ATI Leadership Exam

Correct answer C: I should complete an incident report for an unexpected client occurrence.

Explanation of the correct answer:

C. I should complete an incident report for an unexpected client occurrence.

An incident report is used to document any unexpected or unusual occurrences involving a client, such as falls, medication errors, or equipment malfunction. This documentation is essential for ensuring that the situation is formally reviewed to improve patient safety and prevent similar incidents in the future. It is not intended to be part of the client’s medical record but rather a separate document used for internal review.

Explanation of why the other options are incorrect:

A. I should place a copy of an incident report in the client's medical record.

Incident reports should not be placed in the client's medical record. These reports are confidential and are part of the institution's internal quality assurance process, not the patient's permanent medical record. Including an incident report in the medical record could create legal risks and may be used as evidence in court.

B. I should document the completion of an incident report in the client's medical record.

Incident reports should not be mentioned in the client’s medical record. The medical record should contain the details of the client’s care, while the incident report is a separate document that details the event itself. Documentation in the client’s record should focus on clinical care and treatment, not internal quality assessments like incident reports.

D. I should ask the risk manager to complete the incident reports.

The responsibility for completing incident reports lies with the healthcare provider who witnesses or is involved in the incident, not with the risk manager. While the risk manager may be involved in reviewing the report or handling any follow-up actions, they do not complete the report itself.

Summary:

The correct action for a nurse is to complete an incident report following an unexpected client occurrence to document the event for internal review and quality improvement. It is crucial to understand that incident reports are not part of the client’s medical record and should be kept separate.

Correct Answer D: State Nurse Practice Act (NPA)

Detailed Explanation of the Correct Answer:

D. State Nurse Practice Act (NPA)

The State Nurse Practice Act (NPA) is the most appropriate resource when planning a policy that affects the scope of practice for nurses. Each state's NPA outlines the legal scope of practice for registered nurses, including what nursing procedures are permissible. In this case, the policy regarding peripherally inserted central catheters (PICC) insertion would fall under the scope of practice for nurses. The NPA will help determine if the procedure is within the nurse’s authorized responsibilities or if additional training, certification, or policy development is required. The nurse should review the NPA to ensure that any policy created is in compliance with state regulations.

Explanation of Incorrect Answers:

A. National League for Nursing (NLN)

The NLN focuses on advancing nursing education and ensuring that nursing programs meet accreditation standards. Although the NLN plays a key role in nursing education, it does not dictate the scope of practice or provide the legal framework for clinical nursing procedures. Therefore, it is not the best resource for policy development regarding clinical practices like PICC insertion.

B. American Academy of Nursing (AAN)

The American Academy of Nursing (AAN) is an organization focused on the advancement of the nursing profession, primarily through policy advocacy and research. While the AAN can influence healthcare policies at a national level, it does not provide specific guidance on what individual nurses can or cannot do in terms of clinical procedures. This makes it less relevant than the State Nurse Practice Act in this context.

C. Agency for Healthcare Research and Quality (AHRQ)

The AHRQ is a government agency focused on improving the quality of healthcare through research and the dissemination of evidence-based practices. While the AHRQ can provide useful evidence on the best practices for procedures like PICC insertion, it does not have the authority to dictate the legal scope of nursing practice. This is the responsibility of the State Nurse Practice Act.

Summary:

To develop a policy allowing nurses to insert peripherally inserted central catheters (PICC), the State Nurse Practice Act (NPA) should be consulted, as it defines the legal scope of nursing practice in the state. Other resources, such as the NLN, AAN, and AHRQ, may offer valuable insights on education, advocacy, or evidence-based practices but do not govern the legal scope of nursing procedures.

Correct Answe B: Isolates herself from other staff members.

Detailed Explanation of the Correct Answer:

B. Isolates herself from other staff members.

Social withdrawal or isolation from colleagues can be a significant warning sign of a nurse working while impaired. Behavioral changes such as becoming more withdrawn, irritable, or distant may indicate the nurse is struggling with substance use or other issues that are affecting their ability to interact and function in a team environment. If this is observed, the charge nurse should investigate further and offer appropriate support, ensuring that the nurse’s safety, as well as the safety of their patients, is not compromised.

