ATI Leadership Level 3
ATI Leadership Proctored Professional Nursing 3 (Rasmussen University)
1) A nurse is caring for a client who has a tumor. The provider recommends surgery. The client refuses, but the client's partner wants the surgery performed. Which of the following is the deciding factor in determining if the surgery will be done?
Whether the client understands the risk of refusing the procedure
Whether the partner is the client's durable power of attorney for health care
Whether the client's refusal is based on a religious belief
Whether the facility ethics committee reaches a census on the case
2) A nurse is caring for a client who has a new diagnosis of chlamydia. Which of the following actions should the nurse take?
Report the infection to the local health department
Initiate contact precautions
Instruct the client to use condoms until the treatment is complete
Apply an antiviral cream to the lesions
3) A nurse is caring for a client who has cancer. The client's adult child asks the nurse for information about the client's treatment plan. Which of the following responses should the nurse make?
"I will ask your mother's primary care provider to speak with you."
"What would you like to know about your mother's treatment?"
"You will have to speak directly to your mother about her treatment."
"I cannot provide this information to you without your mother's consent."
4) A nurse is assessing an older adult client who was brought to the emergency department by his adult son, who reportsthat the client fell at home. The nurse suspect's elder abuse. Which of the following actions should the nurse take? Ask the client's son to go to the waiting area
File an incident report
Treat and discharge the client
Ask the client about his injuries with the son present
5) A nurse is conducting a disaster preparedness drill with a group of nurses who are orienting to the facility. Which of the following triage tag colors should the nurse instruct the group to apply to a client who has full thickness burns on 72% of his body? Green
Yellow
Black Red
6) A nurse on a medica-surgical unit is caring for a client who asks about advance directives and states that he wants to appoint a health care proxy. Which of the following responses should the nurse make?
“You must choose a member of your family to serve as your health care proxy”
“A health care proxy can make decisions for you when you are unable to do so”
“You should appoint a health care proxy before undergoing an invasive procedure”
“It is necessary for an attorney to approve your health care proxy”
7) A hospice nurse is caring for a client who has terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?
Continue the medication dosages that relieve the client’s pain
Contact the provider about replacing the opioid with an NSAID
Administer the benzodiazepine but withhold the opioid
Withhold the benzodiazepine but continue the opioid
8) A nurse is orientating a newly license nurse about client confidentiality. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
“I should encrypt personal health information when sending emails”
“I can use another nurse’s password as long as I log off after using the computer”
“I should discard personal health information documents in the trash before leaving the unit “I can post the client’s vitals sings in the client’s room”
9) A nurse is delegating care for a group of clients. Which of the following clients should the nurse assign to the LPN?
A client who is scheduled for an endoscopy later today and requires an enema
A newly admitted client who has sickle cell anemia and requires the development of an initial plan of care
A client who had a myocardial infarction and will be transferring to the unit from the CCU
A newly admitted client who has diabetes mellitus and requires initial teaching on self-administration of insulin 10) A nurse on a med-surge unit is caring for four clients. The nurse should recognize that which of the following clients is the priority?
A client who is postoperative following a laminectomy 12 hour and is unable to void
A client who is scheduled for a tubal ligation in 2 hours and is crying
A client who has peripheral vascular disease and has an absent pulse in the right foot
A client who has type 1 diabetes and needs the first dressing change for an ulcer
A client who has MRSA and has an axillary temperature of 100.4F nurse manager is planning to assign care for four clients on a medical surgical unit. Which of the following clients should the nurse assign to a LPN
a. An older adult who has lung cancer and has periodic episodes of severe dyspnea
b. A middle adult client who has a below the knee amputation and requires a dressing change
c. A young adult client who is postoperative, receiving morphine via epidural, and reports pruritus
d. An adolescent who requires teaching regarding insulin administration nurse manager is planning to assign care for four clients on a medical surgical unit. Which of the following clients should the nurse assign to a LPN
a. An older adult who has lung cancer and has periodic episodes of severe dyspnea
b. A middle adult client who has a below the knee amputation and requires a dressing change
c. A young adult client who is postoperative, receiving morphine via epidural, and reports pruritus
d. An adolescent who requires teaching regarding insulin administration
A nurse manager is planning to assign care for four clients on a medical surgical unit. Which of the following clients should the nurse assign to a LPN
a. An older adult who has lung cancer and has periodic episodes of severe dyspnea
b. A middle adult client who has a below the knee amputation and requires a dressing change
c. A young adult client who is postoperative, receiving morphine via epidural, and reports pruritus
d. An adolescent who requires teaching regarding insulin administration
11) A nurse manager observes assistive personnel (AP) incorrectly transferring a client to the bedside commode. Which of the following actions should the nurse take first?
