ATI Capstone Leadership

a nurse working in a mobile health clinic is assessing a migrant farm worker, what finding should the nurse identify as priority

report of muscle twitching and skin rash

a nurse is caring for a newborn in the nursery following a circumcision, the newborn's grandparent, who does not have an identification bracelet, requests to take the newborn to his mother's room, what actions should the nurse take

respectfully deny the grandparents request

a nurse is planning to discharge a client who has quadriplegia to his home. the nurse suggests that the family might need respite care services. when a family member asks how respite care can help, which response should the nurse provide?

respite care allows the primary caregiver time away from day-to-day care responsibilities

a PH nurse is developing guidelines for management of botulism outbreak, what info should the nurse include

rinse skin with soap and water following exposure to the botulism toxin

a nurse is reinforcing teaching about self-care with a pt who has pelvic inflammatory disease. the pt does not speak English, what action by the nurse is appropriate

seek assistance from a facility-approved interpreter

a nurse is planning a staff education session regarding biological weapons of mass destruction. what should he plan to include in the session

smallpox anthrax botulism

a school nurse is providing care for students in an elementary education facility, what interventions by the nurse addresses the primary level of prevention

teach students about healthy food choices

a nurse is planning discharge teaching for a pt who has multiple sclerosis, what action should the nurse plan to include

teach the pt to avoid extremes in hot and cold temps

a parent of a child who is terminally ill tells a nurse that she wants to take her child home, what response should the nurse make

tell me more about your desires

a nurse is receiving change of shift report on a group of clients, which of the following pts should the nurse assess first

the client who has a fractured femur and reports sharp chest pain

a charge nurse working in a mental health unit is concerned that a nurse is experiencing countertransference when caring for a pt, the charge nurse should identify which of the following behaviors as an indication of countertransference

the nurse is inattentive when spending time with the pt

a nurse in an ED is preparing change of shift report for an older adult pt transffering to the med surg unit using SBAR communication tool, what info should the nurse include in the report

the pt has a DNR prescription the pt has continuous IV of LR the pt was straight cathed for 350mL 2 hours ago

a newly licensed nurse is giving a change of shift report using ISBAR to an oncoming nurse. which of the following statements by the newly licensed nurse should be included in the intro portion of the report

the pt is a 45 year old male admitted 8 hours ago

a nurse is caring for a pt whose family member requests to view the pt's medical record. what response should the nurse make

the pt should provide permission to share the records with you

a nurse is caring for 4 pts who are postop from surgery 24 hours ago, at 1200 the nurse assesses the pts, what pt is priority

the pt whose bp at 0800 was 138/86 and at 1200 is 106/60

a nurse is preparing an in-service about family violence for a group of newly licensed nurse, what statement should the nurse include in the teaching

the victim's risk for homicide is greatest when she decides to leave the relationship

a nurse manager is teaching a group of employees about QSEN, what statements by an employee should the nurse manager identify as quality improvement

we should start tracking how soon pts are discharged after laparoscopic versus open surgery

during an initial visit, a home health nurse is assessing a pt who has different cultural beliefs than her own, what questions should the nurse ask to determine the pts beliefs about environmental control

what do you think you can do to affect your health status

a staff nurse is challenging a shift assignment with the charge nurse, what statement made by the charge nurse is an example of smoothing to resolve conflict

you have been a nurse a long time, so I'm sure you're capable of the tasks

a home health nurse is providing teaching to a family of a client who has seizure manifestations as a result of an inoperable brain tumor. what interventions should the nurse include in the teaching?

pad the side rails of the bed

a nurse is completing discharge teaching with a pt, of the following barriers to learning, the nurse identifies with this pt, which should the nurse interpret as a need to postpone this session

pain

a home health nurse is teaching about CPT treatments with a pt who has COPD, what client statements should the nurse identify as an indication that the teaching has been understood

CPT treatments will decrease my respiratory infections

a nurse is preparing to administer the initial dose of ceftriaxone to a pt who has endometritis, what statements by the pt should cause the nurse to hold the medication and consult the provider

I have a severe allergy to amoxicillin

a nurse is teaching a newly licensed nurse about methods to reduce costs of pt care, what statements by the newly licensed nurse indicates understanding of the teaching

I should encourage clients to receive an annual flu immunization

a nurse manager is preparing to complete staff performance appraisals. which of the following principles should the nurse manger consider when completing the appraisals

performance appraisals should be written in measurable terms

a community health nurse is reviewing the levels of disease prevention, what activities is an example of tertiary prevention

providing treatment for pt's who have COPD

a nurse overhears 2 APs from the med surg unit discussing a hospitalized pt while in the cafeteria, what action should be taken

quietly tell the APs that this is not appropriate

a nurse on a rehab unit is creating a plan of care for a newly admitted pt who has difficulty swallowing following a stroke, what interprofessional team members should the nurse anticipate consulting the pts condition

