LEADERSHIP AND MANAGEMENT ATI COMPREHENSIVE EXAM STUDY GUIDE 2023-2024
Which is a recommended guideline for safe computerized charting? - CORRECT
... [Show More] ANSWER-Passwords to the computer system should only be changed if lost.
2.
Computer terminals may be left unattended during client-care activities.
3.
Accidental deletions from the computerized file need to be reported to the nursing manager or supervisor. (correct)
4.
Copies of printouts from computerized files should be kept on a clipboard at the nurses' station for other nurses to access.
rationale: After any inadvertent deletions of permanent computerized records, the nurse should type an explanation into the computer file with the date, time, and his or her initials. The nurse should also contact the nursing manager or supervisor with a written explanation of the situation. Options 1, 2, and 4 represent unsafe charting actions. Only option 3 follows the guidelines for safe computer charting.
The licensed practical nurse (LPN) enters a client's room and finds the client sitting on the floor. The LPN calls the registered nurse, who checks the client thoroughly and then assists the client back into bed. The LPN completes an incident report, and the nursing supervisor and health care provider (HCP) are notified of the incident. Which is the next nursing action regarding the incident? - CORRECT ANSWER-Place the incident report in the client's chart.
2.
Make a copy of the incident report for the HCP.
3.
Document a complete entry in the client's record concerning the incident. (correct)
4.
Document in the client's record that an incident report has been completed
RATIONALE: The incident report is confidential and privileged information, and it should not be copied, placed in the chart, or have any reference made to it in the client's record. The incident report is not a substitute for a complete entry in the client's record concerning the incident.
An unconscious client, bleeding profusely, is brought to the emergency department after a serious accident. Surgery is required immediately to save the client's life. With regard to informed consent for the surgical procedure, which is the best action? - CORRECT ANSWER-Call the nursing supervisor to initiate a court order for the surgical procedure.
2.
Try calling the client's spouse to obtain telephone consent before the surgical procedure.
3.
Ask the friend who accompanied the client to the emergency department to sign the consent form.
4.
Transport the client to the operating department immediately, as required by the health care provider, without obtaining an informed consent. (CORRECT)
RATIONALE: Generally there are only two instances in which the informed consent of an adult client is not needed. One instance is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second instance is when the client waives the right to give informed consent. Options 1, 2, and 3 are inappropriate
The nurse arrives at work and is told to report (float) to the pediatric unit for the day because the unit is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the pediatric unit. Which is the appropriate nursing action? - CORRECT ANSWER-.
Call the hospital lawyer.
2.
Call the nursing supervisor.
3.
Refuse to float to the pediatric unit.
4.
Report to the pediatric unit and identify tasks that can be safely performed (correct)
RATIONALE: Floating is an acceptable legal practice used by hospitals to solve their understaffing problems. Legally the nurse cannot refuse to float unless a union contract guarantees that the nurse can only work in a specified area or the nurse can prove a
lack of knowledge for the performance of assigned tasks. When faced with this situation, the nurse should identify potential areas of harm to the client
The nurse enters a client's room and notes that the client's lawyer is present and that the client is preparing a living will. The living will requires that the client's signature be witnessed, and the client asks the nurse to witness the signature. Which is the appropriate nursing action? - CORRECT ANSWER-Decline to sign the will. (CORRECT)
2.
Sign the will as a witness to the signature only.
3.
Call the hospital lawyer before signing the will.
4.
Sign the will, clearly identifying credentials and employment agency.
RATIONALE: Living wills are required to be in writing and signed by the client. The client's signature either must be witnessed by specified individuals or notarized. Many states prohibit any employee from being a witness, including the nurse in a facility in which the client is receiving care.
The nurse finds the client lying on the floor. The nurse calls the registered nurse, who checks the client and then calls the nursing supervisor and the health care provider to inform them of the occurrence. The nurse completes the incident report for which purpose? - CORRECT ANSWER-roviding clients with necessary stabilizing treatments
2.
A method of promoting quality care and risk management (correct)
3.
Determining the effectiveness of interventions in relation to outcomes
4.