Help the AP assist the client with the transfer
Demonstrate the proper client transfer technique to the AP
Instruct the AP to request assistance when unsure about a task
Refer the AP to the facility procedure manual
12) A nurse in the emergency department admits a client who has been exposed to cutaneous anthrax. Which of the following actions should the nurse take?
Prepare to administer antibiotics to the client
Wear an N95 respirator makes while caring for the client
Plan to administer an antiviral mediation to the client
Place a surgical mask on the client during transfer to the unit
13) A nurse is caring for a client who is unconscious and whose partner is their health care surrogate. The partner wishes to discontinue the client’s feeding tube, but another family member tells the nurse that they want the client to continue receiving treatment. Which of the following responses should the nurse make?
“You should contact the provider about your wishes for your family member”
“You should speak with the facility’s ethics committee about your concerns
“We’ll need to have the nursing supervisor review the client’s advance directives”
“As the health care surrogate, the client’s partner can make this decision
14) A nurse is preparing to discharge a client who has end- stage heart failure. the client's partner tells the nurse she can no longer handle caring for the client. which of the following actions should the nurse take?
Ask the provider to delay the client's discharge home for a few more days.
Recommend the partner place the client in a long- term care facility.
Contact the case manager to discuss discharge options.
Request another family member assist the client's partner with care.
15) A nurse is providing change-of-shift report for an oncoming nurse. Which of the following information should the nurse include in the report?
“The client is in radiology department for a chest x-ray”
“The client’s partner came to visit him 2 hrs. ago”
“The client has routine vital signs prescribed” “The client is the president of a local bank”
16) A nurse in the emergency department is preparing to care for a client who arrived via ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following actions should the nurse take?
Proceed with treatment without obtaining written consent
Notify risk management before initiating treatment
Have the client sign a consent for treatment
Contact the clients next of to obtain consent for treatment
17) A nurse is preparing to discharge a client who requires home oxygen. The equipment company has not yet delivered the oxygen tank. Which of the following actions should the nurse take?
Instruct the client’s family to contact the insurance provider about the oxygen equipment Send an oxygen tank from the facility home with the client
Contact social services about the delivery of the oxygen equipment
Notify the provider about the delayed oxygen tank delivery
18) A nurse on a medical surgical unit is caring for a group of clients with the assistance of a licensed practicing nurse andassistive personnel. Which of the following tasks should the nurse assign to the LPN?
Accompanying a client who just had a wound debridement to physical therapy
Obtaining a urine specimen from an older adult client Providing postmortem care for a client that just died
Reinforcing dietary teaching with a client who has heart disease
19) ) A nurse manager is leading a discussion about ethical dilemmas. Which of the following situations should the nurse manager include as an example of an ethical dilemma?
A visitor experiences a minor burn after spilling coffee
A parent wants her 14yr old adolescent to receive radiation treatment against his will
A nurse witnesses another nurse administer an incorrect medication
A client receives an operation on the wrong side of her body
20) a nurse is developing a discharge plan for client who is postoperative and will require a wheelchair in the home. the nurse should place a referral to which of the following resources to assist the client with this need? Occupational therapy
Social services
Home health
Physical therapy
21) A nurse is caring for a client who requests information about the prevalence of Tay-Sachs disease. Which of the following resources should the nurse use to obtain this information?
