ATI Practice B Leadership and Management - Update
A nursing unit is undergoing changes to accomodate new bariatric services that will be available to the unit. Some staff members have verbalized displeasure with the changes. Which of the following actions should the charge nurse take? (Select all that apply) A. Role model a positive approach to the changes. B. Redirect the conversation when staff members make negative comments about the changes. C. Encourage staff members who support the changes to discuss the issue with resistant staff. D. Suggest that resistant staff members transfer to a different unit. E. Reprimand staff members who are resistant to the changes.
A and C
A nurse is caring for a client who has a right lower leg deep-vein thrombosis and a prescription for application of an aquathermia pad to the right lower leg. Which of the following actions should the nurse take? SATA. A. Ask the client to report if the aquathermia pad gets too warm. B. Check the client's leg 30 minutes after applying the aquathermia pad. C. Show the client where the power button is located. D. Ensure that the client's call light is in reach. E. Decrease the temperture by 5 degrees if the client's skin becomes reddened.
A,C,D
A charge nurse notices a newly hired nurse consistently does not finish client care tasks by the end of the shift. Which of the following statements should the charge nurse make? A. "You should set aside time to plan your day at the beginning of each shift." B. "You should not take a break until all of your tasks are completed." C. "You should leave your hardest task for the end of the shift." D. "You should save your charting for the end of the shift."
A. " You should set aside time to plan your day at the beginning of each shift."
An assistive personnel (AP) tells a charge nurse that it is unfair that she has to take care of all the clients who are incontinent. Which of the following responses by the charge nurse is appropriate? A. "I delegate tasks to personnel based on their job descriptions." B. "Everyone working here has to care for clients who are incontinent." C. "Let's talk about organizing the workflow so you can care for fewer of these clients." D. "Why do you not want to care for clients who are incontinent?"
A. "I delegate tasks to personnel based on their job descriptions."
There has been a massive community disaster and stable clients must be discharged from a facility to prepare for the influx of new casualties. A nurse should identify that which of the following clients is safe to discharge? A. A client who has MS and reports ataxia. B. A client who has a DVT and an aPTT within the expected reference range. C. A client who has right lower quadrant pain and positive rebound tenderness. D. A client whose amylase and lipase levels are twice the expected value.
A. A client who has MS and reports ataxia.
A nurse is caring for an older adult client who has dementia and has become aggressive. The client's provider has prescribed wrist restraints. Which of the following actions should the nurse take while applying the restraints? A. Apply the padded portion of the restraint around the client's wrist. B. Tie the restraint to the immobile part of the client's bed. C. Use a square knot to secure the restraint to the client's wrist. D. Ensure that one finger can be inserted between the restraint and the client's skin.
A. Apply the padded portion of the restraint around the client's wrist.
A nurse receives notification of a fire on the unit. Which of the following actions should the nurse take first? A. Assist clients who are in immediate danger to a safe location. B. Close doors and windows on the unit. C. Attempt to extinguish the fire using an ABC fire extinguisher. D. Discontinue oxygen use for clients who can breathe without it.
A. Assist clients who are in immediate danger to a safe location.
A nurse is caring for a client who is terminally ill and receiving nutritional support. The client's adult children disagree about continuing nutritional support. The dilemma is referred to the ethics committee. The nurse should expect which of the following actions from the committee? A. Assisting in weighing the options involved in the decision. B. Providing a legal representative for the family. C. Recommending the best course of action for the client. D. Deciding how the nursing team should resolve the dilemma.
A. Assisting in weighing the options involved in the decision.
A nurse is admitting a client to a cardiac intensive care unit. At what time during the client's stay at the facility should the nurse begin planning for the client's discharge needs? A. At the time of the admission interview B. When the client is transferred to the telemetry unit. C. As soon as the provider authorizes discharge. D. Following evaluation of available client resources.
A. At the time of the admission interview
A nurse is reviewing a client's medication administration record and finds that the client has not recieved a prescribed dose of warfarin for 2 days. Which of the following actions should the nurse take first? A. Check the client's last INR. B. Notify the client's provider. C. Notify the risk manager. D. Complete an incident report.
