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NR 442 FINAL EXAM
ATI LEADERSHIP A
1. A nurse is caring for several clients. Which of the following actions should the nurse take to maintain client confidentiality?
A. Tell a client’s partner that the results of his wife’s lab tests cannot be disclosed without her permission
B. Ask the assistive personnel to refer to clients by room number in public areas
C. Explain to a student nurse that verbal permission must be obtained before using a client’s name in school assignments
D. Share info about a client with immediate family members after personal ID has been provided
2. A nurse is caring for a client who asks for info about advance directives. Which of the following is an appropriate response by the nurse? ***
A. Your advance directives will take effect when you are unable to make health care decisions
B. You will not be able to make changes to the advance directives once you sign it
C. Your advance directives can specify which medical care you do not want but cannot specify which medical treatments you can have
D. You must have advance directives on record within 24hr of a hospital admission
3. A nurse assumes care of a client following morning report and notes that the client’s morning lab results have not been received. Which of the following actions should the nurse take?
A. Administer the client’s insulin as prescribed
B. Give the NPH and hold the regular insulin until the lab results are back
C. Obtain a capillary blood glucose reading
D. Hold the client’s breakfast until the lab results are back
4. A nurse on a med-surg unit is caring for four clients. The nurse should recognize that which of the following clients is the highest priority?
A. A client scheduled for a tubal ligation in 2hr who is crying
B. A client who has peripheral vascular disease and has an absent pulse in the right foot
C. A client who has type 1 DM and needs the first dressing change for a stage II decubitus ulcer
D. A client who has MRSA and has an axillary temp of 38C (100.4F)
5. A nurse has four client assignments on a maternal newborn unit. Which of the following tasks can be delegated to an AP?
A. Verifying the mother’s fundal height
B. Assisting the mother with cord care
C. Showing the mother how to position the newborn for sleep
D. Measuring output of the mother’s first voiding
6. An AP tells the 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 care for fewer of these clients
D. Why do you not want to care for clients who are incontinent?
7. A client is considering having a tubal ligation, and she tells the nurse that she is uncertain if it is the right thing to do. Which of the following is an appropriate response by the nurse?
A. Provide information on alternate birth control methods
B. Ask the client if she has her partner’s approval
C. Emphasize the benefits of having the procedure
D. Discuss with the client her feelings about the procedure
8. 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 the conflict to occur in what order?
A. Conflict aftermath 5
B. Felt conflict 3
C. Manifest conflict 4
D. Latent conflict 1
E. Perceived conflict 2
9. A nurse is conducting an orientation class for new clients and their families at a long-term care facility. Which of the following client rights should the nurse address at the orientation? Select all that apply
A. The right to be treated with respect and dignity
B. The right to full access of the facility
C. The right to refuse their medications
D. The right to leave regardless of provider recommendations
E. The right to be fully informed of their health conditions
10. A nurse is witnessing a client sign the consent form for a surgical procedure. The client has a question regarding alternative treatments. Which of the following actions should the nurse take?
A. Review the surgical procedure described on the consent form with the client
B. Provide the client with education materials about the procedure
C. Answer the client’s question and have the client sign the consent form
D. Call the surgeon to discuss alternative treatments with the client
11. A nurse is planning discharge care for an older adult client who has RA. 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
12. A nurse from a medical unit is asked to work on an orthopedic unit. The medical nurse has no ortho experience. Which of the following clients should be assigned to the medical nurse? ***
A. A client in balance skeletal traction
B. A client who had a total hip arthroplasty 3 days ago
C. A client who has a fractured femur with a new cast
D. A client who had a right above-the-knee amputation 24hrs ago
13. A client who is being D/C today asks the nurse for supplies for his wound dressing. Which of the following actions should the nurse take to ensure quality, cost-effective car?
A. Ask the client how many supplies he wants
B. Provide enough supplies for 1-2 days
C. Check the client’s insurance before acting
D. Explain that no supplies are given for home use
14. An older adult-client is being D/C with a postop infection, requiring daily home IV antibiotics through a PICC line. Which of the following actions should the case manager perform prior to discharge?
