Leadership ATI Adaptive Quiz Rationales PDF

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Adaptive quiz rationales for questions that relate to the leadership ATI. These rationales are listed in bullet points to help readers remember important content that is necessary to level up on the proctored exam....

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Leadership ATI  Rights of Delegation o Task o Circumstance o Person o Direction/communication o Supervision/evaluation  Delegation Rules o The nurse who delegates the task is still responsible for the task, even if someone else (like AP) does the task o The nurse should be familiar with the task they are delegating so she can define the task and the expectation of its completed status, monitor the performance of the task, and give feedback o The RN can’t delegate aspects of the nursing process, client education, or tasks that require nursing judgement to LPNs.  LPN Delegation o In scope of practice  Tracheostomy suctioning on a client who is stable or if the tracheostomy is not new to the LPN.  Observing a client who is disoriented because they are stable with a discharge plan in place.  Colostomy care  NG tube patency o Not in scope of practice  Preparing an admission assessment for a preoperative patient  Creating a plan of care for a client  Caring for a patient with a new tracheostomy is not considered stable  A new admit  Interpreting a client’s labs (ex: digoxin level)  Assistive Personnel Delegation o In scope of practice  Simple dressing change  Collecting stool specimen  Measure oral intake  Performing basic CPR  Determine I and O  Postmortem care

 Transferring clients from bed to chair  Collecting vital signs (but not initial vitals)  Show client how to use call light o Not in scope of practice  Interpreting client’s blood glucose levels  Providing advice to family members  Determining effectiveness of the client’s indwelling catheter  Client teaching (like how to use incentive spirometer)  Changing a sterile dressing or checking a surgical incision dressing  No medication administration (including eye drops)  Colostomy care  Status updates to family  NG tube patency o Specifically AP’s that are floating to new units  In scope of practice  Escort clients from ED to other areas for testing  Not in scope of practice  Don’t allow float to stock supplies because they could put things in the wrong spot  Don’t put a float AP at the receptionist desk because they should know how to recognize seriously ill clients who need immediate triage  Shadowing is good for a typical day, but not a short-staffed day  Bed rails o If the patient’s LOC, mobility, and safety are not concerned, you should respect their request if they do not want the side rails up  Client Rights o You can request medical records at any time o 30-day notice if transfer to a LTC facility is required (to promote welfare and for financial preparations) o Seclusion is a restraint and can be done when the client is being violent or is displaying self-destructive behavior that jeopardizes the safety of themselves or others. o Right to be treated with dignity and respect o Right to refuse medications o Right to be fully informed about health conditions o Right to leave regardless of provider recommendations  HIPAA Violations

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o HIPAA – The use and distribution of personal client information o Discussing client information in the cafeteria o Placing in restraints is not a HIPAA violation  could be considered false imprisonment Surgical Consent o Family member doesn’t need to be present o Nurse doesn’t need to explain the procedure o Clerical staff can’t witness signature o The person performing the procedure is responsible for obtaining informed consent Kosher Diet o Seafood with shells (lobster and crab) are prohibited, but can have fish with scales and fins o Meat and dairy can’t be eaten at the same time o Pork is prohibited Nursing Ethics o Veracity – telling the truth. Example: A nurse truthfully answers the client’s questions about upcoming chemotherapy o Autonomy – including the client in the decision-making process for all aspects of care.  Examples: The nurse stops inserting an NG tube when the client refuses the procedure  Allow staff members to schedule their holidays o Justice – fairness. Example: The nurse provides each client with the same amount of time regardless of condition. o Nonmaleficence – do no harm by eliminating threats. Example: giving one pill at a time on the left side to a client who has right sided paralysis due to a stroke. o Responsibility – upholding obligations. Example: Nurse reports an AP who transfers a client without using a gait belt o Accountability – the nurse answers for personal actions. o Confidentiality – protecting the client’s privacy and health care information. You cannot tell a client’s son about what medication they are getting without permission from the client. o Advocacy – Example: Nurse supports the client in the decisions she makes about her health care Client Fall Protocols o First, check client for injuries