A. Check the client's last INR.
A nurse is teaching a newly licensed nurse about the guidelines for obtaining a telephone prescription from a provider. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I should repeat the prescription back to the provider for verification." B. "I should have the pharmacist contact the provider to obtain a new prescription." C. "The provider does not have to sign a presciption if the pharmacist approves it." D. "The provider may leave telephone prescriptions with a student nurse if a licensed nurse is unavailable."
A. I should repeat the prescription back to the provider for verification."
A staff nurse detects alcohol on the breath of another nurse working on the unit. He observes that her gait seems unsteady, and she occasionally slurs her speech. Which of the following actions should the nurse take is he suspects that his colleague is under the influence of alcohol? A. Notify the charge nurse of his suspicions. B. Confront the impaired nurse regarding his suspicions. C. Wait to see is the behavior occurs again before taking action. D. Suggest to the nurse that she request sick leave for the rest of the shift.
A. Notify the charge nurse of his suspicions.
A charge nurse is preparing to observe a newly licensed nurse perform a routine abdominal assessment. Which of the following actions should the charge nurse expect the newly licensed nurse to take? A. Place the client in a dorsal recumbent position for the exam. B. Auscultate for vascular bruits with the disphragm of the stethescope. C. Begin the assessment by using light palpation over the abdomen. D. Ensure that the client has a full bladder before beginning the procedure.
A. Place the client in a dorsal recumbent position for the exam.
A hospice nurse is planning care for a client who does not have advance directives. Which of the following interventions should the nurse include in the plan of care? A. Provide the client with information about advance directives. B. Tell the client's partner to complete advance directives on his behalf. C. Notify the facility chaplain of the client's needs for advance directives. D. Tell the client that his provider will complete a health care proxy form for him.
A. Provide the client with information about advance directives.
A nurse notices a small spark from an outlet when plugging in an IV infusion pump. Which of the following actions should the nurse take? A. Tag the pump as broken. B. Plug the pump into a different outlet. C. Turn the pump on to see if it works correctly. D. Store the pump in a corner of the client's room.
A. Tag the pump as broken.
A nurse is developing a plan of care for a school-age child whose family is homeless. Which of the following findings should the nurse identify as the priority? A. The child has inflamed fissures at the corners of her mouth. B. The child is shy when interacting with staff. C. The child verbalizes not having many friends. D. The child reports having her book bag stolen at school.
A. The child has inflamed fissures at the corners of her mouth.
A nurse is teaching a client about the Patient Protection and Affordable Care Act and his rights regarding insurance coverage. Which of the following statements by the client indicates an understanding of the teaching? A. "My insurance coverage no longer has lifetime coverage limits." B. "I can provide health insurance coverage for my son on my policy until he turns 21 years old." C. "My insurance will not provide coverage for preexisting conditions." D. "I can lose my insurance coverage since I have been sick so much this year."
A."My insurance coverage no longer has lifetime coverage limits."
A nurse is planning discharge care fofr an older adult client who has rheumatoid arthritis. The nurse notes that the client is having difficulty buttoning her clothing. Which of the following is an appropriate referral for the client? A. Pain management clinic B. Physical therapy C. Adult day care D. Occupational therapy
D. Occupational therapy
A nurse is caring for a group of clients on a unit. Which of the following assessment findings should the nurse recognize as the priority to report to the charge nurse? A. A client who has heart failure and 2+ edema of her lower extremities. B. A client who is 2 days postoperative and has a urine output of 20 mL/hr C. A client who started taking verapamil and has a heart rate of 75/min. D. A client who is receiving morphine and reports nausea.
B. A client who is 2 days post operative and has a urine output of 20 mL/hr
A nurse manager is conducting an annual performance review for a staff nurse. Which of the following strategies should the nurse use in the review process. Select all that apply. A. Base the review on the nurse's performance during the past 90 days. B. Include peer evaluations completed by other staff nurses. C. Evaluate the nurse's performance based on a comparison of the nurse to others on the unit. D. Have the nurse conduct a self-apprasial prior to the review. E. Complete a performance checklist.
