a patient requires assistance to stand from a sitting position which action by the nurse ensures patient safety
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Nursing Elites

ATI RN

ATI Capstone Comprehensive Assessment B

1. A patient requires assistance to stand from a sitting position. Which action by the nurse ensures patient safety?

Correct answer: B

Rationale: The correct answer is B. Placing a gait belt around the patient for support is the safest option when assisting a patient to stand from a sitting position. This belt provides stability and support, reducing the risk of falls or injuries during the transfer. Choices A, C, and D are incorrect. Allowing the patient to pull up on the nurse's arm (Choice A) may lead to instability and compromise safety. Having the patient push off the chair with their hands (Choice C) might not provide sufficient support, especially for patients who require assistance. Asking the patient to lift themselves up without support (Choice D) can be dangerous and increase the risk of falls.

2. A nurse manager notes that a nurse is not following safety protocols. What should the manager do first?

Correct answer: B

Rationale: The correct first step for the nurse manager is to notify the hospital's safety committee. This action is crucial to ensure that the appropriate measures are taken promptly to address the non-compliance with safety protocols. Confronting the nurse directly may not be the best initial approach as involving the safety committee can provide a systematic and comprehensive response to the issue. Documenting the observation without addressing it or following up at a later time may delay the necessary actions to maintain a safe environment, making these choices less effective as the first course of action.

3. 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?

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.

4. A client with a urinary tract infection is prescribed ciprofloxacin. Which instruction should the nurse provide?

Correct answer: D

Rationale: The correct instruction for the nurse to provide to a client taking ciprofloxacin for a urinary tract infection is to avoid caffeine. Ciprofloxacin can interact with caffeine, potentially leading to increased side effects or reduced effectiveness. Choice A is incorrect because antibiotics should be taken for the full prescribed course, even if the client starts feeling better. Choice B is incorrect as ciprofloxacin should not be taken with dairy products or antacids as they can interfere with the absorption of the medication.

5. A healthcare provider is assessing a patient with chronic pain. Which finding is most concerning?

Correct answer: C

Rationale: In the context of chronic pain management, the most concerning finding is when the patient's pain persists despite medication. This suggests inadequate pain control or the need for a re-evaluation of the treatment plan. Choices A, B, and D are not as concerning in this scenario. A pain level of 6 on a scale of 0 to 10 is moderate and may be manageable with appropriate interventions. Patients with chronic pain can sometimes lie still due to pain or other reasons, and anxiety and restlessness are common in individuals with pain conditions but may not necessarily indicate a critical issue like uncontrolled pain.

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