LEADERSHIP ATI 2020
1. A nurse is preparing an in-service for an annual skills fair at a community medical facility about fire safety. Place the
... [Show More] steps in the order in which they should be performed in the case of a fire emergency. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)
D. Rescue the clients.
A. Pull the fire alarm.
B. Confine the fire.
C. Extinguish the fire.
2. A nurse is caring for a client who is dying of metastatic breast cancer. She has a prescription for an opioid pain medication PRN. The nurse is concerned that administering a dose of pain medication might hasten the client's death. Which of the following ethical principles should the nurse use to support the decision not to administer the medication?
A. Utilitarianism
Rationale: Utilitarianism refers to actions that are right when they contribute to the greatest good.
B. Nonmaleficence
Rationale: Nonmaleficence is the duty to do no harm. The ethical mandate of nonmaleficence is that health care workers refrain from intentionally inflicting harm to clients.
C. Fidelity
Rationale: Fidelity is the duty to keep one's promises or word. It refers to the obligation to be faithful to the agreements, commitments, and responsibilities that one has made to oneself and others.
D. Veracity
Rationale: Veracity is the duty to tell the truth. It means that one does not intentionally deceive or mislead clients.
3. A charge nurse notes that a staff nurse delegates an unfair share of tasks to the assistive personnel (AP) and the nurses on next shift report the staff nurse frequently leaves tasks uncompleted. Which of the following statements should the charge nurse make to resolve this conflict?
A. "I need to talk to you about unit expectations regarding delegating and completing tasks."
Rationale: This statement opens the conversation in a nonthreatening way. The focus is on the issue of the equity of the assignment rather than on any personal characteristic of the individual.
B. "Several staff members have commented that you don't do your fair share of the work."
Rationale: This statement is accusatory.
C. "If you don't do your share of the work, I will have to inform the nurse manager."
Rationale: This statement is punitive.
D. "You have been very inconsiderate of others by not completing your share of the work."
Rationale: This statement is punitive.
4. A nurse is providing care for a surgeon on a medical-surgical unit. A nurse from another unit asks the nurse about the surgeon’s medical diagnosis. The nurse responds that he is unable to provide the information requested. The nurse is displaying which of the following ethical principles?
A. Utility
Rationale: Utility is the ethical principle that the good of many people outweighs the good of one person.
B. Paternalism
Rationale: Paternalism is the belief that one individual has the right to make decisions for another. It negates the client’s right to autonomy.
C. Justice
Rationale: Justice is the ethical principled based on the belief that everyone should be treated fairly.
D. Nonmaleficence
Rationale: The nurse is obligated to protect the client’s confidential information. A breach of confidentiality can place the client at risk of harm. Nonmaleficence is the ethical duty to prevent harm to the client.
5. When planning delegation of tasks to assistive personnel (AP), a nurse considers the five rights of delegation. Which of the following should the nurse consider when using one of the five rights of delegation?
A. The AP's ability to prioritize
Rationale: Although the nurse could determine the AP’s ability to prioritize, this is not one of the rights of delegation.
B. The AP has the knowledge and skill to perform the task
Rationale: The right person is one of the five rights of delegation. The nurse should seek information from the AP about his individual skill level before delegating the task.
C. The AP's rapport with clients
Rationale: Although a positive rapport with clients is important, this is not one of the five rights of delegation.
D. The AP’s ability to complete the task without assistance
Rationale:
The nurse does not relinquish accountability for supervising the AP; therefore, this is not one of the five rights of delegation.
6. While caring for a client, the nurse experiences a needle stick injury. Which of the following actions should the nurse take first?
A. Complete an incident report.
Rationale: The nurse should complete an incident report; however, there is another action the nurse should take first.
B. Request the risk manager obtain consent for HIV testing from the client.
Rationale: Although it is important that the client’s HIV status is determined, there is another action the nurse should take first.
C. Wash the site of injury with soap and water.
Rationale: The greatest risk to the nurse is infection transmission; therefore, the nurse should first wash the area with soap and water to reduce the risk of transmission.
D. Consent to postexposure treatment with antiretroviral medications.
Rationale: Although treatment with antiretroviral medications should be started within 1 to 2 hr after a needle stick injury and be continued for 28 days if the client’s HIV status is positive, there is another action the nurse should take first.
7. A nurse is caring for a client who has named a person to serve as his health care proxy. The client states he needs clarification about this type of advance directives. Which of the following statements by the client indicates a need for clarification?
A. "I can change who I designate as my health care proxy at any time."
Rationale: This is a correct statement regarding a health care proxy.
B. "If I become incapacitated, end-of-life choices will be made by my proxy."
Rationale: This is a correct statement regarding a health care proxy.
C. "I have to choose a family member as my health proxy."
Rationale: The client should choose someone he trusts and knows about his wishes for day-to-day and end-of-life care. It can be a family member, but it does not have to be a family member.
D. "The health care proxy does not go into effect until I am incapable of making decisions."
Rationale: This is a correct statement regarding a health care proxy.
