a nurse is discussing organ donation with a newly licensed nurse which of the following statements should the nurse include in the teaching
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Nursing Elites

ATI RN

RN ATI Capstone Proctored Comprehensive Assessment Form B

1. A nurse is discussing organ donation with a newly licensed nurse. Which of the following statements should the nurse include in the teaching?

Correct answer: C

Rationale: The correct answer is C. Asking clients over 18 about their organ donation status upon admission is essential to ensure their wishes are respected. Option A is incorrect because organ donation requires consent, not harvesting. Option B is incorrect because the transplant team, not the donor client's provider, is responsible for organ retrieval. Option D is incorrect because the National Organ Transplant Act prohibits the commercialization of organ transactions, not their donation.

2. A nurse is assessing the skin of an immobilized patient. What will the nurse do?

Correct answer: A

Rationale: The correct answer is A. When assessing the skin of an immobilized patient, it is essential to use a standardized tool such as the Braden Scale to identify patients at high risk for impaired skin integrity. This tool helps in early identification and appropriate intervention. Choice B, limiting fluid intake, is not directly related to skin assessment. Choice C, having special times for inspection, may not ensure timely identification of skin issues. Choice D, assessing the skin every 4 hours, lacks specificity regarding the use of a validated tool for risk assessment.

3. A nurse sees another nurse administering medication without using alcohol swabs. What is the first action the nurse should take?

Correct answer: B

Rationale: The correct action for the nurse to take when witnessing unsafe medication administration practices, such as not using alcohol swabs, is to report the behavior to the nurse manager immediately. Patient safety is the top priority, and any actions that compromise it must be addressed promptly. Ignoring the situation (Choice A) is not appropriate as it puts patients at risk. Asking the colleague to be more careful (Choice C) may not be effective in ensuring immediate correction of the unsafe practice. Reporting the issue after speaking to other colleagues (Choice D) delays necessary action and may compromise patient safety further.

4. A nurse is caring for a client who has diarrhea due to shigella. Which of the following precautions should the nurse take?

Correct answer: C

Rationale: The correct precaution for a nurse caring for a client with shigella-induced diarrhea is to wash hands before and after client care. Shigella is a highly contagious bacterium that spreads through contaminated food, water, or contact with infected individuals. While wearing gloves is important when directly handling bodily fluids, hand hygiene is crucial in preventing the transmission of the infection. Wearing a mask or using an N95 respirator is not necessary for preventing the spread of shigella, as it primarily spreads through the fecal-oral route rather than through respiratory droplets.

5. When a nurse is assigned to float to another unit and feels unprepared, what is the most appropriate course of action?

Correct answer: B

Rationale: When a nurse is assigned to float to another unit and feels unprepared, the most appropriate course of action is to request help and clarification from the charge nurse. This allows the nurse to address any concerns, seek guidance, and ensure safe patient care. Refusing the assignment (Choice A) is not a constructive approach as it may leave the unit short-staffed and compromise patient safety. Completing the assignment and documenting concerns later (Choice C) is not recommended as it delays addressing the issues at hand. Filing a formal complaint with hospital administration (Choice D) should be considered only after attempting to resolve the issue at the unit level first.

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