which of the following is an expected finding during the assessment of a client transitioning into a new role

ATI RN

RN ATI Capstone Proctored Comprehensive Assessment Form A

1. What is an expected finding during the assessment of a client transitioning into a new role?

A. The client's ability to express feelings of guilt
B. Presence of suicidal or homicidal ideation
C. Changes in coping skills over the past few weeks
D. Client's involvement in community activities

Correct answer: B

Rationale: During a client's transition into a new role, the presence of suicidal or homicidal ideation should be assessed due to the increased risk associated with significant life changes. This finding could indicate a need for immediate intervention. While assessing the client's ability to express feelings of guilt is important, it may not be the most critical aspect during this specific assessment. Changes in coping skills over time are relevant but might not be the primary focus during a role transition assessment. The client's involvement in community activities, although beneficial for social support, is not directly related to the immediate concerns of assessing a client transitioning into a new role.

2. Which intervention reduces reservoirs of infection in a healthcare setting?

A. Placing capped needles and syringes in puncture-resistant containers
B. Keeping bedside table surfaces clean and dry
C. Changing dressings that become wet or soiled
D. Placing tissues and soiled dressings in paper bags

Correct answer: A

Rationale: Placing capped needles and syringes in puncture-resistant containers is the correct intervention to reduce infection reservoirs in healthcare settings. This practice helps prevent accidental needle-stick injuries and contains potentially infectious materials properly. Keeping bedside table surfaces clean and dry (choice B) is essential for preventing the spread of infections but does not directly address reducing reservoirs of infection. Changing dressings that become wet or soiled (choice C) is important for wound care but does not specifically target infection reservoirs. Placing tissues and soiled dressings in paper bags (choice D) is a proper waste disposal practice but does not directly reduce reservoirs of infection in a healthcare setting.

3. 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.

4. Which action by the nurse will help reduce the risk of venous thromboembolism (VTE) in a postoperative patient?

A. Encourage early ambulation and leg exercises.
B. Apply compression stockings to the patient's legs.
C. Administer anticoagulants as prescribed.
D. Elevate the patient's legs to promote circulation.

Correct answer: A

Rationale: The correct answer is to encourage early ambulation and leg exercises. By promoting early ambulation and leg exercises, blood flow is enhanced, reducing the risk of venous thromboembolism (VTE) in postoperative patients. Choice B, applying compression stockings, helps prevent VTE but is not as effective as early ambulation and exercises. Choice C, administering anticoagulants, is important in VTE prevention but does not directly address improving circulation through physical activity. Choice D, elevating the patient's legs, may be beneficial for circulation in specific cases but is not as effective in preventing VTE as early ambulation and leg exercises.

5. What are the clinical manifestations of hypovolemic shock, and how should a nurse respond?

A. Hypertension, bradycardia, and oliguria
B. Bradycardia, hypertension, and peripheral edema
C. Tachypnea, cool skin, and confusion
D. Tachycardia, hypotension, and decreased urine output

Correct answer: D

Rationale: The correct answer is D: Tachycardia, hypotension, and decreased urine output are classic clinical manifestations of hypovolemic shock. In hypovolemic shock, the body tries to compensate for low blood volume by increasing the heart rate (tachycardia) to maintain cardiac output, leading to hypotension and decreased urine output. Prompt fluid replacement is necessary to restore intravascular volume. Choices A, B, and C are incorrect because they do not represent the typical manifestations of hypovolemic shock.