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ATI RN Leadership Proctored Exam 2023
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Client Selection for Interdisciplinary Care Conference
A nurse in a prenatal clinic is caring for a group of clients. The nurse should recommend a client who is at 35 weeks of gestation and has a biophysical profile of 6 for an interdisciplinary care conference. This client would benefit from a collaborative approach to address the identified concerns.
Discharge Planning for a Client with End-Stage Heart
Failure
A nurse is preparing to discharge a client who has end-stage heart failure. The client's partner tells the nurse that she can no longer handle caring for the client. The nurse should contact the case manager to discuss discharge options. This allows for an assessment of the client's and family's needs and the development of an appropriate discharge plan.
Referral for a Toddler with Asthma
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. The nurse should recommend a referral to a social worker. The social worker can assist the family in obtaining the necessary equipment or financial resources to ensure the child's treatment needs are met.
Correct Feeding Technique for a Client with Dysphagia
A nurse is supervising assistive personnel who are feeding a client with dysphagia. The nurse should identify instructing the client to place their chin to chest while swallowing as the correct technique. This positioning helps to facilitate safe swallowing and prevent aspiration.
Client Rights In-Service
A nurse is providing an in-service about client rights for a group of nurses. The nurse should include the statement "A nurse can disclose information to a family member with the client's permission" in the in-service. This
emphasizes the importance of client consent when sharing information with family members.
Oxygen Equipment Delivery Delay
A nurse is preparing to discharge a client who requires home oxygen. The equipment company has not yet delivered the oxygen tank. The nurse should contact social services about the delivery of the oxygen equipment. This ensures the client has the necessary equipment in place before discharge.
Responding to a Client's Reconsideration of Consent
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. The nurse's appropriate response is "I understand, and it's not too late to change your mind." This acknowledges the client's concerns and respects their right to withdraw consent.
Reporting Abuse by Assistive Personnel
A nurse in a long-term care facility is caring for a client and witnessed the assistive personnel position him in bed with excessive force. The nurse should contact the nurse manager. Reporting the incident to the nurse manager allows for appropriate investigation and intervention to address the abuse.
Immediate Reporting of Meningitis Findings
A nurse is assessing a client who has meningitis. The nurse should immediately report a decreased level of consciousness to the provider. This finding requires prompt medical intervention to address the client's deteriorating condition.
Interventions for a Wandering Client
A nurse is caring for a client who wanders through the halls yelling obscenities at staff, other clients, and visitors. The nurse should contact family members to come visit with the client. Engaging the client with family support can help redirect their behavior and provide a calming presence.
Orienting a Newly Licensed Nurse
A nurse is assisting with the orientation of a newly licensed nurse. The newly licensed nurse is having trouble focusing and had difficulty completing care for their assigned client. The appropriate intervention is to recommend that the newly licensed nurse take time to plan at the beginning of their shift. This allows the nurse to organize their workload and prioritize client care.
Verifying Informed Consent for Emergency Surgery
A nurse enters a client's room to witness an informed consent for a gastroscopy. The client states he does not understand the procedure. The nurse should inform the provider that the client requires clarification about the procedure. Ensuring the client comprehends the proposed treatment is essential before obtaining informed consent.
Prioritizing Discharge Planning Issues
A case manager is preparing a discharge plan for a client following coronary artery bypass grafting surgery. The nurse should address the client's inadequate food supply first. Ensuring the client has access to appropriate nutrition is a critical component of the discharge plan.
Reporting Communicable Diseases
A nurse in a clinic is reviewing laboratory reports for a group of clients. The nurse should report pertussis to the state health department. Pertussis is a communicable disease that requires notification to public health authorities for surveillance and control measures.
Completing an Incident Report
A nurse is preparing to complete an incident report regarding a medication error. The nurse should plan to take the following actions: A. Place a copy of the completed report in the client's medical record B. Make a copy of the incident report for personal record keeping C. Identify the medication name and the dose administered to the client in the report D. Include the time the medication error occurred in the report
Assigning a Floated RN to an Obstetrical Unit
A charge nurse on an obstetrical unit is preparing the shift assignment. The charge nurse should assign a primigravida client who is 1 day postoperative following a Cesarean section and has a PCA pump to the RN who has floated from a medical-surgical unit. This client requires specialized postoperative care that may be outside the typical scope of a medical-surgical nurse.
Prioritizing Care for a Disoriented Client with a Cardiac
Arrhythmia
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. The nurse should prioritize assessing the client's cardiac status and addressing the arrhythmia. Stabilizing the client's hemodynamic condition is the highest priority.
