ATI NU2508 Leadership Final Exam

ATI NU2508 Leadership Final Exam Related

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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.
Correct Answer: A,B,D

Rationale: The correct answers are A, B, and D. The nurse can assign these activities to the assistive personnel (AP) because they do not require nursing judgment or assessment. A: Checking the position of a client in soft wrist restraints is a task that can be delegated as it involves a physical task without interpretation. B: Accompanying a client to occupational therapy is a supportive task that does not require nursing assessment. D: Sitting with a client who has alcohol use disorder and monitoring their condition post-drinking does not involve assessment. Choices C and E involve setting limits with a client who has mania and assessing a client with hypomania, which require nursing judgment and assessment, so they cannot be delegated to the AP.

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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.
Correct Answer: C

Rationale: The correct answer is C because fluctuating blood pressure and pulse indicate unstable vital signs requiring close monitoring and immediate intervention. The nurse giving report is indicating that the client's condition is dynamic and may require frequent assessments and interventions, which necessitates the oncoming nurse assuming total care. Choices A, B, and D do not directly imply the need for total care and could potentially be managed by assistive personnel.

A nurse manager along with members of the nurse practice committee are conducting a skills day for assistive personnel in the medical surgical unit to validate competency. Which skills demonstrated by assistive personnel require immediate follow-up. Select the '3' findings that require immediate follow-up.

  • A. AP 1-Quickly pulls fire alarm, then proceeds to remove the client from room. AP 3-Raised bedrails of the bed for client who was reported not alert or oriented, and was sleeping.
  • B. AP 2-Verifies with nurse the order in which protective equipment should be removed.
  • C. AP 7- While disinfecting portable vital sign monitor wore gloves and washed hand prior to leaving room.
  • D. AP 6 - During simulation, which included assisting client into bed, there was no observed handwashing.
  • E. AP 5-Following simulation, was unable to identify the locations of alarms on medical surgical unit.
  • F. AP 4-Successfully completed skills of simulation including emptying the client's trash can
Correct Answer: A,D,E

Rationale: The correct answer is A, D, and E. Option A requires follow-up because pulling the fire alarm before removing the client may result in leaving the client in a dangerous situation. Option D needs follow-up because not washing hands after assisting a client into bed can lead to the spread of infection. Option E warrants follow-up as not knowing the alarm locations could delay response to emergencies. Options B, C, and F are not immediate concerns as they demonstrate proper procedures or successful completion of tasks.

A nurse is planning to delegate a task to an assistive personnel (AP). Which of the following actions should the nurse plan to take?

  • A. Determine the social skills of the AP.
  • B. Assess the AP's ability to follow the client's teaching plan.
  • C. Provide a clear description of the task to the AP.
  • D. Evaluate the ability of the AP to work with peers.
Correct Answer: C

Rationale: The correct answer is C: Provide a clear description of the task to the AP. This is essential in delegation to ensure the AP understands what is expected. Determining social skills (A) and evaluating ability to work with peers (D) are not directly related to task delegation. Assessing ability to follow a teaching plan (B) is important but not the primary focus in task delegation.

A client who is terminally ill tells a nurse on the medical-surgical unit that she feels hopeless. Which of the following statements by the nurse is appropriate?

  • A. I am sure these feelings will pass once you go home.
  • B. Tell me what you understand about your illness.
  • C. Tell me why you feel hopeless.
  • D. If I were you, I would ask for a referral to hospice care.
Correct Answer: B

Rationale: The correct answer is B: "Tell me what you understand about your illness." This response shows active listening and encourages the client to express their thoughts and feelings, fostering trust and understanding. It allows the nurse to assess the client's knowledge and perception, helping tailor support accordingly. Choice A dismisses the client's feelings, lacking empathy. Choice C may come off as confrontational, potentially shutting down communication. Choice D imposes the nurse's opinion on the client. Choices E, F, and G are not applicable. In summary, choice B promotes therapeutic communication and client-centered care, while the other choices may hinder the nurse-client relationship.

A nurse is preparing to administer a prescribed medication to a client. Which of the following actions should the nurse plan to take to demonstrate client advocacy?

  • A. Insist the client take prescribed medications.
  • B. Inform the client that the medication is the same as taken at home.
  • C. Tell the client that refusal of the medication is considered noncompliance.
  • D. Encourage the client to verbalize questions.
Correct Answer: D

Rationale: The correct answer is D: Encourage the client to verbalize questions. This demonstrates client advocacy as it empowers the client to actively participate in their care, promotes informed decision-making, and ensures understanding of the medication. This approach respects the client's autonomy and right to make informed choices. It also allows the nurse to address any concerns or misconceptions the client may have, leading to better adherence to the treatment plan.

Incorrect choices:
A: Insisting the client take prescribed medications goes against the principles of client autonomy and informed consent.
B: Simply informing the client about the medication without addressing their questions or concerns does not actively involve the client in their care.
C: Labeling the client's refusal as noncompliance can be seen as judgmental and does not encourage open communication or shared decision-making.