ATI RN
ATI Capstone Comprehensive Assessment B
1. Which action by the nurse represents the ethical principle of beneficence?
- A. Ensuring all clients are treated fairly
- B. Preventing harm by providing accurate information
- C. Allowing the client to refuse treatment
- D. Ensuring the client's family agrees with the treatment
Correct answer: B
Rationale: The correct answer is B. Beneficence is the ethical principle of doing good or acting in the best interest of the client. Preventing harm by providing accurate information and necessary care aligns with the principle of beneficence, as it focuses on promoting the well-being and safety of the client. Choices A, C, and D do not directly reflect the concept of beneficence. Ensuring all clients are treated fairly relates more to justice, allowing the client to refuse treatment pertains to autonomy, and ensuring the client's family agrees with the treatment involves collaboration and communication but not specifically beneficence.
2. A newly licensed nurse is giving a change-of-shift report using I-SBAR to an oncoming nurse. Which of the following statements by the newly licensed nurse should be included in the 'Background' portion of the report?
- A. The client has a new prescription for incentive spirometry
- B. The client's partner plans to return later today
- C. The client has no living family members
- D. I initiated a consultation with a nutritionist
Correct answer: C
Rationale: In the 'Background' portion of the report, the nurse should include relevant historical information about the client, such as the fact that the client has no living family members. This information helps provide a more comprehensive understanding of the client's situation. Choices A, B, and D are not typically included in the 'Background' section as they do not pertain to the client's history or background.
3. A nurse sees a healthcare provider administer an incorrect medication dose but does not report the error. What should the nurse do first?
- A. Ignore the situation and continue with patient care.
- B. Report the error to the nurse manager immediately.
- C. Speak to the healthcare provider directly about the error.
- D. File an anonymous report to avoid conflict.
Correct answer: B
Rationale: When a nurse witnesses a healthcare provider administering an incorrect medication dose, the first step should be to report the error to the nurse manager immediately. Reporting medication errors is crucial for patient safety as it allows prompt intervention to prevent harm. Choice A is incorrect as ignoring the situation can jeopardize patient safety. Choice C, while addressing the error directly, may not ensure proper documentation and follow-up. Choice D, filing an anonymous report, is not as effective as directly informing the nurse manager who can take appropriate action and follow-up on the incident.
4. When caring for a client's tracheostomy at home, which instruction should the nurse include in the teaching?
- A. Clean with alcohol
- B. Cover the tracheostomy when outside
- C. Replace the tube weekly
- D. Use tap water to clean
Correct answer: B
Rationale: Covering the tracheostomy when outside is crucial as it helps prevent dust and other irritants from entering the airway, reducing the risk of complications. Cleaning with alcohol (choice A) can be too harsh for the skin around the tracheostomy site. While replacing the tube weekly (choice C) is important, it is typically done by healthcare providers. Using tap water to clean (choice D) is not recommended as it may introduce contaminants to the tracheostomy site.
5. A nurse is providing discharge teaching to a client following a cataract extraction. Which of the following instructions should the nurse include?
- A. Bend at the waist when picking up objects.
- B. Avoid lying on the operative side.
- C. Avoid lifting more than 10 lb.
- D. Apply ice to the affected eye.
Correct answer: C
Rationale: The correct answer is C: 'Avoid lifting more than 10 lb.' After a cataract extraction, the nurse should instruct the client to avoid lifting heavy objects to prevent increased intraocular pressure, which could lead to complications. Choices A, B, and D are incorrect. A - 'Bend at the waist when picking up objects' can increase intraocular pressure; B - 'Avoid lying on the operative side' is not a specific concern related to cataract extraction; D - 'Apply ice to the affected eye' is not a standard post-cataract extraction instruction.
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