The appropriate method of reporting to local, state, and federal agencies
RATIONALE: Proper documentation of unusual occurrences, incidents, accidents, and the nursing actions taken as a result of the occurrence are internal to the institution or agency. Documentation on the incident report allows the nurse and administration to review the quality of care and determine any potential risks present. Options 1, 3, and 4 are incorrect.
The nurse observes that a client received pain medication 1 hour ago from another nurse, but the client still has severe pain. The nurse has previously observed this same
occurrence. Based on the nurse practice act, the observing nurse should plan to take which action? - CORRECT ANSWER-Report the information to the police.
2.
Call the impaired nurse organization.
3.
Talk with the nurse who gave the medication.
4.
Report the information to a nursing supervisor. (CORRECT)
RATIONALE: Nurse practice acts require reporting the suspicion of impaired nurses. The state board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the board of nursing. Options 1 and 2 are inappropriate. Option 3 may cause a conflict.
A nurse lawyer provides an education session to the nursing staff regarding client rights. The nurse asks the lawyer to describe an example that may relate to invasion of client privacy. Which nursing action indicates a violation of client privacy? - CORRECT ANSWER-Threatening to place a client in restraints
2.
Performing a surgical procedure without consent
3.
Taking photographs of the client without consent (CORRECT)
4.
Telling the client that he or she cannot leave the hospital
RATIONALE: Invasion of privacy takes place when an individual's private affairs are intruded on unreasonably. Threatening to place a client in restraints constitutes assault. Performing a surgical procedure without consent is an example of battery. Not allowing a client to leave the hospital constitutes false imprisonment
An older woman is brought to the emergency department. When caring for the client, the nurse notes old and new ecchymotic areas on both of the client's arms and buttocks. The nurse asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her daughter frequently hits her if she gets in the way. Which is the appropriate nursing response? - CORRECT ANSWER-I have a legal obligation to report this type of abuse." (CORRECT)
2.
"I promise I won't tell anyone, but let's see what we can do about this."
3.
"Let's talk about ways that will prevent your daughter from hitting you."
4.
"This should not be happening. If it happens again, you must call the emergency department."
RATIONALE: Confidential issues are not to be discussed with nonmedical personnel or with the client's family or friends without the client's permission. Clients should be assured that information is kept confidential unless it places the nurse under a legal obligation. The nurse must report situations related to child, older adult abuse, and other types of abuse, depending on state laws; gunshot wounds; stabbings; and certain infectious diseases.
The nurse is recording a nursing hands-off (end-of-shift) report for a client. Which information needs to be included? - CORRECT ANSWER-As-needed medications given that shift (correct)
2.
Normal vital signs that have been normal since admission
3.
All of the tests and treatments the client has had since admission
4.
Total number of scheduled medications that the client received on that shift
RATIONALE: The nursing hands-off (end-of-shift) report needs to be an efficient and accurate account of the client's condition during the last shift. It needs to include pertinent information about the client, such as tests and treatments; as-needed medications given or therapies performed during the past 24 hours, including the client's response to them; changes in the client's condition; scheduled tests and treatments; current problems; and any other special concerns. It is not necessary to include the total number of medications given or a list of all the tests and treatments that the client has had since admission. Only significant vital signs need to be included.
The nurse is planning the client assignments for the day. Which is the most appropriate assignment for the unlicensed assistive personnel (UAP)? - CORRECT ANSWER-A client who requires wound irrigation
2.
A client who requires frequent ambulation (correct)
3.
A client who is receiving continuous tube feedings
4.
A client who requires frequent vital signs after a cardiac catheterization
RATIONALE:
The nurse must determine the most appropriate assignment on the basis of the skills of the staff member and the needs of the client. In this case, the most appropriate assignment for the UAP would be to care for the client who requires frequent ambulation. The UAP is skilled in this task. The client who had a cardiac catheterization will require specific monitoring in addition to that of the vital signs. Wound irrigations and tube feedings are not performed by unlicensed personnel.
The nurse employed in a long-term care facility is planning the client assignments for the shift. Which client should the nurse assign to the unlicensed assistive personnel (UAP)? - CORRECT ANSWER-A client who requires a 24-hour urine collection (CORRECT)
2.
A client who requires twice-daily dressing changes
3.
A client who is on a bowel management program and requires rectal suppositories and a daily enema
4.
