indicates cardiac tamponade, a life-threatening complication of pericarditis. This finding requires immediate attention as it suggests potential compromised cardiac function. Choices B, C, and D are associated with pericarditis but do not indicate the same level of urgency as paradoxical pulse.

5. A healthcare professional is preparing to transfer a client from a chair to a bed. The client can bear partial weight and has upper body strength. Which device should the healthcare professional use?

Correct answer: B

Rationale: A stand-assist lift is the appropriate device for transferring a client who can bear partial weight and has upper body strength. This device provides support for the client to stand up and be transferred safely. A hydraulic lift is more suitable for transferring clients who cannot bear weight. A wheelchair is used for mobility but not for transferring between a chair and a bed. A mechanical lift is typically used for transferring clients who are unable to bear weight or have limited mobility.

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