An evidence-based nursing journal
The client's health care provider
The facilities case manager
A collaborative, user-edited website
22) A nurse has just completed assessment charting on the electronic record for an assigned client. As assistive personnel (AP) who just measured the client’s vital signs asks to chart them while the nurse is still logged into the record. Which of the following actions should the nurse take?
Recommend the AP come back later when the record is available
Log out so the AP can log in to document the vital signs
Offer to chart the vital signs for the AP
Allow the AP to document the vital signs prior to logging out
23) A nurse is preparing a teaching session with a client who speaks a different language than the nurse. Which of the following interventions should the nurse plan to include?
Involve the client’s partner to assist with the teaching session
Incorporate gestures and hand signals when presenting information Validate understanding by interpreting the client’s body language
Provide and interpreter when obtaining consent for the client
24) A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of the following information should the nurse include in the change-of-shift report?
The time the client received his last dose of pain medication
The belief that the client has a difficult relationship with his son
The steps to follow when providing wound care The clients preferred time for bathing
25) Nurse on an impatient care unit is working to help reduce unit costs. Which of the following actions is appropriate to include in the cost-containment plan?
Store opened bottles of normal saline in a refrigerator for up to 48hrs Wait to dispose of sharps containers until they are completely full
Use clean gloves rather than sterile gloves for colostomy care
Return unused supplies from the bedside to the unit’s supply stock
26) a nurse is preparing to complete an incident report regarding a medication error which of the following actions should the nurse plan to take? select all that apply
Include the time the medication error occurs in the report
Make a copy of the incident report for personal record-keeping
Identify the medication name and dosage administered to the client in the report
Place a copy of the completed report in the client's medical record
Obtain an order from the client's provider to complete the report
27) A nurse is preparing a client for an elective mastectomy. The client is wearing a plain gold wedding band. Which of the following is the appropriate procedure for taking care of the clients' ring? Agree to keep the ring for the client until after the surgery
Place the clients ring in the facility safe
Tape the ring securely to the client's finger
Place the ring in the bag with the clients' clothes
28) A nurse on a medical-surgical unit is evaluating an assistive personnel’s (AP) use of infection control precautions.
Which of the following actions by the AP indicates correct use of the precautions?
The AP wears a surgical mask when caring for a client who has respiratory tuberculosis
The AP uses alcohol-based hand sanitizer after emptying the bed pan of a client who has Clostridium difficile The AP bundles the clean side of linen inward when changing the sheets for a client who has infected surgical wound
The AP removes her gloves before leaving the room of a client who has MRSA
29A nurse is preparing an educational program for staff members 2 a new intravenous pump. Identify the sequence of actions the nurse should take when developing the program. (Move the steps into the box on the right, placing them in order of performance).
Determine what skills to teach the staff members
Develop learning objectives for the program
Identify resources available to meet objectives
Review the staff member's evaluation of the program
30) A nurse is providing an in-service about client rights for a group of nurses. Which of the following statements should the nurse include in the Inservice?
“A nurse can disclose information to a family member with the client’s permission”
“A nurse is responsible for informing clients about treatment options”
"A nurse can apply restraints on a PRN basis”
“A nurse can administer medications without consent to a client as part of a research study”
31) A nurse is receiving a verbal prescription from the provider for a client who is having increased pain. The nurse should transcribe which of the following prescriptions in the client’s medical record?
MS 10mg IV every 4 hrs. prn for pain
Morphine sulfate 10mg IV q 4hrs. IV prn for pain
MSO4 10mg IVP q 4hrs prn for pain
Morphine sulfate 10.0mg every 4 hours IV prn for pain
32) A nurse is caring for a client who reports acute pain but refuses IM medication. The nurse distracts the client and quickly administers the injection. This illustrates which of the following? Assault
Libel
Battery
False imprisonment
33) A nurse is providing discharge teaching to the parent of a toddler who has a new diagnosis of asthma. The parent states she is unable to afford the nebulizer prescribed for the child. Which of the following referrals should the nurse recommend?