A. Assess the client’s home environment for possible reservoirs of infection
B. Verify the patency of the PICC line
C. Provide dressing change and wound assessment teaching
D. Ensure that home infusion therapy has been arranged
15. A home health nurse is performing a home safety assessment for a family who has toddler. Which of the following findings is a potential environmental hazard the nurse should discuss with the parents?
A. The crib mattress is positioned at the lowest level
B. The toy box does not have a hinged lid
C. The toilet seat lid is in the raised position
D. There is a throw rug under the toddler’s crib
16. A nurse manager is presenting an in-service about preventing readmission of clients due to complications after joint replacement surgery. Which of the following leadership tasks is the nurse performing?
17. A nurse is reviewing a safe use of a wheelchair with a group of AP. Which of the following should the nurse include?
A. Raise the footplates of the wheelchair before transferring the client
B. Lock the brake on one wheel of the chair when transferring the client
C. Push the wheelchair into the elevator with the front wheels first
D. Stand behind the wheelchair when moving a client down a ramp
18. A nursing unit is undergoing changes to accommodate new bariatric services that will be available on the unit. Some staff members have verbalized displeasure with the changes. Which of the following should the charge nurse do? Select all that apply
A. Role model a positive approach to the changes
B. Redirect the conversation when negative comments about the changes are made
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
19. A charge nurse is planning client care assignments for the unit. Which of the following clients should the nurse assign to an LPN?
A. A client who has anemia and is scheduled for a blood transfusion
B. A client who has Crohn’s disease and requires an enteral feeding
C. A client who has a new diagnosis of diabetes and requires teaching for self-administration of insulin
D. A client who has a pulmonary embolism and is receiving an IV infusion of heparin
20. A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within the next 2 hr. The client tells the nurse that she has called a taxicab and is leaving the hospital. After notifying the surgeon, which of the following actions should the nurse take next?
A. Have the client sign the “Against Medical Advice” form
B. Inform the client about the risks she may encounter by leaving the facility
C. Document the client’s statements in the medical record
D. Notify the risk manager
21. A nurse is observing a newly licensed nurse who is performing 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. Maintain a 1.25cm (1/2 inc) border around the edges of the sterile field
C. Picks up first sterile glove by grasping the folded cuff edge
D. Places the transparent dressing using clean gloves
22. A client presents to the ED with weakness, vomiting, and diarrhea for the past 3 days. Which of the following is the highest priority assessment for this client?
A. Bowel sounds
B. The client’s temperature
C. Urine specific gravity
D. Serum potassium level
23. A nurse is caring for a client who is refusing a blood transfusion due to religious beliefs. The provider discusses this treatment and likely outcomes with the client, who remains opposed to the transfusion. Which of the following is the appropriate intervention for the nurse?
A. Have the provider reinforce the necessity of the transfusion
B. Encourage the family to persuade the client to reconsider the transfusion
C. Ask the chaplain to convince the client that the transfusion is acceptable
D. Support the client’s decision to forego the transfusion
24. A client seen in the ED for back pain is provided a prescription for oxycodone. A staff nurse tells the charge nurse that she thinks the client is seeking drugs and is not actually in distress. Which of the following responses by the charge nurse is appropriate?
A. Clients are the experts on their own pain
B. Let’s withhold the oxycodone until we can consult with the provider
C. Contact mental health services to arrange for a consultation
D. It sounds like non-pharmacological interventions would be best for this client
25. A charge nurse is discussing issue with a staff nurse. When evaluating statements by the staff nurse, the charge nurse should recognize that which of the following reflects and intrapersonal conflict?