o Obtain support from another nurse if a witness or additional information is needed when filing an incident report o File an incident report and record the fall to prevent future falls o Notify the provider and communicate whether treatment is needed due to an injury sustained from the fall  Meperidine Hydrochloride IV during transport and consent is needed for surgery o Obtain consent from a relative of the client because this medication can alter the ability to understand the consent process. If the surgery is critical and a family member isn’t present, they can proceed without the client’s consent o Clients can’t give consent if they have a narcotic in their system o Consent for a transfer to another facility doesn’t assume consent for any further procedures, surgery, or care o Delaying surgery until the medication is metabolized can cause unnecessary pain and the risk of complications.  Conflict Resolution Types o Accommodation – When one person puts aside personal goals to satisfy the needs of another individual. o Avoidance – One person uses passive behaviors and withdraws from conflict preventing either person from pursuing personal goals o Compromise – When both individuals give up something to achieve a common goal o Collaboration – Both individuals actively try to find a solution that is acceptable to all parties.  Priority Questions o See who first?  A: Pt needs an indwelling catheter  B: Pt has kidney stones and flank pain of 6/10  C: Pt with early-stage CKD has a creatinine level of 2.0  D: Pt has a new cast and reports tingling fingers  See D first because of concerns of compartment syndrome o See who first?  A: Pt is getting metoclopramide and has diarrhea  B: Pt is getting tamsulosin and feels dizzy  C: Pt is getting cephalexin and reports dyspnea  D: Pt is getting erythromycin and reports epigastric pain

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 See C first because dyspnea can mean that the client is experiencing an allergic reaction from the antibiotic. Discontinue the cephalexin and notify the provider immediately. Give who to the LPN?  A: Pt was just admitted for recurring chest pain  B: Pt has emphysema and pneumonia and is getting oxygen  C: Pt has breast cancer and is getting chemo  D: Pt was just admitted for a CVA  Pts that were just admitted are not for the LPN. The client getting chemo has a specialized IV and medications that require training and expertise. The answer is give the LPN client C because they require routine care, medication administration, and data collection. If there is a disaster, who can be discharged home?  A: Preschooler with asthma and wheezes controlled by albuterol  B: School-aged pt with a femur fracture in an external fixation device with controlled pain  C: Developmentally delayed child with PICC line for 6 more weeks of Abx  D: Toddler with ventricular septal defect and bronchiolitis who is on 28% oxygen by oxyhood  E: Adolescent that is 1 day post-op following scoliosis repair and on a PCA pump  ABC are safe to go home. External fixation devices are work for weeks to months and managed at home. The long-term antibiotics are given at home after the PICC is placed. A home health nurse can help with this at home. Who can be discharged home?  A: Pt with uncontrollable glucose levels and T2D  B: 12 hour post-op after total knee arthroplasty  C: 80yo with dehydration  D: 44yo admitted for carpal tunnel surgery  D can go home because it is elective. Who can be discharged?  A: Pt has a cast removal due to compartment syndrome  B: Pt who is scheduled for dialysis and a potassium level of 6.2  C: Client with T1D and blood glucose of 320mg/dL  D: Pt who is 1 day postop after inguinal hernia repair

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 The patient with compartment syndrome needs continuous monitoring. The hyperkalemic patient may experience dysrhythmic complications from the electrolyte imbalance. A client with T1D and high glucose should be monitored. A client who is 1 day postop after an inguinal hernia repair is stable and can be discharged. What client is at the greatest risk for complication if they have mobility issues?  A: 3yo with a burned foot  B: 80yo with a fractured hip  C: 30yo with a cast for a fractured ankle  D: 42yo with an indwelling catheter  Greatest risk for a complication due to immobility and lack of lower-extremity movement, which can lead to DVT. B is the correct answer. Which pediatric client should be discharged?  Admitted before with status asthmaticus  Admitted before who was dehydrated and is getting fluids  Admitted with tonsilitis and on antibiotics for 24 hours  Adolescent with acute glomerulonephritis with UO of 20mL/hr  The client that is stable and getting antibiotics can continue the antibiotics at home. The client with status asthmaticus is not stable. The toddler with dehydration is not stable and neither is the adolescent with acute glomerulonephritis. What task should the nurse have the AP complete first?  Change transparent dressing on a stage 2 ulcer  Bring water to client who had a lumbar puncture  Transport client to radiology for a routine chest xray  Take ABG specimen to the lab  A transparent dressing does not require strict timing, so it can be done later. A lumbar puncture client should force fluids to prevent a post-lumbar puncture headache, but it is not the first priority. A routine xray can be delayed. Taking an ABG to the lab is important because they are on ice and waiting can lead to degradation. Who should be seen first?  Pt who is crying about procedure in 2 hours  PVD and absent pulse  DM and needs a dressing change for an ulcer  MRSA and temp of 100.4