Pharmacist
Child protective services
Social worker
Respiratory therapist
34) A nurse manager is reviewing isolation guidelines with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teachings?
"I will place a client who has a compromised immunity in a negative air pressure room"
"I will wear a N95 respirator mask when caring for a client who is on droplet precautions"
"I will instruct visitors to wear a mask when visiting a client who is on contact precautions"
"I will have a client who is on airborne precautions wear a mask when out of her room"
35) A charge nurse on an obstetrical unit is preparing the shift assignment. Which of the following clients should be assigned to an RN who has floated from a medical-surgical unit?
A primigravida client who is one day postoperative following a cesarean section and has a PCA pump
A multigravida client who has preeclampsia and is receiving misoprostol for the induction of labor
A client who has gestational diabetes and is receiving biweekly nonstress tests
A client who is at 32 weeks gestation and has premature rupture of membranes
36) A nurse working in an emergency department is performing triage. To which of the following clients should the nurse assign priority?
A client who reports night sweats and fever for the last week client who has compound fractures of the tibia and humerus A client who reports severe vomiting and diarrhea
A client who has soot markings around each naris following a house fire
37) A nurse in the emergency department is performing triage for a group of clients who were in a train crash. Which of the following clients should the nurse tag as emergent?
A client who has an asymmetrical thorax
A client who has an open fracture of the femur
A client who has preorbital edema
A client who has a deep-partial thickness burn on the lower extremities
38) A nurse is comparing the rate of medication errors on the medical unit to the rate from a medical unit in a magnet hospital. Which of the following quality improvement methods is the nurse using? Root cause analysis
Benchmarking
Risk benefit analysis Structure audit
39) A charge nurse making rounds observes that assistive personnel has applied wrist restraints to a client who is agitated and does not have a prescription for restraints. Which of the following actions should the nurse take first? Review the chart for nonrestraint alternatives for agitation
Inform the unit manager
Speak with the AP about the incident
Remove the restraints from the client’s wrist
40) A nurse working in the emergency department is assessing several clients. Which of the following clients is the highest priority?
A client who has active bleeding from a puncture wound to the groin areaA client who has a raised red skin rash on his arms, neck, and face
A client who reports shortness of breath and left shoulder and neck pain A client who reports right sided flank pain
41) A nurse is caring for a client who has a prescription for transcutaneous electrical nerve stimulation (TENS). Which of the following member of the interdisciplinary team should the nurse contact for assistance? Physical therapist
Respiratory therapist
Occupational therapist Pharmacist
42) A nurse participating in the development of a disaster management plan for a hospital. The nurse should recognize that which of the following resources is the highest priority to have available in response to a bioterrorism event? A system for tracking client information
A sufficient supply of personal protective equipment
A mental health specialist on the response team
A network for communication between staff members and families
43) To resolve a conflict between staff members regarding potential changes in policy, a nurse manger decides to implement the changes she prefers regardless of the feelings of those who oppose those changes. Which of the following conflict resolution strategies is the nurse manager using?
Compromising
Collaborating Cooperating Competing
44) A nurse is teaching a newly licensed nurse about implementing droplet precautions for a client who has influenza. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
“I will wear a surgical mask within 3ft of the client”
“I will check that the room has high-efficiency particulate air filtration system”
“I will wear an N95 respirator when providing care for the client”
“I will assign the client to a room with positive airflow”
45) A charge nurse witnesses assistive personnel failing to follow facility protocol when discarding contaminated lines. Which of the following actions should the nurse take first?
