ATI RN LEADERSHIP MANAGEMENT PROCTORED EXAM VERSION 15

ATI RN LEADERSHIP MANAGEMENT PROCTORED EXAM VERSION 15

A nurse is preparing a client who speaks limited English for surgery. Which of the following is the most appropriate nursing action in obtaining informed consent from this client?

Select one:

• Do nothing as this is the provider's

primary concern.

• The nurse should explain the

procedures using pictures and hand gestures.

• Have the nurse respond to the client's

concerns so the provider can prepare for surgery.

• Seek the assistance of a nurse on the

floor who is fluent in the client's language.

A nurse is performing initial teaching with a client who will be receiving electroconvulsive therapy (ECT). Which statement by the client indicates a need for further teaching?

Select one:

• "My Dilantin dose will be increased

several days before the procedure."

• "Before the procedure, I will have an

EKG to assess for heart irregularities."

• "I will need to continue taking my

regular blood pressure medication."

• "I will stop taking my lithium for 2

weeks prior to my procedure."

A daughter of a client with a terminal illness pulls a nurse to the side and says, "Although my mother's living will states she is not to be resuscitated, the family wants everything done to save her if she has a cardiac arrest." How should the nurse respond?

Select one:

• "The living will documents your

mother's wishes and must be followed."

• "I will contact the provider to make him

aware of your request."

• "If your mother has a cardiac arrest, we
• Seek the assistance of a nurse on the

floor who is fluent in the client's language.

The nurse is responsible for ensuring that the client understands the information provided regarding the procedure.

• "My Dilantin dose will be increased

several days before the procedure."

Because the therapeutic action of ECT is to induce seizures, any medications that affect the client's seizure threshold must be decreased or discontinued several days before the procedure.

Any cardiac conditions, such as dysrhythmias, should be monitored and treated before the procedure

• "The living will documents your

mother's wishes and must be followed."

A living will is a document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. The client's wishes should be followed by the health care provider. 1 / 4

will begin resuscitation if you wish."

• "Since the living will is a legal

document a lawyer will have to make the changes."

A provider informs the wife of a comatose client with terminal cancer that she will need to sign the consent for insertion of a gastrostomy feeding tube. The nurse knows this is against the client's wishes.What is the appropriate action by the nurse?

Select one:

• Inform the wife she cannot sign the

consent

• Prepare the consent for the wife to

sign.

• Ask the provider for an order for a NG

tube instead.

• Consult the hospital's ethics

committee.

A client is seeking treatment for stress related to unexpected loss of employment and is engaging in the stress management technique of cognitive reframing. Which of the following statements would indicate to the nurse that the client understands this stress management technique?

Select one:

• "I have excellent job skills; I just need

to find a new employer."

• "When I do my daily yoga exercises, I

feel so much better."

• "Once I decided what was most

important to me, things got easier."

• "I can visualize the perfect interview

and being offered a new job."

A nurse is preparing a client with terminal illness for discharge to a nursing home

when he states: "I don't want to go to a

nursing home to die. I would rather die at home." What would be the most appropriate action by the nurse?

Select one:

• Consult the hospital's ethics committee.

If the nurse believes the provider's actions are directly against the client's wishes, the nurse should contact the hospital's ethics committee. These committees are typically multidisciplinary and are organized to consciously and reflectively consider significant and often difficult issues related to client care. Any nurse can consult the hospital's ethics committee when deemed necessary.

Unless the client has designed another person as his health care power of attorney, the wife, as immediate next of kin, can legally sign the consent for the procedure if she wishes.

• "I have excellent job skills; I just need to

find a new employer."

Cognitive reframing is a simple and effective technique for reducing stress by looking at things in a more positive light in order to experience them as less stressful.Cognitive reframing for this client would involve building confidence in job skills and searching for a new job.

• Contact the client's case manager.

Contact the client's case manager would be the most appropriate action by the nurse. The case manger would be able to determine if the client's wishes could be carried out. 2 / 4

• Contact the client's case manager.
• Continue to make the discharge

arrangements.

