the nurse discovers a patient on the floor the patient states i fell out of bed after assessing the patient the nurse places the patient back in bed w
Logo

Nursing Elites

ATI RN

ATI Capstone Comprehensive Assessment B

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

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.

2. How should the nurse manage the client's pain if a client with a history of substance abuse is requesting pain medication?

Correct answer: B

Rationale: When a client with a history of substance abuse requests pain medication, the nurse should first assess the patient's pain level. It is important to determine the nature and intensity of the pain before administering any medication to ensure appropriate pain management. Administering medication without assessing the pain level can lead to unnecessary drug administration or inadequate pain relief. Administering a placebo would be unethical and ineffective. Refusing to give any medication without proper assessment can compromise the client's comfort and recovery. Therefore, the correct approach is to assess the patient's pain level first before deciding on the most suitable pain management intervention.

3. A client reports difficulty sleeping while in the hospital. Which of the following actions taken by the assistive personnel (AP) while the client is sleeping should prompt the nurse to intervene?

Correct answer: B

Rationale: The correct answer is B because flushing the client's toilet after emptying the urinary catheter's drainage bag could disturb the client's rest. The nurse should intervene to ensure a restful environment for the client. Choices A, C, and D are not actions that would be disruptive to the client's sleep. Closing the door to the client's room, measuring vital signs routinely, and asking personnel in the hall to speak quietly are appropriate actions that do not directly disturb the client's rest.

4. Which nursing action is essential when administering a blood transfusion?

Correct answer: C

Rationale: The correct answer is to administer the transfusion at a slow rate for the first 15 minutes. This practice is crucial as it helps in detecting any adverse reactions early on. Checking the patient's vital signs every 30 minutes (choice B) is important but not as essential as ensuring a slow rate at the beginning. Administering blood within 4 hours (choice A) is a standard practice but not directly related to the initial administration. Documenting the transfusion immediately (choice D) is necessary but does not directly impact the safety of the initial administration.

5. A client who had a stroke is complaining of left-side weakness. What should the nurse prioritize?

Correct answer: B

Rationale: The correct answer is to contact the physical therapy team. When a client who had a stroke presents with left-side weakness, the nurse should prioritize coordinating with the physical therapy team rather than immediately initiating physical therapy. The initial step should involve assessing the client's condition and involving the appropriate healthcare team for a comprehensive care plan. Administering pain medication or starting treatment without consulting others can delay or hinder the appropriate care needed for the client's recovery.

Similar Questions

When a patient refuses to remove their religious jewelry before surgery, what is the best response for the nurse preparing for the procedure?
How can dehydration be assessed in an elderly patient?
When administering a subcutaneous injection of insulin to a client, what angle should the nurse use for the injection?
A client expresses concern about hair loss during chemotherapy. What should the nurse suggest?
A healthcare professional is assessing a patient with pneumonia. Which finding is most concerning?

Access More Features

ATI RN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

ATI RN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

Other Courses