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. A patient reflects a correct understanding about the relationship between the gate control theory of pain and the use of meditation to relieve pain?

Correct answer: C

Rationale: The correct answer is C. According to the gate control theory, meditation helps relieve pain by blocking pain impulses from coming through the gate in the central nervous system. Choice A is incorrect as meditation does not directly alter the chemical composition of pain neuroregulators. Choice B is incorrect because meditation does not stop the occurrence of pain stimuli. Choice D is incorrect as meditation does not open the gate but rather closes it to block pain impulses.

3. How is the effectiveness of a diuretic in a patient with heart failure evaluated?

Correct answer: A

Rationale: The correct way to evaluate the effectiveness of a diuretic in a patient with heart failure is by checking daily weights and lung sounds for improvement. Daily weights help to assess fluid retention changes, while improvement in lung sounds indicates reduced pulmonary congestion. Assessing blood pressure and urine output (Choice B) is important but does not directly evaluate the effectiveness of the diuretic. Monitoring for weight loss and reduction in edema (Choice C) are valid indicators of diuretic effectiveness, but direct observation of daily weights and lung sounds is more specific. Measuring heart rate and lung sounds (Choice D) is relevant but does not directly assess the impact of the diuretic on fluid balance and pulmonary status.

4. A nurse is preparing to administer medication to a client by nasogastric tube. What should the nurse do first?

Correct answer: B

Rationale: The correct answer is B: Check the tube placement before administering any medication. Before administering medication through a nasogastric tube, the nurse must first verify the tube's correct placement to ensure the medication reaches the stomach and to prevent complications such as aspiration. Options A, C, and D are incorrect because administering medication without confirming proper tube placement can lead to serious consequences for the client.

5. A school nurse is providing care for students in an elementary education facility. Which of the following interventions by the nurse addresses the primary level of prevention?

Correct answer: B

Rationale: The correct answer is B because teaching students about healthy food choices is a primary prevention strategy that aims to prevent future health issues by promoting healthy behaviors. Choice A, designing interventions for an individual education plan (IEP), is more related to addressing specific educational needs rather than preventing health issues. Choice C, performing first aid for minor injuries, is a form of secondary prevention aimed at reducing the impact of existing health problems. Choice D, performing scoliosis screenings for students, falls under secondary prevention by detecting health issues early rather than preventing them.

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