A client with diabetes mellitus who requires daily insulin and the reinforcement of dietary measures
RATIONALE:
The nurse must determine the most appropriate assignment on the basis of the skills of the staff member and the needs of the client. The assignment of tasks needs to be implemented on the basis of the job description of the individual, the individual's level of clinical competence, and state law. Options 2, 3, and 4 involve care that requires the skill of a licensed nurse. A UAP is not licensed
The nurse is assigned to care for four clients. When planning client rounds, which client should the nurse check first? - CORRECT ANSWER-A client on a ventilator (CORRECT)
2.
A client in skeletal traction
3.
A postoperative client preparing for discharge
4.
A client admitted on the previous shift who has a diagnosis of gastroenteritis
RATIONALE:
The airway is always a priority, and the nurse first checks the client on a ventilator. The clients described in options 2, 3, and 4 have needs that would be identified as intermediate priorities
The nurse employed in an emergency department is assigned to assist with the triage of clients arriving to the emergency department. The nurse should assign priority to which client? - CORRECT ANSWER-A client complaining of muscle aches, a headache, and malaise
2.
A client who twisted her ankle when she fell while in-line skating
3.
A client with a minor laceration on the index finger sustained while cutting an eggplant
4.
A client with chest pain who states that he just ate pizza that was made with a very spicy sauce (correct)
RATIONALE: In an emergency department, triage involves classifying clients according to their need for care, and it includes establishing priorities of care. The type of illness, the severity of the problem, and the resources available govern the process. Clients with trauma, chest pain, severe respiratory distress, cardiac arrest, limb amputation, or acute neurological deficits and those who sustained a chemical splash to the eyes are classified as emergent, and these clients are the number 1 priority. Clients with conditions such as simple fractures, asthma without respiratory distress, fever, hypertension, abdominal pain, or renal stones have urgent needs, and these clients are classified as the number 2 priority. Clients with conditions such as minor lacerations, sprains, or cold symptoms are classified as nonurgent, and they are the number 3 priority.
The nurse is educating a new nurse about mass casualty events (disasters). Which statement by the new nurse indicates a need for further teaching? Select all that apply - CORRECT ANSWER-"An event is termed a mass casualty when it overwhelms local medical capabilities."
2.
"Mass casualty events do not require an increase in the number of staff that are needed." (CORRECT)
3.
"A mass casualty event occurs only within the heath care facility and could endanger staff." (CORRECT)
4.
"A mass casualty event occurs if a fight between visitors occurs in the emergency department."
(CORRECT)
5.
"Mass casualty events may require the collaboration of many local agencies to handle the situation.
RATIONALE: Mass casualty events, also known as disasters, overwhelm local medical capabilities and may require the collaboration of multiple agencies and health care facilities to handle the crises. This type of event can occur in the health care facility or outside of it. Fights in the emergency department are not termed mass casualty events but are agency security and local enforcement issues. Mass casualty events almost always require an increase in staffing to ensure safe patient care.
The nurse is attending an agency orientation meeting about the nursing model of practice implemented in the facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that which is a characteristic of this type of nursing model of practice? - CORRECT ANSWER-A task approach method is used to provide care to clients.
2.
Managed care concepts and tools are used when providing client care.
3.
Nursing staff are led by the nurse when providing care to a group of clients. (correct)
4.
A single registered nurse is responsible for providing nursing care to a group of clients.
RATIONALE: In team nursing, nursing personnel are led by the nurse when providing care to a group of clients. Option 1 identifies functional nursing. Option 2 identifies a component of case management. Option 4 identifies primary nursing
A client experiences a cardiac arrest. The nurse leader quickly responds to the emergency and assigns clearly defined tasks to the work group. In this situation, the nurse is implementing which leadership style? - CORRECT ANSWER-1.
Autocratic (correct)
2. Situational
3. Democratic
4.
Laissez-faire
RATIONALE: Autocratic leadership is an approach in which the leader retains all authority and is primarily concerned with task accomplishment. It is an effective leadership style to implement in an emergency or crisis situation. The leader assigns clearly defined tasks and establishes one-way communication with the work group, and he or she makes all decisions independently. Situational leadership is a comprehensive approach that incorporates the leader's style, the maturity of the work group, and the situation at hand. Democratic leadership is a people-centered approach that is primarily concerned with human relations and teamwork. This leadership style facilitates goal accomplishment and contributes to the growth and development of the staff. Laissez- faire leadership is a permissive style in which the leader gives up control and delegates all decision making to the work group.