Explanation of Incorrect Answers:

A. Refuses to work overtime shifts.

While refusing overtime shifts could indicate various personal reasons, such as fatigue, stress, or scheduling preferences, it is not necessarily a sign of impairment. Many nurses may choose not to work overtime due to personal or health concerns, but this alone does not indicate impairment.

C. Skips lunch break to complete charting.

Skipping breaks to complete tasks such as charting can be a sign of stress or time management issues, but it is not necessarily indicative of impairment. Some nurses may skip breaks because they feel overwhelmed by their workload or prefer to stay busy, but this behavior is not a direct indicator of impairment.

D. Volunteers to help other nurses with their assignments.

Volunteering to assist others can often be seen as a positive, team-oriented behavior. It does not necessarily suggest impairment, as it could simply reflect the nurse’s willingness to collaborate and help their colleagues. However, if the volunteer behavior becomes excessive, forced, or out of character, it may require further observation.

Summary:

The most significant indicator of a staff nurse working while impaired is social isolation (B). Withdrawal from colleagues and a lack of interaction can signal emotional or psychological distress related to impairment. Other behaviors, such as refusing overtime or skipping breaks, are not conclusive signs of impairment on their own.

Correct answer D: Occupational therapy

Explanation of the correct answer:

D. Occupational therapy

Occupational therapy focuses on helping clients improve their ability to perform activities of daily living (ADLs), such as dressing, grooming, and cooking. For a client with rheumatoid arthritis who has difficulty buttoning clothing, a referral to occupational therapy is appropriate. The occupational therapist can assess the client’s functional abilities and provide adaptive strategies or devices to help with dressing, including using button hooks or teaching new techniques to facilitate the process.

Explanation of why the other options are incorrect:

A. Pain management clinic

While a pain management clinic could help the client manage the discomfort associated with rheumatoid arthritis, it is not the best referral for addressing the specific difficulty with buttoning clothing. This referral would focus more on managing the pain rather than improving the client’s functional abilities related to daily activities.

B. Physical therapy

Physical therapy is focused on improving strength, mobility, and physical function. While important for managing rheumatoid arthritis, physical therapy is not the most appropriate intervention for addressing difficulties with activities of daily living (ADLs) like buttoning clothing. Occupational therapy is the more suitable choice for this type of functional impairment.

C. Arthritis support group

An arthritis support group could provide emotional support and help the client connect with others facing similar challenges, but it would not directly address the functional issues related to the client’s difficulty with buttoning clothing. An occupational therapy referral would be more practical in this scenario.

Summary:

For a client with rheumatoid arthritis who has difficulty buttoning clothing, the most appropriate referral is to occupational therapy (Option D). Occupational therapy will focus on helping the client with adaptive strategies and devices to improve their ability to perform activities of daily living.

Correct answer D: A client who has pertussis.

Explanation of the correct answer:

D. A client who has pertussis.

Pertussis (also known as whooping cough) is a highly contagious respiratory infection caused by Bordetella pertussis. It is transmitted via respiratory droplets when an infected person coughs, sneezes, or talks. Therefore, droplet precautions are required. These precautions include wearing a mask when within 3 feet of the patient, placing the patient in a private room, and using appropriate hand hygiene. The goal is to prevent transmission of large-particle droplets that do not remain suspended in the air for long.

Explanation of incorrect options:

A. A client who has shigella.

Shigella is a bacterial infection transmitted through the fecal-oral route, commonly through contaminated food or water. The appropriate precautions are contact precautions, not droplet. This involves wearing gloves and a gown when in contact with the patient or their environment, especially where fecal contamination is possible.

B. A client who has measles.

Measles requires airborne precautions, not droplet. Measles is caused by a virus that is transmitted via airborne particles that can remain suspended in the air for long periods. Patients with measles should be placed in a negative-pressure room, and caregivers must wear an N95 respirator mask.