B,D,E
Which of the following instructions provided by a nurse reflects effective communication regarding delegation of a task to an AP? A. "Take vital signs every two hours for the client who had a cholecystectomy in room 6122." B. "Check the urinary output at 1100 for John Doe and report it to me immediately." C. "Report to me if the chest tube drainage is excessive for Jane Doe in room 2438." D. "Please notify me of any clients whose vital signs or blood glucose levels are significant."
B. "Check the urinary output at 1100 for John Doe and report it to me immediately."
A nurse is caring for a client who recently learned she has a mutation of the BRCA2 gene. The client states that she does not plan to tell her adult daughters about the diagnosis. Which of the following responses displays client advocacy by the nurse? A. "You should tell your daughters because this could affect their health as well." B. "Let's review what you understand about this test result." C. "Why would you not want to share this information with your daughters?" D. "I feel it would be best for you to reconsider your decision."
B. "Let's review what you understand about this test result."
A nurse is teaching a newly licensed nurse about using electronic medical records. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I can allow another nurse to use my password to look up a client's lab values." B. "My access to client electronic records may be tracked by my nurse manager." C. "A client's partner has the right to read through the client's electronic medical record." D. "I should stay logged in to the electronic medical record throughout the shift to save time."
B. "My access to client electronic medical records may be tracked by my nurse manager."
A nurse is receiving change-of-shift report. Which of the following clients should the nurse assess first? A. A client who has a WBC count of 15,000/mm3 and is receiving antibiotics. B. A client who had abdominal surgery 6 hours ago and had a heart rate of 120/min for the last 2 hours. C. A client who is requesting pain medication 24 hr after an open reduction and internal fixation (ORIF) of the left ankle. D. A client who has pneumonia and an oxygen saturation of 95% is refusing prescribed medication.
B. A client who had abdominal surgery 6 hours ago and had a heart rate of 120/min for the last 2 hours.
A nurse has just received report on four clients on a medical-surgical unit. Which of the following clients should the nurse plan to assess first? A. A client who has COPD and an oxygen saturation level of 92%. B. A client who is postoperative following a total knee arthroplasty and has a capillary refill of 4 seconds. C. A client who has diabetes mellitus and a blood glucose of 150 mg/dL D. A client who is 12 hr postoperative following abdominal surgery and has absent bowel sounds.
B. A client who is postoperative following a total knee arthroplasty and has a capillary refill of 4 seconds.
A nurse on a medical-surgical unit is caring for a client who is terminally ill. Which of the following actions demonstrates that the nurse is practicing in an ethical manner when caring for the client? A. Limit visitors when the client is in acute pain. B. Collaborate with the client to establish realistic goals for his end-of-life care. C. Insist the client take a sedative medication that he previously declined. D. Encourage the client to hope that treatment might slow the progression of his illness.
B. Collaborate with the client to establish realistic goals for his end-of-life care.
A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the following actions should the nurse plan to take? A. Clean the client's incision twice daily with half-strength hydrogen peroxide. B. Inform the assistive personnel of the client's weight bearing status. C. Instruct the client to cross his legs at the ankles when sitting in a chair. D. Teach the client's partner to assist the client to flex the hip at least 120 degrees each hour
B. Inform the assistive personnel of the client's weight bearing status.
A charge nurse observes that a staff nurse's behavior has changed over the past few weeks. Which of the following behaviors should the charge nurse identify as an indication that the staff nurse is working while impaired? A. Refuses to work overtime shifts. B. Isolates herself from other staff members. C. Skips lunch break to complete charting. D. Volunteers to help other nurses with their assignments.
B. Isolates herself from other staff members.
A nurse manager finds that there has been an increase in urinary tract infections on the unit. To address this problem, which of the following actions should the nurse manager take first? A. Conduct an in-service that reviews proper catheter insertion and maintence. B. Perform a chart review to gather data about the clients who developed infections. C. Observe each staff nurse perform a urinary catheter insertion. D. Require completion of a self-paced instruction program
B. Perform a chart review to gather data about the clients who developed infections.
A charge nurse is planning client care assignments for a unit. Which of the following tasks should the nurse assign to an LPN? A. Determine the swallowing ability of a client who has had a stroke. B. Provide an enteral feeding to a client who has Chron's disease. C. Develop a teaching plan for a client who has a new diagnosis of type 2 diabetes mellitus. D. Weigh a client who is 3 days postoperative following coronary artery bypass grafting.