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 Use ABCs to determine that absent pulse indicates no blood flow to the extremity In a disaster, who should be seen first?  Penetrating head injury and RR of 4  Comminuted fracture of femur  6in laceration on scalp with clotted blood visible  Sucking chest wound  The first client may not life, so move on. The fracture can wait and the laceration can wait since the clot is visible. A sucking chest wound places client at immediate threat to life. Which client should a new orthopedic nurse care for?  Pt in balanced skeletal traction  Pt has a total hip arthroplasty (hip replacement) 3 days ago  Pt with a fractured femur and a new cast  Pt with AKA 24 hours ago  Experiential knowledge is required in the care of a new cast, balanced skeletal traction, and a hip arthroplasty (because of postop restrictions), so the client should work with the AKA. The surgical dressing after an AKA is left on for 48-72 hours, so the residual limb doesn’t require any special care at this time. Who should the nurse see first?  Constipated after abdominal surgery  Hip replacement 4/10 pain  Catheter removed 8 hours ago and pt can’t void  Scheduled for discharge today  Not voiding for 6-8 hours after catheter removal indicates that the client is at risk for urinary retention, which can cause a UTI. Overdistention of the bladder can cause damage to the mucosa. Report this to the provider. Who is priority?  Facial drooping after a stroke 8 hours ago  Femur fracture and SOB  Appendectomy 12 hr ago and 5/10 pain  Open cholecystectomy 4 days ago and serosanguineous drainage  B is correct. Clients who have a fracture can develop a DVT, which can lead to a PE. What is the authoritarian approach to addressing an increase in medication errors?  Inform staff of the penalties that can result from errors.

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 Encourage the staff to have two nurses verify.  Provide suggestion box  Ask three experienced nurses to investigate the common causes of the errors.  The second is democratic because they are providing feedback. The fourth is also democratic because they are consulting with others to help the decision-making process. The third is Laissezfaire because it places emphasis on group decision making. The first is authoritarian because they use penalty to promote behavior change. Client has been vomiting and has diarrhea for past 6 hours. What is priority?  Auscultate bowels  Get temp  Check USG  Get potassium level  Check USG to check dehydration, temp because fluid loss can cause mild hyperthemia, and auscultate for increased peristalsis but these aren’t priority. Vomiting and diarrhea can contribute to potassium loss through fluids. Can cause cardiac dysrhythmias as a result of hypokalemia. Who should be seen first?  COPD and oxygen saturation of 92%  Postoperative after total knee replacement and capillary refill of 4 seconds  DM and glucose of 150  12 hours postop following abdominal surgery and absent bowel sounds  B because cap refill should be three or less Patient is postop and has a PCA. They have restlessness, an elevated pulse, and a decreased BP. What action should the nurse take?  Encourage the use of the PCA for comfort  Modified Trendelenburg  Have the provider give a sedative  The client’s pain is not the problem. The PCA will not treat a rapid pulse and decreased blood pressure. Place the client in modified Trendelenburg because this client is showing signs of hemorrhage or hypovolemic shock. This position increases venous circulation. Which patient is safe to discharge?