C. A client who has toxic shock syndrome.

Toxic shock syndrome is not typically considered contagious and does not require transmission-based precautions like droplet, airborne, or contact precautions. Standard precautions are sufficient unless another condition is present that warrants additional measures.

Summary:

Droplet precautions are required for infections like pertussis (Option D), which spread through respiratory droplets. The other conditions listed require either contact precautions, airborne precautions, or standard precautions.

Correct Answer:

D. A newborn has not voided or stooled since birth 24 hr ago.

Explanation:

A newborn who has not voided or stooled within 24 hours of birth requires immediate assessment because this can indicate renal or gastrointestinal dysfunction. Normal newborns should pass urine and meconium within the first 24 hours. The nurse must notify the provider promptly to initiate evaluation and intervention. This is a critical finding, as it can signify underlying anatomical or physiological issues needing urgent attention.

Correct Answers:

A. A wheeled office chair at the client’s computer desk

B. A throw rug covering some cracked vinyl flooring in the kitchen

C. Two-wheeled walker used to assist the client with ambulation

E. A folding chair without armrests

Explanation:

A. A wheeled office chair at the client’s computer desk

Wheeled chairs are unstable and can roll unexpectedly, increasing the risk of the client losing balance and falling.

B. A throw rug covering some cracked vinyl flooring in the kitchen

Loose rugs and uneven flooring create tripping hazards, which are common causes of home falls.

C. Two-wheeled walker used to assist the client with ambulation

A two-wheeled walker provides less stability than a standard four-legged walker, increasing the risk of imbalance and falls.

E. A folding chair without armrests

Folding chairs are less stable, and lack of armrests makes it difficult for the client to safely sit or rise, increasing fall risk.

Correct answer A: Recheck the client's blood pressure.

Explanation of the correct answer: A. Recheck the client's blood pressure.

The RN's first priority should be to confirm the accuracy of the blood pressure reading. It is important to recheck the blood pressure to ensure that the elevated reading was not due to an error in technique, equipment, or other transient factors. Rechecking provides the opportunity to verify whether the blood pressure is truly elevated, which will guide further interventions.

Explanation of why the other options are incorrect:

B. Treat the client's blood pressure with a prescribed antihypertensive.

Treating the elevated blood pressure with medication is not appropriate without first confirming the accuracy of the blood pressure measurement. Administering medication based on a potentially inaccurate reading could lead to unnecessary or harmful treatment. The RN must first verify the reading before deciding on any medical interventions.

C. Ask the LPN to review the technique for obtaining blood pressure.

While it is important to ensure correct technique in obtaining vital signs, the first step is to recheck the blood pressure to confirm that the reading is accurate. If the recheck shows an elevated reading, the RN can then review the technique with the LPN as needed, but confirming the reading should be the RN's first action.

D. Review the client's medical record for other episodes of elevated blood pressure.

While reviewing the client’s medical record may provide useful information about trends in blood pressure, the first priority is to verify the current blood pressure reading. Only after confirming the current reading should the RN consider the client’s medical history and decide on further actions.

Summary:

The RN should first recheck the client's blood pressure to confirm the accuracy of the elevated reading. This step ensures that any decisions made regarding treatment or further action are based on accurate and reliable information. Treating elevated blood pressure or reviewing the LPN’s technique should occur after confirming the initial reading.

Correct Answers:

A. "I administer pain medication to my clients even if they have a history of narcotic addiction."

D. "I will attend continuing education classes for professional growth."

Explanation:

A. "I administer pain medication to my clients even if they have a history of narcotic addiction."

The nursing code of ethics emphasizes nonjudgmental care and advocacy for clients’ needs, including effective pain management. Nurses must provide appropriate pain relief regardless of a client’s history of substance use, ensuring safe and ethical care.

D. "I will attend continuing education classes for professional growth."

The code of ethics requires nurses to maintain competence and professional development. Continuing education ensures that nurses provide safe, evidence-based care and uphold ethical and professional standards.