A. I’m not sure whether I want to apply for the unit manager’s position or start a family this year
B. I feel frustrated because I just readmitted a client who refuses to take his insulin
C. The unit manager is more concerned with saving money than with clients getting quality care
D. Every time I request an extra day off I’m denied, but other nurses’ requests are approved
26. An older adult client is brought to ED by family members. The client has stage IV pressure ulcers, and a close inspection of the wounds reveals the presence of maggots. Which of the following is the nurse’s legal responsibility regarding this situation?
A. Confront the family members
B. Call the local police department
C. Notify Adult Protective Services
D. Report the situation to facility administrators
27. A nurse working in a community health clinic is caring for four clients who each have a communicable disease. Which of the following conditions is considered a nationally notifiable infectious disease?
A. Respiratory syncytial virus (RSV)
D. Chlamydia trachomatis
28. A charge nurse is talking with a staff nurse following a workshop on advance directives. Which of the following statements by the staff nurse demonstrates understanding of advance directives? ***
A. A client’s advance directives are not valid until the provider writes a prescription
B. A health care proxy should make decisions for a client who has a terminal illness
C. A family member of a client can have the living will overturned in some cases
D. A client who has an acute illness may not have a DNR prescription
29. A nurse working in a long-term care facility is making a room assignment for a client who has dementia and is easily agitated. Which of the following rooms should the nurse select for the client?
A. A semiprivate room near the unit’s activity room
B. A newly renovated room near the entrance of the unit
C. A corner room between the conference room and elevator
D. A private room near the nurse’s station
30. A charge nurse is planning care for a group of clients. Which of the following tasks should be delegated to an AP? Select all that apply
A. Flushing a client’s saline lock
B. Ambulating a client who uses a walker
C. Adding thickener to thin liquids on a client’s food tray
D. Showing a client how to use an incentive spirometer
E. Evaluating a client’s gag reflex before mealtime
31. A charge nurse is assigning tasks to an RN, an LPN, and an AP. Which of the following tasks should the charge nurse delegate to the RN?
A. Completing an admission assessment for a client who has just transferred from the ED
B. Inserting an indwelling urinary cath for a client who has not voided for 6 hr
C. Assisting a client who is 12hr post op from eye surgery to ambulate
D. Obtaining a sterile specimen from a client’s infected surgical wound
32. 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 if he suspects that his colleague is under the influence of alcohol?
A. Notify the charge nurse of his assessment
B. Confront the impaired nurse regarding his suspicions
C. Wait to see if the behavior occurs again before taking action
D. Suggest to the nurse that she request sick leave for the rest of the shift
33. A nurse is receiving change-of-shift report at the start of the shift. 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 6hr ago and has a HR of 120 for the last 2 hr
C. A client who is requesting pain meds 24hr after an ORIF of the left ankle
D. A client who has pneumonia and is refusing prescribed medication
34. A nurse finds that a new IV pump has infused 400mL of solution over 2hr when the rate was set at 100mL/hr. After notifying the provider and verifying that the pump was properly programmed, which of the following is the nurse’s highest priority?
A. Fill out an incident report and submit it to the nurse manager
B. Consult with the other nurses who have experience with this type of pump
C. Tag the pump for maintenance and acquire a new pump for the client
D. Call the biomedical engineering dept and report the problem
35. A nurse case manager is developing a critical pathway for clients who have pneumonia. Which of the following data should the nurse include?
A. Type of insurance
B. Home medication
C. Significant others
D. Treatment milestones
36. A nurse receives report on 4 clients. Which of the following clients should the nurse assess first?
A. A client admitted with COPD who has a pulse ox reading of 90% on 2L/min of oxygen
B. A client admitted with acute pancreatitis whose PCA cassette is nearly empty
C. A client admitted for a fractured hip who has developed slurred speech
D. A client admitted with bronchitis who is reporting pain on inspiration
37. A nurse manager finds that there has been an increase in UTIs on the unit. To address this problem, the first action the nurse manager should take is to
A. Conduct an in-service that reviews proper catheter insertion and maintenance
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
38. A charge nurse is supervising the care of several clients. Which of the following actions requires intervention by the charge nurse?