B. Provide an enteral feeding to a client who has Crohn's disease
A nurse is caring for an older adult client who has renal failure. The client tells the nurse that he has decided to stop hemodialysis treatment. Which of the following actions should the nurse take to act in the role of the advocate for the client? A. Inform the client that many clients receiving hemodialysis face discouragement. B. Support the client's decision regarding treatment. C. Tell the client that he made the right decision. D. Suggest that the client's family advocate for continued treatment.
B. Support the client's decision regarding treatment
A case manager is planning an interprofessional conference for a client who is 3 days postoperative following an open reduction and internal fixation of the right hip. Which of the following concerns is the priority for discussion at the confrence? A. The client does not have transportation for discharge home. B. The client refuses to attend physical therapy sessions. C. The client's home health nurse has not completed the home assessment. D. The client describes feelings of depression after his family visits.
B. The client refuses to attend physical therapy sessions.
A nurse is caring for a client who has a sealed radiation therapy implant. Which of the following precautions should the nurse plan to take when providing client care? A. Limit visitors to 1 hour per day. B. When wearing the lead apron, avoid turning her back to the client. C. When visitors are present, keep them at least 3 feet from the client. D. Keep the door to the room open.
B. When wearing the lead apron, avoid turning her back to the client.
A nurse is teaching a newly licensed nurse about incident reports. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I should place a copy of an incident report in the client's medical record." B. "I should document the completion of an incident report in the client's medical record." C. "I should complete an incident report for an unexpected client occurrence." D. "I should ask the risk manager to complete the incident reports."
C. "I should complete an incident report for an unexpected client occurrence."
A nurse is providing discharge teaching to a client who is scheduled to receive oxygen at home. Which of the following client statements indicates an understanding of the teaching? A. "I can use petroleum jelly when the oxygen makes my nose feel dry." B. "I can use my wool blanket in the winter when I have my oxygen on." C. "I will verify the flow rate on my oxygen equipment daily." D. "I will store my oxygen concentrator system in the closet."
C. "I will verify the flow rate on my oxygen equipment daily."
A nurse is speaking with the daughter of a client who has advanced Alzheimer's disease. The daughter is fcrying and tells the nurse, "I don't know how much longer I can keep this up." Which of the following responses should the nurse make? A. "I understand how you must be feeling." B. "You should speak with your mother's doctor about this." C. "Let's discuss options for respite care." D."You'll need to get help if your mother becomes combative."
C. "Let's discuss options for respite care."
A nurse is caring for a client who has a terminal illness and voices concern about how she will care for herself at home after discharge. Which of the following statements should the nurse make? A. " Your insurance company will decide how much care you will need after you get home." B. "You will be ineligible for a skilled nursing facility due to your terminal condition." C. "Your case manager will coordinate the resources you will need throughout your illness." D. "You will need to enter hospice care until you are well enough to care for yourself at home again."
C. "Your case manager will coordinate the resources you will need throughout your illness."
A nurse is participating in obtaining a client's informed consent. Which of the following tasks is the role of the nurse when witnessing informed consent? A. Explain the procedure to the client. B. Review the risks of the procedure. C. Confirm the client voluntarily signed the consent. D. Answer the client's questions about the procedure.
C. Confirm the client voluntarily signed the consent.
A nurse case manager is planning a teaching session on the use of critical pathways with a group of newly licensed nurses. The nurse should include which of the following information in the teaching? A. Critical pathways promote individualized care. B. Critical pathways decrease administrative work time. C. Critical pathways prevent unnecessary expense. D. Critical pathways incorporate provider preferences.
