Review ATI NU2508 Leadership Final Exam

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ATI NU2508 Leadership Final Exam

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Total Questions : 120

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Question 1:

A nurse is receiving change-of-shift report at the start of the shift. Which of the following statements by the nurse giving report indicates to the oncoming nurse that she should assume total care for the client, rather than assigning tasks to the assistive personnel (AP)?

A. "The client works in the hospital radiology department." B. "The client discussed having prior thoughts of suicide." C. "The client's blood pressure and pulse have been fluctuating throughout the day." D. "The client's family members have been present most of the day."

Answer and Explanation

Choice A:

A. "The client works in the hospital radiology department": This information is irrelevant to the client’s current health status and does not imply a need for total care by the nurse.

Choice B:

B. "The client discussed having prior thoughts of suicide": While suicidal ideation is serious and requires careful monitoring and assessment, this information alone does not necessarily indicate that the nurse must assume total care. A nurse would still delegate non-critical tasks to the AP, but constant monitoring and appropriate interventions would still be the nurse’s responsibility.

Choice C:

C. "The client's blood pressure and pulse have been fluctuating throughout the day": Fluctuating vital signs, especially blood pressure and pulse, can indicate an unstable condition that may require immediate attention and careful monitoring. This scenario suggests that the client’s condition may be critical and requires ongoing assessment and evaluation by the nurse, rather than simply delegating tasks like monitoring vital signs to assistive personnel (AP). The nurse needs to assess the situation thoroughly, interpret the fluctuations, and adjust the care plan accordingly.

Choice D:

D. "The client's family members have been present most of the day": Family presence alone does not impact the need for total care by the nurse. It is important for the nurse to communicate with the family, but this statement does not indicate the need for the nurse to assume total care over other team members.

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Question 2:

Day 1, 2115:

Client admitted to the behavioral health unit. Client has a history of schizophrenia with psychosis and had not been taking medications prior to admission. While in common area appeared agitated, stated, "I need my sunglasses" and "I want to go home" repeatedly. Client appeared to be talking to someone not present.

2330:

Client was constantly rocking back and forth, mumbling to self, and intermittently yelling. Client repeatedly shuffled a deck of cards constantly, looking at an empty chair, and kept repeating the same sentences. Patient was agitated about sunglasses and being in an unfamiliar place.

Day 2, 0500:

When approached by staff, the client stated, "My sunglasses are broken, I still want them." Staff retrieved client's sunglasses. When the client saw the broken sunglasses, they yelled, "You broke my sunglasses more!" Continuously moving body and hands were fidgeting

0900:

Client raising voice, appeared to be talking to someone not present and hitting self. Escalation resulted in the client throwing chair. Other clients were removed from the common room and client removed to seclusion room Primary provider has been informed awaiting return call.

Day 1, 2130:

Lorazepam 1 mg IM PRN for agitation

Day 2, 0905:

Lorazepam 1 mg IM as prescribed.

A nurse is supervising a newly licensed nurse who is caring for a client on a behavioral health unit.

Exhibits

Complete the following sentence by using the list of options.

The nurse should instruct the newly licensed nurse to first

then .

Answer and Explanation

Explanation

Provide continuous monitoring of this client: Continuous monitoring is essential to ensure the client's safety while in seclusion, particularly given their agitated and potentially harmful behavior.

Obtain provider prescription for seclusion or restraints: It's necessary to ensure that the use of seclusion is appropriately authorized and documented, following the facility's protocol and legal requirements.

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Question 3:

A nurse manager observes an unknown man in a laboratory coat making copies of a client's medical record. Which of the following actions should the nurse plan to take first?

A. Report the observation to the nurse caring for that client. B. Inform the nursing supervisor. C. Approach the man and ask why he is making copies. D. Notify hospital security.

Answer and Explanation

Choice A:

Reporting the observation to the nurse caring for that client is important but not the immediate priority.

Choice B:

Informing the nursing supervisor is necessary but should be done after assessing the situation directly.

Choice C:

Approaching the man and asking why he is making copies is the most immediate and direct action. It allows the nurse to assess the situation and determine if the man has legitimate access to the client's medical record or if further action is needed.

Choice D:

Notifying hospital security may be necessary if the man’s actions are unauthorized, but the first step is to gather more information.