A. A student nurse is photocopying his assigned client’s diagnostic test results
B. An AP documents a client’s vital signs on the client’s paper-based graphic record
C. The unit secretary faxes a client’s lab results to the provider
D. An RN stays with a client who is reading the medical records that he requested
39. 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 has 2+ edema of her lower extremities
B. A client who is 2 days postop and has a urine output of 20mL/hr
C. A client who started taking atenolol and reports feeling lethargic
D. A client receiving morphine and reports nausea
40. A nurse in the ED is performing triage for a group of clients following a MVC. Which of the following clients should the nurse request the provider assess first?
A. A client who has a closed leg fracture and reports peripheral paresthesia
B. A client who reports a sprained ankle and has a laceration over the medial ankle
C. A client who has arm contusions and manifests asymmetrical thoracic movement
D. A client who has abrasions to the face and is requesting medication for severe pain
41. A facility has identified an increase in health care-associated UTIs on the med-surg unit. A nurse is participating in a quality improvement process to address this problem. Which of the following should be the first step in the process?
A. Determine the effectiveness of planned interventions
B. Implement strategies to decrease the incidence of UTIs
C. Develop a plan that outlines the process for data collection
D. Establish best practice guidelines for reducing the incidence of UTIs
42. A charge nurse is delegating tasks on a nursing unit that is short staffed. A client has a prescription for a wound irrigation twice a day. Which of the following is an appropriate action for the charge nurse to take? ***
A. Perform the dressing change himself on rounds
B. Delegate the procedure to an AP
C. Assign the procedure to an LPN
D. Reschedule the procedure to be performed once per day
43. A charge nurse is evaluating a newly licensed nurse at the end of orientation. Which of the following behaviors indicates the nurse is using effective time management skills?
A. Performs total care for her assigned clients
B. Waits to complete charting until the end of the shift
C. Uses a set list of priorities throughout the shift
D. Makes a list of non-essential tasks to perform later
44. A hospital has been notified of a train derailment resulting in multiple clients experiencing life-threatening injuries. The external disaster plan has been activated. Which of the following is an appropriate action of the charge nurse on the PACU? ***
A. Take extra wheelchairs to the ED
B. Send PACU AP to assist with triage
C. Identify stable clients for transfer to a surgical unit
D. Report to the command center for further instructions
45. A nurse is caring for a client who is 3 days postop following open heart surgery and is to transfer to the medical-surgical unit. Which of the following should the nurse plan to include in the verbal report?
A. The client’s dressing change schedule
B. The client’s LOC
C. The client’s vital signs from the previous shift
D. The client’s occupation
46. A case manager is initiating the plan of care for a client receiving warfarin who had a stroke. Which of the following is most important for the case manager to include in the client’s plan of care?
A. Scheduling follow-up tests for prothrombin time and INR
B. Making a referral to speech therapy
C. Arranging physical therapy home visits
D. Providing client education related to dietary restrictions
47. A nurse manager needs to address an increased rate of client med errors. Which of the following strategies represents an authoritarian approach to managing this issue?
A. Inform the staff of the penalties that can result from med errors
B. Encourage the staff to have 2 nurses verify medication orders to prevent errors
C. Provide a suggestion box for the staff to submit ideas for error prevention
D. Ask 3 experienced nurses to help investigate common causes of the errors
48. A charge nurse is responsible for a caseload of clients on a surgical unit. Which of the following occurrences during the shift requires the completion of an incident report?
A. A client’s advance directives are not in the med record
B. A nurse administers a routine medication 30 min after the scheduled time when the client returns from physical therapy
C. A client’s IV solution infused over 6 hr instead of the prescribed 8 hr
D. A nurse documents a client’s vital signs on the graphic record at the end of the shift
49. A nurse manager is coordinating staff assignments for RNs and LPNs following a local disaster. Which of the following is an appropriate assignment by the nurse manager to provide safe and effective client care? ***
A. RNs transport class IV (black tag) clients
B. LPNs provide care to class III (green tag) clients
C. LPNs initiate care to class I (red tag) clients
D. LPNs facilitate care to class II (yellow tag) clients
50. An RN delegates the task of obtaining the BP of a client who is 2hr postop following a cholecystectomy to an LPN. The LPN reports a BP that is significantly higher than the client’s previous reading. Which of the following actions should the RN take first?