SLP OT dietician

a nurse is planning care for 4 clients and is assigning tasks to a LPN, and an AP, what should be assigned to the LPN

reinforcing teaching to a pt to begin taking enoxaparin at home following a hip arthroplasty

a nurse in a long-term care facility enters the day room and finds the window curtains on fire, what is the order of emergency actions

remove the pt from the room activate the fire alarm close the door extinguish the fire

a nurse is caring for a group of pts. which of the following clients should the nurse refer to a social worker?

a client who requires placement in an assisted living facility a pt who requests to secure an emergency notification system in the home a pt who requests to get school assignments while hospitalized on a pediatric unit

a nurse is discussing organ donation with a newly license nurse, should the nurse include in the teaching

a donor needs to use his signature to agree to the gift of donation upon admission to the hospital it is required that all clients over 18 be questioned about organ donation documentation about giving permission or refusing to donate is placed in the EMR

a nurse is teaching a class on torts, the nurse should include what situation as an example of negligence

a nurse identifies the absence of peripheral pulsation in a casted extremity in the early morning and reports it to the provider in the early afternoon

a nurse is assigned a group of pts at the start of the shift. what client should the nurse care for first

a pt asking about his PCA pump that contains morphine

a nurse is planning a staff education program to review nursing interventions for pts who have kidney failure, what sources should the nurse identify as the best source for obtaining EBP info

a recent peer reviewed nursing research article

a charge nurse on a med surg unit is preparing to delegate tasks to a licensed practical nurse (LPN), what tasks should the charge nurse delegate to the LPN

administering an oral antibiotic to a pt

a nurse in the emergency department is caring for a pt who has extensive partial and full-thickness burns of the head, neck , chest. while planning the pts care, the nurse should identify which of the following risks as the priority for assessment and intervention

airway obstruction

a newly licensed nurse tells a charge nurse he is unsure about accepting telephone med prescriptions. which of the following providers should the charge nurse identify as having the legal ability to give telephone medication prescriptions

anesthesiologists physician assistants nurse practitioners

a nurse is reviewing the med record of an older adult pt who has a new prescription for cimetidine, what lab findings should the nurse identify as the priority to report to the provider

aspartate aminotransferase 50 units/L

a nurse on a surgical unit is caring for a group of pts, what is a priority action of the nurse

assessing a pt who experiences unilateral calf pain when ambulating

a nurse is providing instructions for a 52 year old pt who is scheduled for a colonoscopy, the pt reports that he has not had the procedure before and is anxious about pain, what response by the nurse is appropriate

before the examination, your provider will give you a sedative that will make you sleepy

a nurse enters a pts room and finds the client pulseless, the living will requests no resuscitation be performed, but the provider has not written the prescription. what actions should the nurse take

begin CPR

a nurse is caring for a pt who has been in a motor vehicle crash and has a minor TBI, what findings should the nurse recognize as a complication and report to the provider

bradycardia vomiting drainage from the ear unequal pupils

a community health nurse is reviewing information about infectious diseases with the nurses on her team. the nurse should remind the team that which of the following diseases are included in the list of nationally notifiable infectious diseases

chancroid gonorrhea chlamydia

a nurse is caring for an OA pt who is disoriented and has a history of falls, what actions should the nurse take

check on the pt hourly instruct the pt to use the call light apply an ambulation alarm to the pt's leg

a nurse is caring for a pt and realizes she administered the wrong medication, what actions should the nurse take first

check the condition of the pt

a nurse is caring for four pts, after administering morning meds, she realizes that the nifedipine prescribed for one pt was inadvertently administered to another pt, what actions should the nurse take first

check the pt's vital signs

a nurse is among the first responders to a mass-causality incident and does not know what type of personal protective equipment (PPE) is needed. which of the following actions should the nurse take?