Alert the infection control department
Discuss the issue with the AP
Reinforce facility protocols at the next staff meeting
Notify the unity manager about the incident
46) A nurse is supervising assistive personnel (AP) who is feeding a client who has dysphagia. Which of the following actions by the AP should the nurse identify as correct technique? Providing a 10min rest period prior to meals
Elevating the head of the client’s bed to 30 degrees during mealtime
Instructing the client to place her chin toward her chest when swallowing Withholding fluids until the end of the meal
47) A nurse manager is receiving report and is faced with the following situations that require intervention. Which of the following should the nurse manager address first?
A client is refusing care from assistive personnel of the opposite gender
No transport assistance is available to take a client to physical therapy Two nurses had a heated disagreement about a scheduling issue
Three staff members have called to say they will be absent
48) A nurse in an ambulatory care setting is orienting a newly licensed nurse who is preparing to return a call to a client. The nurse should explain that which of the following is an objective of telehealth? Establishing communication between providers
Developing client treatment protocols
Assessing client needs
Providing medication reconciliation
49) A nurse is assessing a client who has meningitis. Which of the following findings should the nurse report to the provider immediately?
Decreased level of consciousness
Increased temperature
Generalized rash over trunk Report of photophobia
50) A nurse is preparing a client for surgery. The client has signed the consent form but tells the nurse that she has reconsidered because she is worried about the pain. Which of the following responses by the nurse is appropriate?
“If you have the procedure now, you won’t have to deal with pain and disability later”
“I understand, and it’s not too late to change your mind”
“Why didn’t you discuss your concerns with your provider”
“You’ll be fine. You’ll discuss receive a prescription for pain medication”
51) A nurse is caring for a client who has anorexia nervosa. Which of the following interdisciplinary team members should be consulted in regard to this clients'care?
Mental health counselor
Nutritional therapist
Physical therapist
Case manager
Occupational therapist
52) A nurse is assessing a client who is postoperative following a left leg below-the-knee amputation. Which of the following client statements indicates the potential need for a referral to an occupational therapist?
“I am not sure how I will pay for all the therapy I will need”
“I hope I can adjust to using crutches while I am recovering”
“I just don’t think I can handle looking at my leg”
“I am worried about taking care of my toddler at home”
53) A nurse is caring for a client who wanders through the halls yelling obscenities at staff, and visitors. Which of the following actions should nurse take?
Administer a sedative to the client
Contact a family member to come and sit with the client
Place the client in a wheelchair with a lap try
Keep the client in her room with the door closed
54) A nurse is preparing to delegate bathing and turning of a newly admitted client who has end-stage bone cancer to experienced assistive personnel. Which of the following assessments should the nurse make before delegating care?
Is the client’s family present so the AP can show them how to turn the client
Does the AP have time to change the client’s central IV-line dressing after turning her?
Has data been collected about specific client needs related to turning?
Has the AP checked the client’s pain level prior to turning her?
55) A nurse at a long-term facility is planning a fall prevention program for the residents. Which of the following interventions should the nurse include?
Institute rounds every 2 hr. during the day to offer toileting.
Keep four side rails up on the beds at night
Apply vest restraints on the residents who are confused
Accompany residents older than 85 years of age during ambulation
56) A nurse enters the hallway and discovers a visitor looking at a client’s medical information on a computer. Which of the following actions should the nurse take first?
Close the documentation program on the computer
Find out which staff member left the documentation program on the screen
Tell the charge nurse that visitor viewed a client’s protected health information
Inform the visitor that client records are confidential
57) A nurse is teaching a newly licensed nurse about client confidentiality. the nurse should include which of the following examples represents a violation of client confidentiality?
Calling the pharmacy with a prescription for the client's partner to pick up
Informing housekeeping staff that the client is in the dialysis unit
Reporting a client's disposition to the referring provider
Providing a copy of the client's medical record to the transporting paramedic
58) A nurse in prenatal clinic is caring for a group of clients. Which of the following clients should the nurse recommend for an interdisciplinary care conference?
