a nurse is teaching a client about how to use her new hearing aids which of the following statements should the nurse identify as an indication that t

ATI RN

RN ATI Capstone Proctored Comprehensive Assessment Form A

1. A nurse is teaching a client about how to use her new hearing aids. Which of the following statements should the nurse identify as an indication that the client needs further instruction?

A. I will not use hairspray if I am wearing the hearing aids
B. I will clean the hearing aids with alcohol wipes
C. I will change the batteries once a week
D. I will expect the hearing aids to whistle when I cup my hand over them

Correct answer: B

Rationale: The correct answer is B because cleaning the hearing aids with alcohol wipes can damage them. It is important to use specialized cleaning tools or follow specific cleaning instructions provided by the manufacturer to prevent harm to the hearing aids. Choices A, C, and D demonstrate good understanding and appropriate care for hearing aids, indicating that the client does not need further instruction in those areas.

2. Which action by a nurse demonstrates effective communication with a patient?

A. Providing the patient with written information about their care.
B. Maintaining eye contact and listening actively to the patient.
C. Using medical jargon to explain the patient's condition.
D. Speaking with the patient in a hurried manner to save time.

Correct answer: B

Rationale: Maintaining eye contact and actively listening to the patient is crucial in effective communication as it helps build rapport, shows empathy, and ensures that the patient feels heard and understood. Providing written information can be helpful, but the direct interaction is essential for effective communication. Using medical jargon may confuse the patient instead of clarifying their condition. Speaking hurriedly can make the patient feel rushed and not valued, hindering effective communication.

3. A nurse notices that a colleague has an odor of alcohol while on duty. What is the most appropriate action?

A. Speak to the colleague in private.
B. Report the behavior to the nurse manager immediately.
C. Confront the colleague directly on the floor.
D. Do nothing and document the situation.

Correct answer: B

Rationale: Reporting the behavior to the nurse manager immediately is the most appropriate action when a nurse suspects a colleague of being impaired while on duty. This is crucial to ensure patient safety and maintain a professional and safe work environment. Speaking to the colleague in private may not address the issue effectively and could potentially put patients at risk if the colleague is indeed impaired. Confronting the colleague directly on the floor may lead to a confrontation and is not the most professional way to handle the situation. Doing nothing and documenting the situation without taking immediate action can jeopardize patient safety and is not an appropriate response when substance use is suspected.

4. What is the most important nursing intervention for a patient with diarrhea?

A. Encourage the patient to increase fluid intake.
B. Monitor the patient's skin integrity.
C. Check the patient's electrolyte levels.
D. Educate the patient about infection control measures.

Correct answer: B

Rationale: The correct answer is to monitor the patient's skin integrity. This is crucial because diarrhea can lead to skin breakdown due to frequent bowel movements and increased moisture in the perineal area. By monitoring skin integrity, nurses can prevent skin breakdown, infection, and other associated issues. Encouraging fluid intake (Choice A) is important but not the most critical intervention. Checking electrolyte levels (Choice C) is essential but may not be the top priority at the onset. Educating the patient about infection control (Choice D) is important but secondary to preventing skin breakdown in a patient with diarrhea.

5. The nurse is caring for a patient who is at risk for infection. Which action by the nurse indicates correct understanding about standard precautions?

A. Teaches the patient about good nutrition.
B. Disposes of an uncapped needle in the designated container.
C. Wears eyewear when emptying the urinary drainage bag.
D. Dons gloves when wearing artificial nails.

Correct answer: C

Rationale: The correct understanding of standard precautions includes wearing appropriate personal protective equipment to prevent exposure to body fluids. Wearing eyewear when emptying the urinary drainage bag is crucial as it protects the nurse's eyes from potential splashes of body fluids. Teaching the patient about good nutrition (Choice A) is important for overall health but is not directly related to standard precautions. Disposing of an uncapped needle correctly (Choice B) is part of safe needle handling but does not specifically relate to standard precautions. Donning gloves when wearing artificial nails (Choice D) is not a correct understanding of standard precautions, as artificial nails can harbor microorganisms and increase the risk of infection transmission.