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Question 4:

A nurse is planning to assign care activities to the assistive personnel (AP) on her team. Which of the following activities can the nurse assign to the AP? (Select all that apply.)

A. Check the position of a client in soft wrist restraints. B. Accompany a client who has depression to occupational therapy. C. Set limits with a client who has mania. D. Sit with a client who has alcohol use disorder and whose last drink was five days ago. E. Assess a client who has hypomania for exhaustion.

Answer and Explanation

Choice A:

Check the position of a client in soft wrist restraints is appropriate for an AP as it involves routine monitoring and ensuring the client's safety.

Choice B:

Accompany a client who has depression to occupational therapy is a task that can be assigned to an AP, as it involves providing support and ensuring the client's safe arrival to therapy.

Choice C:

Set limits with a client who has mania is not appropriate for an AP, as this involves therapeutic communication and behavior management, which requires nursing judgment.

Choice D:

Sit with a client who has alcohol use disorder and whose last drink was five days ago can be assigned to an AP as it involves providing a supportive presence and monitoring, but the nurse should assess for withdrawal symptoms.

Choice E:

Assess a client who has hypomania for exhaustion is a nursing responsibility that involves evaluation and judgment, making it inappropriate to delegate to an AP.

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Question 5:

A nurse is planning to assign tasks for a group of clients. Which of the following tasks should the nurse plan to assign to an assistive personnel (AP)? (Select all that apply.)

A. Ambulate an older adult client who has hypertension. B. Provide discharge instructions for a client who has a new skin graft. C. Check a blood product with another nurse prior to administration. D. Weigh a client who has heart failure. E. Perform an admission assessment on a client.

Answer and Explanation

Choice A:

Ambulate an older adult client who has hypertension is a task that an AP can perform, provided the client is stable and has been assessed by the nurse.

Choice B:

Provide discharge instructions for a client who has a new skin graft is a task that requires nursing judgment and cannot be delegated to an AP.

Choice C:

Check a blood product with another nurse prior to administration is a nursing responsibility that requires verification by licensed personnel and cannot be delegated to an AP.

Choice D:

Weigh a client who has heart failure is appropriate for an AP, as it involves routine measurement that can be delegated.

Choice E:

Perform an admission assessment on a client is a nursing responsibility and cannot be delegated to an AP.

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Question 6:

A nurse suspects that a coworker is diverting opioid analgesics. Which of the following is an adverse effect of opioid medications?

A. Dilated pupils B. Euphoria C. Rhinorrhea D. Hallucinations

Answer and Explanation

Choice A:

Dilated pupils are typically associated with stimulant use, not opioids.

Choice B:

Euphoria is a common effect of opioid use and can indicate misuse or diversion of these medications.

Choice C:

Rhinorrhea is usually associated with withdrawal from opioids rather than their use.

Choice D:

Hallucinations can occur with certain drugs but are less commonly associated with opioid use compared to euphoria.

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Question 7:

A nurse is caring for a client who has a history of dementia. The client is alert and oriented to person, place, and time, and has advance directives. The client is scheduled for a procedure that requires informed consent. Which of the following persons should sign the informed consent?

A. The client B. The client's son, who has a durable power of attorney C. The client's partner D. The client's daughter, who is the primary caregiver

Answer and Explanation

Choice A:

The client should sign the informed consent if they are alert, oriented, and capable of making decisions. The client's ability to understand the procedure and its implications is key to valid informed consent.

Choice B:

The client's son, who has a durable power of attorney would only sign the consent if the client were not competent or unable to understand the procedure, which is not the case here.

Choice C:

The client's partner may be involved in the decision-making process but does not have the legal authority to sign the consent unless designated as a legal representative.

Choice D:

The client's daughter, who is the primary caregiver would also not have the legal authority to sign the consent unless she holds a durable power of attorney or the client is deemed incapable of giving consent.

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Question 8:

1400:

Client transferred from PACU following appendectomy. Oriented to person, place, and time. Surgical dressing is dry and intact. Wound drain has 30 mL of serosanguinous drainage. Client reports pain is 7 on a scale of 0 to 10.

