a nurse is talking with a client who is about to start using transcutaneous electrical nerve stimulation tens to manage chronic pain which of the foll

ATI RN

RN ATI Capstone Proctored Comprehensive Assessment Form B

1. A nurse is talking with a client who is about to start using transcutaneous electrical nerve stimulation (TENS) to manage chronic pain. Which of the following statements should the nurse identify as an indication that the client needs further teaching?

A. I wish I didn't have to attach the electrodes to my skin
B. I will need to shave the hair off the skin where I place the electrodes
C. I hope I don't have to take as many pain pills
D. It's unfortunate that I have to be in the hospital for this treatment

Correct answer: D

Rationale: TENS is a portable treatment that can be done at home, so the client should not expect to remain in the hospital for this treatment.

2. A case manager at an assisted living facility is reviewing the use of complementary health practices by several clients. Which of the following actions should the case manager plan to take?

A. Plan to report a client's use of echinacea to the provider as a contraindication to aspirin therapy
B. Plan to schedule time for a new client to continue tai chi practice as a stress reduction technique
C. Tell a client that yoga has not been proven effective to reduce manifestations of menopause
D. Tell a client who drinks cranberry juice daily that it can help treat existing urinary tract infections

Correct answer: B

Rationale: The correct answer is B. Tai chi is a recognized complementary health practice for stress reduction. Scheduling time for a new client to continue tai chi practice aligns with supporting holistic care. Choice A is incorrect because reporting a client's use of echinacea as a contraindication to aspirin therapy is not necessary without further context or evidence of interactions. Choice C is wrong because yoga can indeed be effective in reducing manifestations of menopause. Choice D is also incorrect because while cranberry juice is known to help prevent urinary tract infections, it is not typically used to treat existing infections.

3. A client has urinary incontinence, and the nurse is caring for them. Which of the following actions should the nurse implement to prevent the development of skin breakdown?

A. Request a prescription for the insertion of an indwelling urinary catheter
B. Check the client's skin every 8 hours for signs of breakdown
C. Apply a moisture barrier ointment to the client's skin
D. Clean the client's skin and perineum with hot water after each episode of incontinence

Correct answer: C

Rationale: The correct action to prevent skin breakdown in a client with urinary incontinence is to apply a moisture barrier ointment to the skin. This ointment helps protect the skin from the harmful effects of moisture exposure, reducing the risk of breakdown. Requesting an indwelling urinary catheter (Choice A) should not be the first-line intervention for skin breakdown prevention. Checking the client's skin for signs of breakdown (Choice B) is important but not as effective as applying a moisture barrier. Cleaning the skin with hot water (Choice D) can actually be detrimental as hot water can strip the skin of its natural oils and worsen skin integrity.

4. After placing the patient back in bed, what should the nurse do next?

A. Re-assess the patient.
B. Complete an incident report.
C. Notify the health care provider.
D. Do nothing, no harm has occurred.

Correct answer: C

Rationale: After placing the patient back in bed, the nurse should notify the health care provider. This is important because the health care provider needs to be informed of the incident and assess the patient further to ensure no underlying injuries or issues exist. Re-assessing the patient is crucial but notifying the health care provider takes precedence in this situation. Completing an incident report is important for documentation purposes but not the immediate next step. Doing nothing is incorrect as there was an incident involving a fall that needs further evaluation.

5. Which action by the nurse demonstrates effective infection control measures?

A. Perform hand hygiene before and after patient contact.
B. Wear gloves when administering medications.
C. Dispose of used equipment in designated containers.
D. Wear a mask when interacting with the patient.

Correct answer: A

Rationale: The correct answer is A: Perform hand hygiene before and after patient contact. Effective hand hygiene is a fundamental infection control measure that helps prevent the spread of pathogens. Wearing gloves when administering medications (choice B) is important for protecting both the patient and the nurse but is not a direct demonstration of infection control. Disposing of used equipment in designated containers (choice C) is more related to proper waste management than infection control. Wearing a mask when interacting with the patient (choice D) is essential in certain situations, but hand hygiene is a more universal and critical practice for infection control.