Ati Leadership B

ATI Leadership B

RN Duty: Informed ConsentReview Previously provided info about the procedure
Sealed Radiation Therapy ImplantVisitors- max of 30min per day and stay 6ft away from client
Keep Pt in a Private Room
RN to avoid turning back to pt when wearing a lead apron
HC associated Infections on unit; Auditing Quality Control Process RN’s First Action to Take:Use Benchmarks to establish standards
E.D. admitting pt’s after an earthquake. Emerg Disaster Plan is implemented; large number of casualties. Which Pt needs immediate evaluation by a provider?Crushing Chest Wound (Red Tag)

Massive Head Injury (Blk- little to no chance of survival)
Open compound fractures in both legs (Yellow-can wait a short time)
6inch scalp laceration (Green- non-emergent)

New RN & AP arguing over AP not restocking unit supplies. AP leaves, Nurse Mgr tells RN:“I would like you to approach the AP to resolve the problem”

Encourage Face-to-face communication to resolve the conflict

An occupational health nurse is triaging pts at the site of an industrial explosion. Example of a Green Tag (Class III) Pt:Facial Contusion- Green
Open Femur Fracture- Yellow
Hypovolemic Shock- Red
Penetrating spinal Injury- Red
Med-Surg Acute care facility. Which event requires an incident report?Med administered 45 min late because it was unavailable. Acceptable practice is 30 min before or after ordered time.
Presentation of “Role of the Nurse as a Client Advocate;” What should nurse mgr include in presentation?nfo about confidentiality disclosure is an example of an RN being a pt advocate
Shift assignments: RN, LPN & AP; Which task can be delegated to an LPN?Reinforcing Teaching to a client- LPN
Vitals- AP
Post-mortem care- AP
Simple Dressing Change- AP
Annual performance review for a staff nurse; Strategies to be used in the review process:Include Peer Reviews by AP, Have Nurse complete a self-appraisal prior to the review, conduct a performance checklist
Indicator of neglect: Older pt w/ dementiaMeds brought to hospital are expired
Home Health RN teaching about online resources regarding validity of information; Most credible source source of information:Website affiliated with a government agency
Alzheimer’s Pt’s Daughter, “I don’t know how much longer I can keep this up”RN Response, “Let’s discuss options for respite care”
LPN’s & AP’s; Charge nurse should intervene in what situation:LPN develops POC for a pt with pneumonia; This is not within the scope of practice for an LPN
Immediate Intervention:Pt with Hx of esophageal varices who has diaphoresis and pallor. Diaphoresis and pallor indicate pt may be hemorrhaging from ruptures esophageal varices.
Which situation indicates a legal issue:phlebitis at IV site that was placed 4 days ago. IV has been in place too long. Failure to meet the standard of care and a possible long-lasting injury to the client.
Advanced Directives:Must be documentation in the MR about whether a client has AD’s or not
Effective Communication regarding delegation to AP“Check urinary output at 11am for John Doe and report to me immediately”
Massive Community Disaster; DC Stable pt’s, Who is safe to DC?Pt with MS that reports ataxia (Ataxia an expected finding with MS)
Terminally Ill pt; RN is participating in an ethical manner:Collaborate with client to establish realistic goals for her end-of-life care
Immediate Intervention:Substernal chest discomfort (4/10)
RN reprimanded by provider in front of client:Discuss situation with provider in private
Pt recovering from a MVA & needs ADL’s assistance; RN to request a referral for:OT
Home Health RN gets labs for 4 pt’s. Who should she see first?Platelets of 100,000/mm3. Decreased platelet count labels pt as unstable and is the highest priority.
Demonstrates the AP is using effective time-management skillsgrouping activities for several clients in the same location
older client with expressive aphasia. RN did not get informed consent prior to:This procedure does not require an informed consent
Postop pt with PCA; Restless, elevated pulse, decreased BP; RN’s action:Place pt in modified trandelenburg
Smoke in WastebasketR- Rescue Pt
A- Activate Alarm
C- Contain the Fire/Smoke
E- Extinguish
Spanish Speaking PtUse Spanish/English medical dictionary to assist, ask Spanish speaking AP that is assigned to client to assist, Request hospitals interpreter to provide education
Newborn is being DC’d; RN’s best action to ensure newborn safety:Observe parents securing newborn into infant care seat in parents car
Terminally ill w/ nutritional support. Children disagree with continuation of support, referred to ethics committee. What should RN do?Assist with weighing options involved in the decision
3 days post op: open reduction with internal fixation of the right hip. Discussion priority:Refusing PT
Policies regarding electronic medical recordsWill shred printouts when finished with assignements
Local chemical plant explosion; RN’s priority intervention when pt’s arrive:Isolate clients and irrigate with water
Pt with dementiaplace client in a room near the nurses station
Abdominal Pain Pt admitted, what MUST be performed by the RN:Admission Assessment
Newborn & Mother who requires apnea monitoring at home. Who should the client be referred to?Home Health
Renal Failure Client stops dialysis. RN’s action shows patient advocacy:Supports the clients decisions to DC treatment
Health Care Law info:Patient Self-Determination Act requires an RN to give clients info about end-of-life options
At what time during a hospital stay should the nurse assess the clients DC planning?At the time of the admission interview
Suspected TB:wear a particulate respirator mask
Adherence to HIPAA guidelinesshares test results with an AP on the same nursing team
Pt complains of call light not being answered timelyask pt to verbalize his expectations
Pain assessments not being performed as required by policyReport to Nurse Mananger
conflict management with staff who does not agree with assignment. Example of “smoothing strategy”“You always do a great job and I think you can handle this.
Progressive Discipline Steps:Informal Reprimand, Formal written reprimand, suspend without pay, terminate employee
18 yr old: does not want chemo again. Which is consistent with the clients rights?“I can gather info on palliative care for you.”
which patient may give an informed consent?Blood alcohol level of 0.05
Charge nurse notices an RN has made 2 med errors in 1 shift and suspects RN is chemically impaired. First action:remove the staff member from the work environment
Poor attendance at staff meetings. Which should charge nurse do first?explore the reasons staff are not attending meetings
Highest PriorityAdult client with a femur fracture reporting SOB
How to use Evidenced Based Practice to improve client outcomes. Recommend as a qualitative research method:Phenomenology; used for studying participants’ experiences.
Home oxygen therapy needs further teachingoxygen concentration is plugged into an extension cord.
Cancer pt vomits blood on linens and floor.mop floor with a bleach solution. Clean PATIENT with chlorhexidine gluconate solution; not floor
validate that client understands the procedure (after pt has signed informed consent):Ask the client to verbalize the purpose, risks and benefits of the procedure.
2 nurses say the other is not “doing their fair share.” What is an appropriate approach to this conflict?Explore alternative solutions to address unit workflow with the nurses.
Which of the following actions should the nurse take to ensure the AP is qualified to perform a particular task?Review the AP’s skill competency checklist
Pt with AMS and R lower leg deep vein thrombosis has a prescription for application of aquathermia pad to the lower right leg. Nursing priority actions:check pt’s leg 10 min after applying the aquathermia pad
Nurse Managers Highest Priority:assigning client care to staff