Appropriate Task Assignment to an LPN
A nurse on a medical-surgical unit is caring for a group of clients with the assistance of an LPN and an assistive personnel. The nurse should assign reinforcing dietary teaching with a client who has heart disease to the LPN. This teaching aligns with the LPN's scope of practice and educational preparation.
Scheduling an Interdisciplinary Conference
A nurse working on a medical-surgical unit is managing care for four clients. The nurse should schedule an interdisciplinary conference for a client who is receiving heparin and has an aPTT of 34 seconds. This client's complex medical condition warrants a collaborative approach to care planning.
Responding to a Visitor Accessing Client Information
A nurse enters the hallway and discovers a visitor looking at a client's medical information on the computer. The nurse should first close the documentation program on the computer. This immediate action helps to secure the client's confidential information.
Reporting Suspected Elder Abuse
A nurse is assessing an older adult client who was brought to the emergency department by his adult son, who reports that the client fell at home. The nurse suspects elder abuse. The nurse should ask the client's son to go to the waiting area. Separating the client from the suspected abuser allows for a private assessment and reporting of the suspected abuse.
Responding to Conflicting Wishes Regarding End-of-Life
Care
A nurse is caring for a client who is unconscious and whose partner is their healthcare surrogate. The partner wishes to discontinue the client's feeding tube, but another family member tells the nurses they want the client to continue receiving treatment. As the healthcare surrogate, the client's partner can make the decision to discontinue the feeding tube. The nurse should respect the partner's authority as the designated decision-maker.
Administering Medication Against a Client's Wishes
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 the ethical principle of battery, as the nurse administered medication without the client's consent.
Reporting a Sexually Transmitted Infection
A nurse is caring for a client who has a new diagnosis of chlamydia. The nurse should report the infection to the local health department. Communicable diseases like chlamydia must be reported to public health authorities for surveillance and contact tracing purposes.
Prioritizing Nurse Manager Interventions
A nurse manager is receiving report and is faced with several situations that require intervention. The nurse manager should address the medication error incident report first. Addressing a potential safety issue related to medication administration is the highest priority.
Addressing Missed Meal Breaks
A charge nurse notices that two staff nurses are not taking meal breaks during their regular 8-hour shifts. The nurse should first determine the reasons the nurses are not taking scheduled breaks. Understanding the underlying factors is necessary to develop an appropriate intervention.
Transcribing a Verbal Prescription
A nurse is receiving a verbal prescription from the provider for a client who is having increased pain. The nurse should transcribe the prescription as "Morphine sulfate 10 mg IV q 4 hr for pain." This accurately captures the medication, dose, route, and frequency as verbally ordered.
Prioritizing Emergency Department Assessments
A nurse working in the emergency department is assessing several clients. The client who is the highest priority is the one who reports shortness of breath and left neck and shoulder pain. This presentation may indicate a life-threatening condition, such as a myocardial infarction, that requires immediate intervention.
Consulting the Interdisciplinary Team for TENS
A nurse is caring for a client who has a prescription for transcutaneous electrical nerve stimulation (TENS). The nurse should contact a physical therapist for assistance. The physical therapist has specialized expertise in the application and management of TENS therapy.
Demonstrating Understanding of Droplet Precautions
A nurse is teaching a newly licensed nurse about implementing droplet precautions for a client who has influenza. The statement by the newly licensed nurse that indicates understanding is "I will have a client who is on airborne precautions wear a mask when out of her room." This reflects the appropriate use of a mask for a client on droplet precautions.
Prioritizing Client Assessments
A nurse is caring for four clients. The client the nurse should assess first is the one who reports restlessness. Restlessness may be an early indicator of a change in the client's condition that requires prompt evaluation.
Obtaining a Wheelchair Prescription
A nurse is developing a discharge plan for a client who is post-operative and will require a wheelchair in the home. The nurse should place a referral to occupational therapy to obtain the client's prescription. Occupational therapists have the expertise to assess the client's needs and provide the appropriate wheelchair recommendation.
Quality Improvement Process: Initial Action
A nurse is working on a quality improvement team that is assessing an increase in client falls at a facility. After problem identification, the nurse should plan to collect data about specific client needs related to turning as the first action in the quality improvement process. Gathering relevant data is a crucial step to inform the development of targeted interventions.
Triage Tag Color for a Client with Extensive Burns
A nurse is conducting a disaster preparedness drill with a group of nurses who are orienting to the facility. The nurse should instruct the group to apply a black triage tag to a client who has a full-thickness burn on 72% of their body. A black tag indicates the client is expectant, meaning their injuries are not survivable with the available resources.
Completing Electronic Documentation
A nurse has just completed assessment charting on an electronic medical record for an assigned client. The nurse should ensure that the documentation is saved and closed appropriately to maintain the integrity and confidentiality of the client's electronic health record.