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MS and ataxia DVT and aPTT within range RLQ pain and positive rebound tenderness Amylase and lipase levels are twice the expected value The client with a DVT requires aPTT monitoring at least daily because of the risk for a PE. The MS client can go home because ataxia is an expected finding. Client Education o Leg Wound Discharge Teaching  Cleanse the wound with tap water or 0.9% sodium chloride.  Discard soiled bandages in a moisture-proof bag. These bags shouldn’t go in the trash  Wrong answers: Using cotton balls to clean because the fibers can get caught in the wound. Drying the wound after cleaning should be avoided because the wound should be open to air to allow the wound to retain moisture and promote healing. Use a warm the cleaning solution to the client’s body temperature, if possible, but don’t use a microwave because it can get too hot. Case Manager Duties o Coordinate and plan client care o Collaborate with other health professionals o Monitor costs and quality of care Critical Pathway o A multidisciplinary tool that guides client care and bases outcomes on an externally imposed timeline o Nurses use critical pathways to implement evidence-based strategies and promote cost-effective care for clients who have a specific, common diagnosis o Address appropriate nursing care and actions that other disciplines are responsible for as well. o Developed for individual diagnoses o Critical pathways are not legal documents. They establish the standard of care in an institution, but variances from the pathway often occur for multiple reasons. Advanced Directives o Assess the client’s understanding of life-sustaining measures in order to make informed decisions in advance directives. o Clients on Medicare and Medicaid should be asked if they have AD but aren’t required to complete them during hospitalization

o If the client is alert and oriented, they can make decisions, not the health care proxy. The proxy takes over when the client can’t discuss their wishes. o If the client doesn’t have directives, the family’s ethics committee may be called in o It is the client’s job to create their AD, not an attorney o The witness does not need to be related and in some states, they cannot be related. o The Joint Commission doesn’t require the client to have advanced directives. o The Patient Self-Determination Act requires that the nurse ask if the client has AD.  Adult Day Care vs. Assisted-Living Facility vs. Long-Term Care o Adult day care – for people with ADLs to have a place while family is at work. The client lives at home during the night and evening o Assisted-living facility – can live independently and require minimal assistance o Long-term facility  Client forgets what doctor will do during the procedure, but has signed the consent form. What action should the nurse take? o Since they already signed the consent form, the nurse should clarify details the provider previously gave the client. If they are still unsure, tell the charge nurse or call the provider.  Living Will o Purpose – allows client to specify what aspects of care and treatment are accepted or refused in the event that the client can’t communicate those decisions o The nurse can provide the client with information about completing a living will. The provider does not need to be involved unless they have questions regarding treatment options. o Pt can change the living will at any time. o Often addresses treatments that can prolong life: CPR, mechanical ventilation, and feeding by artificial means. A living will does NOT assume a DNR status o Can be handwritten. o If the living will says don’t give enteral feedings, don’t give them even if the family wants you to. The nurse can tell the family that the living will is used as a guide for treatment unless a durable power of attorney has been created.

 Health Care Proxy or Durable Power of Attorney o Purpose – often accompanies a living will, but not considered part of it. It establishes who will make health decisions for the client if they can’t do it themselves.  Float nurse o Provide the new float a resource person to help. It is likely an RN who is experienced on the unit.  Bomb Threat Evacuation o Get ambulatory clients out first because it reduces the number of people who need to get out. o Do not ask clients to rescue unstable clients. Sometimes, the ambulatory clients can assist stable clients in a wheelchair. o Evacuate everyone before taking containing measures.  Capital Budget o A capital budget involves planning for spending related to equipment and major purchases that have a long life of use.  Operating Budget o This type of budget reflects expenses that change in response to the volume of services (supplies, electricity, etc.)  Restraining Force o Restraining forces impede change. o Example: When staff members are resistant to learning new forms of documentation  Nursing Code of Ethics o A guide for fulfilling nursing responsibilities in a way that reflects quality in nursing care and upholds the ethical obligations of the nursing profession. o It is not a legally binding contract for nurses. o It is not mandatory for the practice of nursing. o It is not a description of requirements for nursing licensure.  Precautions o Airborne – measles, TB, varicella (MTV). Droplets are smaller than 5 microns. Client needs negative-pressure airflow with 6-12 air exchanges per hour. Wear N95 when caring for client. Client should wear a surgical mask when leaving the room. o Droplet – Microns are larger than 5 microns. The droplets are spread by being within 3 ft of the client. The client should be in a private room and the nurse should wear a mask when providing care.

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o Contact – Put client in a private room or a room with another client who has the same infection. Shigella o Protective – For immunocompromised patients who are susceptible of acquiring an infection. Put pa...