C. Critical pathways prevent unnecessary expense
A nurse manager is completing a performance improvement audit and determines documentation of client discharge teaching is below the expected benchmark. Which of the following actions should the nurse implement first? A. Offer incentives for the staff once the unit's benchmark is above average. B. Train specific nurses to use a standard discharge teaching plan. C. Determine the factors that interfere with the documentation of client education. D. Include client discharge teaching as part of the annual performance evaluation.
C. Determine the factors that interfere with the documentation of client education
A nurse is caring for a client who is recovering from a stroke. The provider recommends an extracranial-intracranial bypass, but the client tells the nurse that he will not have the surgery. Which of the following actions should the nurse take? A. Inform the client of the consequences of decreased cerebral circulation. B. Initiate a mental health consultation to determine why the client refuses the surgery. C. Discuss with the client his concerns about having the surgery. D. Provide the client with information on additional treatment options.
C. Discuss with the client his concerns about having the surgery.
A public health nurse is developing a list of recommendations for her supervisior on how to use EBP to improve community outcomes. Which of the following should the nurse recommend as a qualitative research method? A. Meta-analysis B. Experimental Study C. Phenomenology D. Secondary Analysis
C. Phenomenology
A nurse is observing a newly licensed nurse perform a sterile dressing change on a client who has a central venous catheter. Which of the following is an appropriate action by the newly licensed nurse? A. Opens the top flap of the sterile package toward herself. B. Maintains a 1.25 cm (1/2 in) border around the edges of the sterile field C. picks up first sterile glove by grasping the folded cuff edge. D. Removes soiled dressings using sterile gloves.
C. Picks up first sterile glove by grasping the folded cuff edge.
A home health nurse is planning her daily visits and receives lab results for four adult clients. The nurse should first see the client who has which of the following lab values? A. Digoxin 1.0 ng/mL B. WBC 6,000/mm3 C. Platelets 100,000/mm3 D. Serum potassium 4.0 mEq/L
C. Platelets 100,000/mm3
A nurse is assigning care for four clients. Which of the following tasks should the nurse plan to delegate to an AP? A. Perform an admission assessment on a client. B. Administer subcutaneous medications to a client. C. Record a client's meal intake. D. Develop a plan of care for a client.
C. Record a client's meal intake.
A nurse overhears two staff members in the facility elevator discussing a client's care. Which of the following interventions should the nurse take? A. Clarify the client information the staff members are discussing. B. Inform the client's provider of the incident. C. Report the incident to the nurse manager. D. Tell the client about overhearing a discussion regarding his care.
C. Report the incident to the nurse manager.
A nurse is presenting information on health care law to a group of newly licensed nurses. Which of the following information shuold the nurse include? A. Good Samaritan laws provide protection for nurses who are negligent when providing volunteer services. B. The Emergency Medical Treatment and Active Labor Act (EMTALA) provides nursing guidelines for providing client care outside the health care facility. C. The Patient Self-Determination Act (PSDA) requires a nurse to give clients information about end-of life options. D. State nurse practice acts are informal guidelines that direct professional nursing practice.
C. The Patient Self-Determination Act (PSDA) requires a nurse to give clients information about end-of life options.
A client who has back pain presents to an emergency department and is provided a prescription of oxycodone. A staff nurse tells the charge nurse that he thinks the client is seeking drugs and is not actually in distress. Which of the following responses by the charge nurse is appropriate? A. "It sounds like nonpharmacological interventions would be best for this client." B. "Let's withhold the oxycodone until we can consult with the provider." C. "Contact mental health services to arrange for a consultation." D. "Clients are the experts on their own path."
D. "Clients are the experts on their own path."
A nurse in the emergency department is admitting clients following an eartquake. The emergency disaster plan has been implemented due to the anticipated arrival of a large number of casualities. Which of the following clients should the nurse recommend the provider evaluate first? A. A client who has a penetrating head injury and respirations of 4/min. B. A client who has a comminuted fracture of the femur. C. A client who has a 6-inch laceration to the scalp with clotted blood visible. D. A client who has a sucking chest wound.
