a nurse is reviewing the notes from a previous shift and finds incomplete documentation what is the most appropriate action
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Nursing Elites

ATI RN

RN ATI Capstone Proctored Comprehensive Assessment 2019 A with NGN

1. While reviewing notes from a previous shift, a nurse finds incomplete documentation. What is the most appropriate action?

Correct answer: B

Rationale: The most appropriate action when finding incomplete documentation is to notify the nurse manager of the issue. This ensures that accurate records are maintained and the situation can be addressed properly. Completing the missing documentation on behalf of someone else may lead to inaccuracies, asking the nurse to complete it may not guarantee timely correction, and confronting the nurse could create a confrontational situation that is not conducive to effective teamwork.

2. Which nursing action will most likely increase a patient's risk for developing a health care-associated infection?

Correct answer: C

Rationale: The correct answer is C. Using a clean technique for inserting a urinary catheter increases the risk for healthcare-associated infections. Invasive procedures like catheter insertion require a sterile technique to prevent introducing pathogens into the urinary tract. Choices A and B demonstrate appropriate infection control measures by emphasizing the use of sterile or aseptic techniques. Choice D represents an incorrect technique that can lead to the introduction of bacteria from the rectum into the urinary tract, potentially causing infections.

3. A nurse is using the ecologic model for population health to develop interventions to address HIV in a community. Which of the following interventions should the nurse include to address financial factors affecting community health?

Correct answer: B

Rationale: The correct answer is B. Distributing condoms addresses financial barriers by providing access to essential protective measures in remote areas. Choice A focuses on education rather than direct intervention related to financial factors. Choice C involves advertising and not a direct intervention to address financial factors. Choice D pertains to education about HIV transmission rather than directly addressing financial barriers affecting community health.

4. What is a primary goal when managing a client with generalized anxiety disorder (GAD)?

Correct answer: D

Rationale: When managing a client with generalized anxiety disorder (GAD), a primary goal is to teach relaxation techniques to help manage anxiety. Relaxation techniques such as deep breathing, progressive muscle relaxation, and mindfulness can be effective in reducing anxiety symptoms. Encouraging the client to engage in regular physical exercise (Choice A) can be beneficial but teaching relaxation techniques is more specific to managing anxiety. Avoiding anxiety triggers through behavioral therapy (Choice B) may be part of the treatment plan but teaching relaxation techniques is more directly aimed at managing anxiety. While encouraging the client to express feelings openly (Choice C) can be important for overall emotional well-being, teaching relaxation techniques is more focused on addressing the symptoms of anxiety.

5. A client with a do-not-resuscitate (DNR) order has requested resuscitation during a family visit. How should the nurse respond?

Correct answer: B

Rationale: The correct answer is B. Nurses have a legal and ethical obligation to honor a client's do-not-resuscitate (DNR) order, regardless of any request for resuscitation during a family visit. It is crucial for the nurse to explain to the client that the DNR order must be respected. Choice A is incorrect because starting resuscitation against the client's documented wishes goes against the principle of autonomy. Choice C is inappropriate as it disregards the client's autonomy and legal directives. Choice D is not the best option as the nurse should prioritize honoring the client's decision as per the DNR order.

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