• Assess the client's reasons for feeling

this way.

• Inform the provider of the client's

decision.

A client is hospitalized for multiple rib fractures following a motor vehicle accident (MVA). The results of an arterial blood gas (ABG's) are; pH 7.30, pCO2 48, HCO3 26 and pO2 91 on 2 L/min of oxygen per nasal cannula. Which of the following interventions has the highest priority?

Select one:

• Assist the client to deep breathe,

splinting with a pillow.

• Increase the client's O2 delivery to 4

L/min.

• Administer an anti-anxiety agent to

calm the client.

• Notify the health care provider of the

abnormal ABG's.

The nurse is caring for a client admitted with diverticulitis. The client reports severe abdominal pain and assessment reveals that the client's abdomen is rigid and tender. The client's vital signs are: T:

101.8 F (38C); HR: 120; B/P: 100/50.

Urine output was less than 300 ml during the previous eight hours. The client states the pain is "worse than before". What is the priority nursing intervention for this client?

• Assist the client to deep breathe,

splinting with a pillow.

The client is experiencing respiratory acidosis from hypoventilation caused by painful respirations due to fractured ribs.Splinting the chest wall with a pillow will decrease pain associated with deep breathing. Deeper breaths will allow for better gas exchange, which will correct the acidosis.

• Notify the client's health care provider

The client is febrile, tachycardic and hypotensive with verbalization of increased worsening abdominal pain.These are signs of possible rupture of the diverticulum, pelvic abscess, or bowel obstruction and the provider needs to be notified.

Select one:

• Encourage the client to increase fluids
• Administer the prescribed scheduled

antibiotic

• Notify the client's health care provider
• Administer bisacodyl suppository as

needed

The nurse is caring for four clients receiving chemotherapy. Which of the following clients should the nurse see first?

• A client with breast cancer and a

sodium level of 115 mEq/L

A sodium level less than 120 mEq/L is 3 / 4

Select one:

• A client with cervical cancer and a

hemoglobin level of 8.2 mg/dL

• A client with breast cancer and a

sodium level of 115 mEq/L

• A client with ovarian cancer with a

white blood cell count of 4,500 cells/mcL

• A client with endometrial cancer and a

potassium level of 5.0 mEq/L

At 0715 the nurse is assigned to care for the following four clients. Which of the following clients should the nurse plan to see first?

Select one:

• A client who will be transferred to a

skilled care facility at 0930.

• A client with diabetes mellitus type I

waiting for a breakfast tray at 0745.

• A client scheduled for a bronchoscopy

at the bedside at 0900.

• A client with pneumonia scheduled for

a portable chest x-ray at 0730.

A nurse is caring for a client who has been committed to an acute Mental Health facility with an involuntary emergency commitment order. What should the nurse include when orienting the client to the facility?

Select one:

• The client can leave the facility at any

time if they sign a medical release form.

• Length of stay at the facility will be

determined by the courts.

• Family will not be able to visit until

their provider grants the visitation privileges.

• The client has the right to refuse

treatment, unless he has been judged to be incompetent.considered a medical emergency and needs immediate assessment and treatment.

• A client with diabetes mellitus type I

waiting for a breakfast tray at 0745.

The diabetic client waiting for breakfast should be assessed first. Prior to breakfast the client's blood glucose needs to be drawn and if insulin coverage is required it is administered before breakfast. Once the client begins to eat and digest food they will be at risk for increasing blood glucose levels without their insulin coverage.

• The client has the right to refuse

treatment, unless he has been judged to be incompetent.

Clients admitted under involuntary commitment are still considered competent and have the right to refuse treatment, unless they have gone through a legal competency hearing and have been judged incompetent. The client who has been judged incompetent has a temporary or permanent guardian, usually a family member if possible, appointed by the court. The guardian can sign informed consent for the client. The guardian is expected to consider what the client would want if they were still competent.

This type of commitment is usually imposed by primary care providers, mental health providers, or police officers based on the client's need for psychiatric

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