D. A client who has a sucking chest wound.
A charge nurse is conducting an in-service with staff members about infection control precautions. The nurse should instruct the staff that which of the following clients requires droplet precautions? A. A client who has shigella. B. A client who has measles. C. A client who has toxic shock syndrome D. A client who has pertussis.
D. A client who has pertussis.
Two nurses on a unit each contend that the other is not doing a fair share of work. The conflict is affecting the functioning of the unit. A charge nurse should recognize that which of the following is an appropriate approach to this conflict? A. Schedule the nurses to work on alternating shifts. B. Organize a task force to evaluate the situation. C. Tell the nurses that it is their responsibility to cooperate with coworkers. D. Explore alternative solutions to address unit workflow with the nurses.
D. Explore alternative solutions to address unit workflow with the nurses.
A nurse is preparing to administer medication to a client who has Crohn's Disease. The client states, " I want to skip this dose of my medication. I am too tired to take it." Which of the following actions should the nurse take? A. Leave the medication on the client's bedside table to take later. B. Return in 1 hour to administer the medication. C. Mix the medication in applesauce to administer to the client. D. Inform the client of the consequences of refusing the medication.
D. Inform the client of the consequences of refusing the medication.
A nurse is assessing a client who is postoperative and has a PCA. The client exhibits restlessness, an elevated pulse, and decreased blood pressure. Which of the following actions should the nurse take? A. Assign an AP to monitor the client's vital signs. B. Encourage increased use of the PCA for comfort. C. Have the client's provider prescribe a sedative. D. Place the client in a modified Trendelenburg position.
D. Place the client in a modified Trendelenburg position.
A nurse is caring for a client who is comatose. The client has a living will that declines the use of artificial enteral nutrition as a life-sustaining measure, but the client's family has requested that the staff begin tube feedings. Which of the following actions should the nurse take? A. Insert the tube and begin feedings per the family's request. B. Ask the provider to discuss the issue with the family. C. Report the dilemma to the facility's dietitian. D. Review the client's request with the family.
D. Review the client's request with the family.
A client presents to an emergency department and reports weakness, vomiting, and diarrhea for the past 3 days. Which of the following is the priority assessment for this client? A. Bowel sounds B. Temperture C. Urine Specific Gravity D. Serum potassium levels
D. Serum potassium levels
A nurse is serving on a committee that is considering the creation of a policy that will allow nurses to insert peripherally inserted central catheters in the intensive care unit. Which of the following resources should the nurse consult in planning for this policy? A. National League for Nursing (NLN) B. American Academy of Nursing (AAN) C. Agency for Healthcare Research and Quality (AHRQ) D. State Nurse Practice Act (NPA)
D. State Nurse Practice Act (NPA)
A nurse is providing change-of-shift report to the oncoming nurse. Which of the following information shuold the nurse include? A. Subjective comments about the client. B. Routine morning care the nurse provided. C. The client's insurance provider. D. The time of the client's last pain medication
D. The time of the client's last pain medication
A charge nurse is evaluating a plan of care that a novice nurse developed for a client who is to receive a continuous NG tube feeding. Which of the following interventions should the charge nurse ensure is part of the plan of care? A. Flush the tube every 8 hours with 0.9% sodium chloride irrigation. B. Use an acidic juice to unclog a blocked tube. C. Add dissolved medications to the enteral feeding. D. Use a 60 mL syringe to flush out a clogged tube.
D. Use a 60 mL syringe to flush out a clogged tube
A nurse is precepting a newly licensed nurse who is caring for a client who has suspected pulmonary tuberculosis. The nurse should recommend that the newly licensed nurse take which of the following actions? A. Place the client on droplet precautions. B. Place the client in a room with a postive pressure airflow. C. Wear surgical masks when taking the client out of the room. D. Wear an N95 respirator mask when in the client's room.
D. Wear an N95 respirator when in the client's room.
A nurse manager is reviewing the stages of conflict resolution with the nursing staff. The nurse manager should instruct the staff to expect the stages of conflict to occur in what order?
Latent Conflict. Percieved Conflict. Felt Conflict. Manifest Conflict. Conflict Aftermath.