A client who is 37wks gestation and has an L/S ration of 2:1
A client who is 28wks gestation and has a negative Coombs's titer
A client who is at 39wks gestation and has a negative contraction stress test
A client who is at 35wks gestation and has a biophysical profile of 6
59) A nurse working on a quality improvement team that is assessing an increase in client falls at the facility. After problem identification, which of the following actions should the nurse plan to take first as part of the quality improvement process?
Review current literature regarding client falls
Implement a fall prevention plan
Identify clients who are at risk for falls Notify staff of the increased fall rate
60) A nurse is working on a medical surgical unit and is managing the care of four clients. The nurse should schedule an interdisciplinary conference for which of the following clients?
A client who has type 1 diabetes an uses an insulin pump
A client who is receiving heparin and has an aPTT of 34 seconds
A client who has orthostatic hypotension and is receiving IV fluids
A client who is at risk for pressure ulcers and has an albumin level of 4.2 g/dl
61) A nurse is assisting with the orientation of a newly licensed nurse. The newly licensed nurse is having trouble focusing and has difficulty completing care for his assigned clients. Which of the following interventions is appropriate? Advise him to complete less time-consuming tasks first
Recommend that he take time to plan at the beginning of his shift
Offer to provide care for his clients while he takes a break
Ask other staff members to take over some of his tasks
62) A case manager is preparing a discharge plan for a client following coronary artery bypass grafting surgery. Which of the following client issues should the nurse address first?
Limited social support
Decreased self-esteem
Inadequate food supply Low pain tolerance
63) A nurse enters a client’s room to an informed consent for a gastroscopy. The client states he does not understand the procedure. Which of the following actions should the nurse take? Educate the client about the risks of refusing the procedure Complete an incident report
Inform the provider that the client requires clarification about the procedure Answer the client’s questions concerning the procedure
64) A charge nurse notices that two staff nurses are not taking meal breaks during their shifts which of the following actions should the nurse take first?
Determine the reasons the nurses are not taking scheduled breaks
Provide coverage for the nurses' breaks
Review facility policies for taking scheduled breaks
Discuss time management strategies with the nurses
65) A nurse in long-term care facility is caring for a client who reports the assistive personnel repositioned him in bed using excessive force. Which of the following actions should the nurse take?
Document in the client’s chart that an incident report has been filed
Call risk management to interview the client
Contact the nurse manager
Reassure the client that the staff is well trained
66) A nurse is caring for a client who has been admitted and diagnosed with type 1 diabetes mellitus. The client tells the nurse she has decided to go home. Which of the following actions should the nurse take?
Ask the client if she would like a sedative to help her relax
Inform the client that she cannot leave without a discharge prescription from the provider
Have the client sign the Against Medical Advice form
Assign a security officer to the clients room until the provider can speak with the client
67) A charge nurse is making shift assignment on a medical-surgical unit. Which of the following tasks should the nurse assign to the AP?
Measuring oxygen saturation for a client who has dyspnea
Performing nasal hygiene for a client who has a NG tube
Pouching a clients ostomy bag for a new colostomy
Inserting a rectal suppository for a client for a client who is vomiting
68) A nurse is the emergency department is assessing a client who is unconscious following a motor-vehicle crash. The client requires immediate surgery. Which of the following actions should the nurse take?
Transport the client to the operating room without verifying informed consent
Delay the surgery until the nurse can obtain informed consent
Obtain telephone consent form the facility administrator before the surgery Ask the anesthesiologist to sign the consent
69) A nurse is caring for four clients. Which of the following clients should the nurse assess first?
A client who has Alzheimer’s disease and bacterial pneumonia with newly onset restlessness
A client who is newly admitted with diabetes mellitus and whose fasting blood glucose level is 200mg/dL
A client who is 24hr postoperative following surgical reduction of a hip fracture and reports a pain level of 7 on a scale from 0-10
A client who is 3 days postoperative following abdominal surgery and is ready for discharge
70) A nurse in a clinic is reviewing laboratory reports for a group of clients. Which of the following diseases should the nurse report to the state health department? Rotavirus
Pertussis
Respiratory syncytial virus
Group B
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