Nursing Concepts and Interventions
Charting Vital Signs
When an assistive personnel asks to chart a client's vital signs while the nurse is still logged in, the nurse should:
Have the client sign the "Against Medical Advice" form. Log out so the assistive personnel can log in and document the vital signs.
Infection Control Precautions
The correct use of infection control precautions by an assistive personnel is indicated by:
Removing gloves before leaving the room of a client with MRSA.
Advance Directives and Healthcare Proxies
When a client asks about advance directives and states they want to appoint a healthcare proxy, the nurse should respond:
"A healthcare proxy can make decisions for you when you are unable to do so."
Client Confidentiality Violations
Examples of client confidentiality violations include:
Discussing a client's condition with someone other than the client or authorized personnel. Leaving client information visible in a public area. Accessing a client's medical records without a legitimate need.
Change-of-Shift Report
The nurse should include the following information in the change-of-shift report:
The client's current medical status and any recent changes. The client's response to interventions and any ongoing treatment needs. The client's discharge plan, if applicable.
Language Barriers and Interpreters
When providing care to a client who speaks a different language, the nurse should plan to:
Provide an interpreter to facilitate communication and obtain informed consent.
Addressing Breaches in Facility Protocol
When witnessing an assistive personnel failing to follow facility protocol for discarding contaminated linens, the nurse should:
Inform the assistive personnel of the correct protocol and provide additional training as needed. Document the incident and report it to the appropriate supervisor or manager.
Prioritizing Client Care
When caring for four clients, the nurse should recognize the highest priority is a client who:
Has a cardiac arrhythmia and is disoriented.
Obtaining Consent for Treatment
When caring for a client who is disoriented and has a cardiac arrhythmia, the nurse should:
Proceed with treatment without obtaining written consent (Implied Consent).
Delegating Tasks to Licensed Practical Nurses (LPNs)
The nurse should assign the following tasks to an LPN:
Ambulating a client who is scheduled for discharge later in the day. Admitting a new client with chronic back pain to the unit.
The nurse should not assign the administration of an IV morphine bolus to a client who is 3 hours postoperative to an LPN.
Opioid and Benzodiazepine Administration
When a hospice client becomes somnolent and difficult to arouse after receiving prescribed opioid and benzodiazepine, the nurse should:
Contact the provider about adjusting the medication regimen to better manage the client's pain and sedation.
Jewelry Management for Surgical Clients
The appropriate procedure for taking care of a client's plain gold wedding band before surgery is to:
Place the ring in the bag with the client's clothing.
Chemical Exposure Incident
When admitting a client who has been exposed to a liquid chemical in an industrial setting, the nurse should first:
Remove the client's clothing. Irrigate the exposed area with water.
Cardiac Catheterization Teaching
When providing teaching to a 10-year-old child scheduled for an arterial cardiac catheterization, the nurse should include:
You will need to keep your legs straight for 8 hours following the procedure.
Post-Tonsillectomy Diet
The nurse should offer the preschooler who is post-operative following a tonsillectomy sugar-free cherry gelatin as an appropriate dietary choice to resume oral intake.
Patent Ductus Arteriosus
The nurse should identify that the patent ductus arteriosus defect is a switch in the location of the aorta and pulmonary artery.
Head Injury Assessment
The nurse should first assess the respiratory status of the 10-month-old child who sustained a head injury.
Failure to Thrive Care Plan
The nurse should include assigning consistent nursing staff to care for the infant with failure to thrive in the plan of care.
Scabies Home Care Teaching
The nurse should instruct the parent to soak combs and brushes in boiling water for 10 minutes to treat scabies.
Medication Administration for a Preschooler
Nurse's Statement to a Preschooler Refusing Oral
Diphenhydramine
The nurse should make the following statement to the preschooler who is refusing to take the oral diphenhydramine medication:
"Sometimes, when a child has to take medication, they feel sad. But this medicine will help you feel better."
This statement acknowledges the child's feelings, while also explaining the purpose of the medication in a simple, age-appropriate manner.
Bicycle Safety Teaching for a School-Age
Child
Nurse's Instructions for Bicycle Safety
The nurse should include the following instructions in the teaching about bicycle safety for a school-age child:
Your child should walk the bicycle through intersections. Your child's feet should be three to six inches off the ground when seated on the bicycle. You should try to keep the bicycle at least three feet from the curb while riding in the street. Your child should ride the bicycle with the flow of traffic.
Care for a School-Age Child with a Cast
Nurse's First Action
The nurse should first administer pain medication to the school-age child following the application of a cast to a fractured right tibia.