choose the highest level of protection equipment available

a nurse manager is implementing a quality improvement project to to reduce the number of MRSA infections, what action should the nurse manager take first

conduct a chart review to evaluate precepting factors of clients who develop MRSA

a charge nurse allows 2 nurses who are arguing about who gets to go to lunch first to go together. the charge nurse agrees to take care of both of the nurse's pts while they are at lunch, the charge nurse is demonstrating which of the following types of conflict management

cooperating

a nurse educator is discussing community mental health with a group of nursing students, what sites should the educator identify as a source of secondary preventions

crisis center

a forensic nurse is using the epidemiological triangle to explain factors that predispose an individual to violent behavior which of the following factors should the nurse identify as an environmental factor in the epidemiological triangle

crowded living conditions

a nurse is using the ecologic model for population health to develop interventions to address HIV in a community, what interventions should the nurse include to address financial factors affecting community health

distribute condoms through remote community clinics

a nurse manager on the acute care unit is preparing a staff presentation about promoting cost-effective care, what strategies should the nurse plan to include in the presentation

educate staff about the correct use of PPE for isolation precautions

a community health nurse is reviewing primary prevention for West Nile virus with a group of pts in a rural health clinic, what instructions should the nurse include

eliminate areas of standing water

a charge nurse is discussing HIPAA with a newly licensed nurse, which action should the charge nurse include in the teaching as an example of HIPAA violation

emailing the pt's positive hepatitis results from an unencrypted server

a nurse is planning care for a pt who has hepatitis B, what interventions should the nurse include in the plan

encourage short periods of ambulation

a school nurse is developing a teaching plan about testicular cancer for a group of adolescents. what info should the nurse include in the teaching?

expect testicles to be uniform in consistency when performing a testicular self-examination

a community nurse is instructing a group of high school students about the transmission of hep A, what following modes of transmission should the nurse include in the teaching

fecal oral

a charge nurse is working with an AP who provides excellent care to pts and is an effective team member. what action shoudl the nurse take first to recognize the APs contributions to pt care

give positive feedback directly to the AP

a hospice nurse is providing teaching to a pt who has a new diagnosis of a terminal illness and her family. which statement should the nurse include in the teaching?

hospice care continues to help families with grief after a death occurs

a nurse is caring for a pt who has an ethical conflict about the care she is receiving, what resources should the nurse consult about resolving the dilemma

hospital ethics committee

a nurse is supervising a LPN who is providing care to a pt who is postoperative. which of the following statements by the pt requires the nurse to follow up with the PN?

i have not received any of my medications today

a nurse manager is teaching a class about proper body mechanics during a facility's annual competency event. which of the following statements by one staff member in attendance indicates the use of proper body mechanics

i should bend my knees when lifting objects off the floor

a home health nurse is providing teaching to a pt who has a new diagnosis of a gastric ulcer and a new prescription for sucralfate oral suspension, what statements by the pt should the nurse identify as a understanding of the teaching

i will take this medicine 1 hour before meals and at bedtime

a case manager completes a history and physical assessment for a pt who has COPD, what actions should the case manager take next

identify the pt's current health needs

a nurse manager of a rural clinic is orienting a new employee on characteristics of residents in the area, what facts about rural health should the nurse manager include

increased rates of chronic illness

a nurse manager is discussing EMR with a new nurse, what should the nurse to maintain client confidentiality

log off computer terminal before leaving change computer access passwords on a regular basis avoid accessing information about pts admitted to other units shred computer generated client worksheets after use

a nurse is conducting a home visit with an older adult client, what observation should the nurse address to promote safe environment

low chairs without armrests

a charge nurse is preparing an educational session about addictive disorders for nursing staff. which of the following should the nurse include as an etiological factor of addictive disorder?

low self-esteem family history of addiction personality disorders

a nurse is reviewing the guidelines for reporting nationally notifiable infectious disease, what disease should the nurse report to the CDC

lyme disease

a nurse is completing an assessment of a recently widowed older adult, he states he is unable to drive and is afraid to cook on the stove, the nurse should recommend which of the following community resources

meals on wheals

a charge nurse is planning care for a group of pts on a med surg unit, what tasks should the nurse delegate to an assistive personnel

measure hourly urinary output for the postop pt

after signing a informed consent form, a client states, "i have changed my mind and do not want to have the procedure" which of the following actions should the nurse take?

notify the surgeon that the client wishes to withdraw informed consent for the procedure

a nurse on a pediatric unit is caring for a pt and his family, his parents define family as a husband, wife, and child, this is the definition of a

nuclear family

an AP reports to the nurse that a pt who is 3 days postoperative following an abdominal hysterectomy has a dressing that is saturated with blood, what tasks should the nurse delegate to the AP?

obtain vital signs

a nurse is planning care for a pt who follows the mormon belief system, what modifications should the nurse include to meet mormon dietary practices

offer noncaffeinated beverage options

a county public health nurse is developing a list of interventions to address the 3 core functions of public health, what interventions should the nurse include as a part of the assurance function

organize an immunization clinic for at-risk members of the community

a nurse in a clinic is caring for a pt who has UTI, what prescription should the nurse verify with a provider

oxybutynin