2200

Bowel sounds are present in all quadrants. Client is passing flatus. Urinary output is 400 mL over 6 hr. Client reports incisional pain of 4 on a scale of 0 to 10. Surgical dressing has a moderate amount of serosanguinous drainage. Wound drain has 0 mL output over 8 hr.

1400:

Temperature 37.8° C (100" F)
Heart rate 110/min
Respiratory rate 18/min
Blood pressure 165/70 mmHg
SpO2 95% on room air

1800:

Temperature 37.8° C (100° F)
Heart rate 96/min
Respiratory rate 20/min
Blood pressure 125/78 mmHg
SpO2 96% on room air

1400

Ceftriaxone 1 gram IV daily
Acetaminophen 650 mg PO every 6 hours for pain

A nurse is caring for a client who is postoperative.

Exhibits

Which of the following should the nurse request as a recommendation in an SBAR report to the provider? Select All That Apply

A. Medication for elevated temperature B. Insertion of NG tube for decompression C. Oxygen 2 to 4 L/min via nasal cannula D. Insertion of urinary catheter E. Evaluation of surgical wound drain

Answer and Explanation

Choice A:

While the client's temperature is not extremely high, it is elevated and persistent. Requesting an antipyretic or further evaluation may be warranted to prevent potential complications.

Choice B:

Insertion of NG tube for decompression is not necessary as the client is passing flatus and has bowel sounds in all quadrants, indicating normal gastrointestinal function.

Choice C:

Oxygen 2 to 4 L/min via nasal cannula is not necessary since the client's SpO2 levels are within normal range on room air.

Choice D:

The client's urinary output is adequate (400 mL over 6 hours), so a catheter is not required at this time.

Choice E:

The lack of drainage from the wound drain could indicate a problem that requires immediate attention. This could prevent complications like infection or fluid accumulation.

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Question 9:

A nurse and an assistive personnel (AP) are providing care for four clients who were admitted to the medical-surgical unit on the previous shift. The nurse should delegate meal assistance for which of the following clients to the AP?

A. A client who has Guillain-Barre syndrome B. A client who has a lumbosacral spinal tumor C. A client who has systemic sclerosis D. A client who has amyotrophic lateral sclerosis (ALS)

Answer and Explanation

Choice A:

A client who has Guillain-Barre syndrome requires close monitoring and specialized care due to progressive weakness and potential respiratory issues. This client's care may involve more complex needs that are beyond the AP's scope.

Choice B:

A client who has a lumbosacral spinal tumor is likely to have fewer immediate needs related to eating assistance, making this task appropriate to delegate to the AP. The client’s primary concern may be mobility or pain management, but meal assistance is a routine task.

Choice C:

A client who has systemic sclerosis may have issues with gastrointestinal motility and swallowing, requiring more careful feeding assistance and monitoring, which should be performed by the nurse.

Choice D:

A client who has amyotrophic lateral sclerosis (ALS) requires specialized care for swallowing difficulties and respiratory issues, making it inappropriate to delegate meal assistance to the AP.

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Question 10:

A nurse manager is reviewing the admission history of four adults who were admitted to the medical-surgical unit during the shift. Which of the following situations is the nurse required to disclose information to an outside agency about the client or the client's circumstances?

A. A young adult client admitted for acute glomerulonephritis following a viral infection B. A dependent adult admitted for the treatment of a spiral fracture C. A young adult client admitted for asthma and has track marks that may indicate IV drug abuse D. An emancipated minor who has acute appendicitis and wants to leave the facility without treatment

Answer and Explanation

Choice A:

A young adult client admitted for acute glomerulonephritis following a viral infection does not indicate a mandatory report situation.

Choice B:

A dependent adult admitted for the treatment of a spiral fracture suggests potential abuse or neglect. As mandated reporters, nurses are required to report suspicions of abuse or neglect to the appropriate authorities.

Choice C:

A young adult client admitted for asthma and has track marks that may indicate IV drug abuse does not necessarily require mandatory reporting unless there is evidence of abuse or harm that needs to be reported.

Choice D:

An emancipated minor who has acute appendicitis and wants to leave the facility without treatment may raise concerns about the minor's capacity to make decisions, but it does not automatically necessitate reporting to an outside agency.

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ATI NU2508 Leadership Final Exam

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