8. A nurse is serving on a continuous quality improvement (CQI) committee that has been assigned to develop a program to reduce the number of medication administration errors following a sentinel event at the facility. Which of the following strategies should the committee plan to initiate first?
A. Provide an inservice on medication administration to all the nurses.
Rationale: A recommendation for staff education may be indicated, but this does not assist the committee to identify factors that lead to medication errors.
B. Require staff nurses to demonstrate competency by passing a medication administration examination.
Rationale: Ensuring competency in medication administration may be indicated, but this does not assist the committee to identify factors that lead to medication errors.
C. Review the events leading up to each medication administration error.
Rationale: After a sentinel event, the first step the committee should plan to take is to use root cause analysis to identify the underlying cause or causes that led to the medication errors.
D. Develop a quality improvement program for nurses involved in medication administration errors.
Rationale: Although development of a quality improvement program for nurses involved in medication errors may be indicated, this does not assist the committee to identify factors that lead to medication errors.
9. A charge nurse has access to the facility’s electronic client records. It is appropriate for the charge nurse to share her personal password with whom?
A. The nurse manager
Rationale: A nurse manager authorized to have access to a computer will have a personal password.
B. No one
Rationale: Computer passwords cannot be shared with others for any reason. Any facility employee authorized to have access to the database on a computer will have a personal password.
C. A nursing student who is completing a preceptorship on the unit
Rationale: A nursing student who is authorized to have access to the database on a computer will have a personal password.
D. The unit clerk
Rationale: A unit clerk authorized to have access to a computer will have a personal password.
10. A nurse on a medical-surgical unit is reconciling a newly admitted client’s medication. The nurse is reviewing the process of medication reconciliation with a newly licensed nurse. The nurse should include which of the following information?
A. The American Hospital Association requires accredited facilities to have protocols in place requiring
medication reconciliation.
Rationale: The Joint Commission requires accredited facilities to have protocols in place requiring medication reconciliation.
B. The purpose of medication reconciliation is to prevent adverse medication reactions.
Rationale: Medication reconciliation includes reviewing an accurate list of all medications the client is taking and comparing that list to new medications the provider has prescribed. This action decreases the risk of medication interactions and adverse outcomes.
C. The nurse who performs medication reconciliation is demonstrating the ethical principal of veracity.
Rationale: This action by the nurse does not demonstrate the ethical principal veracity, which means telling the truth. The nurse who performs medication reconciliation is demonstrating the ethical principle beneficence, which means the nurse takes action to promote good, and nonmaleficence, which means the nurse takes action to prevent harm.
D. The International Council of Nurses Code of Ethics stipulates that the nurse performs medication reconciliation when a client is admitted to a facility, is transferred to another facility, and when a client is discharged from a facility.
Rationale: The International Council of Nurses Code of Ethics stipulates that nurses have a responsibility to promote health and prevent illness, but it does not mandate medication reconciliation. The Institute for Healthcare Improvement recommends the nurse perform medication reconciliation when a client is transferred and The Joint Commission requires medication reconciliation when a client is admitted and when a client is discharged.
11.A A nurse is caring for a client on the medical-surgical unit. The client has been taking warfarin at home and her laboratory values reveal her INR is 3.5. The client states she is checking herself out of the hospital and refuses to wait until her provider can discuss the situation with her. Which of the following actions should the nurse take?
A. Tell the client she will not be permitted to leave the facility until she has signed the against medical advice (AMA) form.
Rationale: The nurse should attempt to get the client to sign the AMA form because this measure can help to defend the facility if a lawsuit ensues; however, the nurse should not tell the client she will not be permitted to leave the facility because this action could lead to charges of false imprisonment.
B. Tell the client if she leaves without a written prescription for discharge, her insurance will not pay for the facility visit.
Rationale: This action by the nurse is uncaring and the client could perceive it as a threat.
C. Explain the risk the client faces if she leaves the facility.
Rationale: The expected reference range for INR while a client is taking warfarin is 2 to 3.The nurse has an obligation to explain to the client that her INR is very high and she is at risk for bleeding.
D. Ask the security department to guard the room to the client’s door.
Rationale: This action could lead to charges of false imprisonment.
12.A A nurse on a medical-surgical unit is planning to delegate tasks to an adult volunteer. Which of the following tasks should the charge nurse avoid assigning to the volunteer?
A. Delivering meal trays to clients in their rooms
Rationale: Delivering meal trays is an appropriate task to delegate to a volunteer.
B. Assisting a client who has difficulty seeing the foods on the tray while eating
Rationale: Assisting a client who has a vision deficiency to eat is an appropriate task to delegate to a volunteer.
C. Delivering a routine urine specimen to the laboratory
Rationale: Delivering a routine urine specimen is an appropriate task for a volunteer.
D. Observing a postoperative client who is confused
Rationale: A nurse who uses delegation is responsible for delegating tasks to the right person. A volunteer does not have the training to intervene if this client tries to get out of bed or starts pulling at tubes. The observation of this client should be assigned to a member of the nursing staff. [Show Less]