Preparing a School-Age Child for an Invasive
Procedure
Nurse's Actions
The nurse should plan to take the following actions to prepare a school-age child for an invasive procedure:
Explain the procedure to the child using simple, age-appropriate language. Demonstrate deep breathing and counting exercises to the child.
Urine Collection from a Female Infant
Nurse's Actions
When collecting a urine specimen from a female infant using a urine collection bag, the nurse should take the following actions:
Stretch the perineum taut when applying the bag. Place a snug-fitting diaper over the drainage bag.
Elevated heart rate Excessive diaphoresis
Administering Enteral Feeding to an
Adolescent
Nurse's First Action
The nurse should first check the pH of the gastric secretion before administering an enteral feeding to an adolescent with an NG tube.
Findings to Report for an Adolescent Post-
Appendectomy
Nurse's Reporting
The nurse should report the following finding to the provider for an adolescent 1 hour post-operative following an appendectomy:
Abdominal pain
Immunization for a 12-Year-Old Client
Nurse's Plan
The nurse should plan to administer the Diphtheria, Tetanus, and Pertussis (DTaP) immunization to the 12-year-old client during the well-child visit.
Care for an 8-Month-Old Infant with Heart
Failure
Nurse's Interventions
The nurse should include the following interventions in the plan of care for an 8-month-old infant with heart failure:
Administer cool, humidified oxygen via nasal cannula. Provide less frequent, higher volume feedings.
Promoting Sleep for a School-Age Child
Nurse's Intervention
The nurse should include the following intervention to promote adequate sleep for the school-age child:
Follow the child's home sleep routine to reduce anxiety.
Initiating IV Antibiotic Therapy for a 12-
Month-Old Infant
Nurse's Actions
The nurse should plan to take the following actions when initiating IV antibiotic therapy for a newly admitted 12-month-old infant:
Use a 24-gauge catheter to start the IV. Start the IV on the infant's foot.
Teaching about Digoxin Toxicity for an Infant
Nurse's Teaching
The nurse should include the following manifestation as an indication of digoxin toxicity in the teaching to the guardian of an infant with a new prescription for digoxin:
Bradycardia
Calculating Amoxicillin Dose for a 2-Year-Old
Client
Nurse's Calculation
The nurse should administer 10 mL of amoxicillin suspension per dose to the 2-year-old client who weighs 10 kg (22 lb).
Laboratory Tests to Confirm Rheumatic Fever
Diagnosis
Nurse's Identification
The laboratory tests that can contribute to confirming the diagnosis of rheumatic fever are:
Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) Anti-streptolysin O (ASO) titer
Findings to Report for a 5-Month-Old Infant
Nurse's Reporting
The nurse should report the following finding to the provider for the 5- month-old infant:
Exhibits head lag when pulled to a sitting position
Findings Indicating Hemorrhage after
Tonsillectomy and Adenoidectomy
Nurse's Identification
The nurse should identify continuous swallowing as an indication of hemorrhage in the five-year-old child following a tonsillectomy and adenoidectomy.
Therapeutic Question for a Parent of a 3-
Month-Old Infant
Nurse's Question
The therapeutic question the nurse should ask the parent of the three- month-old infant is:
"What do you do when your infant is fussy?"
Parent's Understanding of Sun Exposure
Teaching for a Toddler
Parent's Response
The response by the parent that indicates an understanding of the teaching about the effects of sun exposure for a toddler is:
"My child should wear a wide-brimmed hat."
Indication of Effective Chest Physiotherapy
for a Child with Cystic Fibrosis
Nurse's Identification
The nurse should identify increased expectoration as an indication that the chest physiotherapy treatment has been effective for the 6-year-old child with cystic fibrosis.
Care for an Infant with Bacterial Meningitis
Nurse's Interventions
The nurse should include the following interventions in the plan of care for the six-month-old infant with bacterial meningitis:
Place the infant in a private room. Provide range of motion to the neck and shoulders.
Findings to Report for a Child with Cystic
Fibrosis
Nurse's Reporting
The nurse should report the oxygen saturation to the provider for the child with cystic fibrosis.
Findings in an Infant with Severe Dehydration
Nurse's Expectations
The nurse should expect the following findings in the infant with severe dehydration due to gastroenteritis:
Increased respiratory rate Capillary refill of 2 seconds
Findings in an Infant with Intussusception
Nurse's Expectations
The nurse should expect the following finding in the infant with intussusception:
Sausage-shaped abdominal mass
Indication of Effective Elevation of the
Affected Extremity in an Adolescent
Nurse's Identification
The nurse should identify that the adolescent is able to move their fingers freely as an indication that the intervention of elevating the affected extremity has been effective.