A. Recheck the client’s BP
B. Treat the client’s BP with a prescribed antihypertensive
C. Ask the LPN to review the technique for obtaining BP
D. Review the client’s medical record for other episodes of elevated BP
51. A charge nurse is performing chart reviews on infection control precautions implemented by nursing personnel during the admission of clients to the unit. Which of the following is an appropriate infection control precaution?
A. Droplet precautions for a client who has meningococcal pneumonia
B. Airborne precautions for a client who has shigella
C. Droplet precautions for a client who has MRSA
D. Airborne precautions for a client who has RSV
52. A staff nurse at a long-term care facility is evaluating an AP caring for a group of clients who require restraints. Which of the following is an appropriate action by the AP?
A. Securing mitten restraints around the forearm
B. Using a square knot when securing the restraint strap
C. Applying the belt restraint beneath the client’s clothing
D. Placing the restraint tie on a moveable part of the bed frame
53. A nurse case manager is planning a teaching session on use of critical pathways with a group of newly licensed nurses. The nurse should include which of the following in the teaching about critical pathways?
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
54. A nurse is reviewing facility data on hand hygiene adherence and finds that nurses are not performing hand hygiene after client contact 28% of the time. Which of the following is the first action the nurse should take when developing a plan to increase employee hand hygiene adherence?
A. Schedule training sessions to teach proper technique
B. Provide alcohol-based hand wash outside of each client’s room
C. Identify a way to measure hand hygiene adherence
D. Set a goal for improvement in adherence
55. A nurse manager is developing a class for newly licensed nurses on strategies to promote client rights. Which of the following should the nurse manager include in the teaching?
A. Spend equal amounts of time providing care for each client
B. Verify that a provider prescription is in the medical record for clients who have restraints
C. Ensure that competent clients do not leave the hospital without medical discharge
D. Present the purpose, risks, and benefits of a surgery when the provider is unavailable
56. A charge nurse on a medical unit hears the fire alarm and announcement that a fire is occurring on the unit. Which of the following is the priority action by the charge nurse?
A. Turn off the oxygen supply valve to the unit
B. Instruct ambulatory clients to go to a safe area
C. Verify that unit fire doors are closed
D. Direct personnel to use fire extinguishers
57. A nurse is caring for a school-age client who is seeking treatment for a laceration to the right forearm that occurred during soccer practice. The client was transported to the ED by a friend’s parent and the soccer coach. The nurse should ensure that informed consent is given by
A. The client
B. The friend’s parent
C. The client’s guardian
D. The soccer coach
58. A charge nurse is reviewing the plan care for a client who has active herpes simplex lesions. Which of the following interventions is appropriate for the plan of care?
A. Admit the client to a private room with negative-pressure airflow
B. Wear a gown and gloves when caring for the client
C. Have the client wear a mask during transport
D. Wear a face mask and eye protection when caring for a client
59. A nurse is caring for a client who has metastatic cancer and decides not to continue treatment. Which of the following is an appropriate response by the nurse?
A. Tell me what this is like for you
B. Have you discussed your concerns with your doctor
C. Is your family supportive of your decision to D/C treatment
D. Have you considered trying alternative therapy for your cancer
60. A nurse has a friend who is a client on another unit. The nurse is concerned about the friend’s prognosis. Which of the following is an appropriate action by the nurse?
A. Review the friend’s medical records
B. Page the primary care provider for information
C. Ask the assigned nurse about the friend’s prognosis
D. Ask the friend what the provider has told her
[Solved] ATI LEADERSHIP A NURSING - NR 442
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