The nurse has delegated several nursing tasks to staff members. Which is the nurse's primary responsibility after the delegation of the tasks? - CORRECT ANSWER- Document that the task was completed.
2.
Assign the tasks that were not completed to the next nursing shift.
3.
Allow each staff member to make judgments when performing the tasks.
4.
Perform follow-up with each staff member regarding the performance and outcome of the task. (correct)
RATIONALE: The ultimate responsibility for a task lies with the person who delegated it. Therefore, it is the nurse's primary responsibility to follow up with each staff member regarding the performance of the task and the outcomes related to implementing the task. Not all staff members have the education, knowledge, and ability to make
judgments about tasks being performed. The nurse documents that the task has been completed, but this would not be done until follow-up was implemented and outcomes were identified. It is not appropriate to assign the tasks that were not completed to the next nursing shift.
The nurse is assigned to care for four clients. When planning client rounds, which client should the nurse collect data from first? - CORRECT ANSWER-A client scheduled for a chest x-ray
2.
A client requiring daily dressing changes
3.
A postoperative client preparing for discharge
4.
A client receiving oxygen who is having difficulty breathing
RATIONALE: The airway is always a priority, and the nurse would attend to the client who has been experiencing an airway problem first. The clients described in options 1, 2, and 3 would have intermediate priority
The emergency department nurse receives a telephone call and is informed that a tornado has hit a local residential area and numerous casualties have occurred. The victims will be brought to the emergency department. Which should be the initial nursing action? - CORRECT ANSWER-Prepare the triage rooms.
2.
Activate the agency emergency response plan. (CORRECT)
3.
Obtain additional supplies from the central supply department.
4.
Obtain additional nursing staff to assist with treating the casualties.
RATIONALE:
During a widespread disaster, many people will be brought to the emergency department for treatment. Although options 1, 3, and 4 may be components of preparing for the casualties, the initial nursing action should be to activate the emergency response plan.
A client is brought to the emergency department by the ambulance team after collapse at home. Cardiopulmonary resuscitation is attempted but is unsuccessful. The wife of the client tells the nurse that the client is an organ donor and that his eyes are to be donated. Which action should the nurse take next? - CORRECT ANSWER-Place dry, sterile dressings over the eyes of the deceased.
2.
Call the National Donor Association to confirm that the client is a donor.
3.
Close the eyes, elevate the head of the bed, and place a small ice pack on the eyes. (CORRECT)
4.
Ask the wife to obtain the legal documents regarding organ donation from the lawyer.
RATIONALE: When a corneal donor dies, antibiotic eyedrops may be prescribed and instilled. The eyes are closed and a small ice pack is placed on the closed eyes. The head of the bed is raised to 30 degrees to prevent edema. Within 2 to 4 hours, the eyes are enucleated. The cornea is usually transplanted within 24 to 48 hours. Option 1 is incorrect because dry dressings are not applied. Some organ donation protocols indicate using normal saline-moistened gauze. Option 2 is not an immediate action. In addition, the client should have a signed donor card, living will, or an organ donor- identified driver's license stating his or her wishes. Additional legal documentation should not be required. Agency procedures regarding donor care should be followed.
A client tells the nurse about deciding to refuse external cardiac massage. Which should be the most appropriate initial nursing action? - CORRECT ANSWER-Discuss the client's request with the family.
2.
Document the client's request in the client's record.
3.
Notify the health care provider of the client's request. (correct)
4.
Conduct a client conference to share the client's request
RATIONALE: External cardiac massage is one type of treatment that a client can refuse. The appropriate initial action is to notify the health care provider (HCP) because
a written "do not resuscitate" (DNR) prescription from the HCP must be present. The DNR prescription must be reviewed or renewed on a regular basis, per agency policy.
The nurse is documenting information regarding a client's care into the computerized medical record. Which actions by the nurse would be most effective in ensuring client confidentiality? Select all that apply - CORRECT ANSWER-Change the password for entering computer files at least monthly. (correct)
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