ATI Leadership Exam

Correct answer D: You always complete your work on time and do a great job. I believe you can handle the assignment well.

Explanation of the correct answer:

Smoothing is a conflict resolution strategy where one party attempts to reduce tension or minimize conflict by emphasizing areas of agreement and affirming the other person’s positive qualities. In this case, the charge nurse is acknowledging the staff nurse's strengths and reinforcing their confidence in handling the assignment, which helps to ease the conflict without addressing the underlying concerns directly. This tactic can temporarily smooth over tension while keeping the conversation positive and focused on the staff nurse's abilities.

Explanation of why the other options are incorrect:

A. Would you accept the assignment if we reassign your client who has total care needs and assign another client who can provide more self-care?

This statement is an example of problem-solving, not smoothing. The charge nurse is offering a potential solution to the conflict by altering the assignment based on the staff nurse's concerns. While this is a valid approach, it does not represent smoothing because it directly addresses the disagreement rather than attempting to smooth over the situation

B. Tell me what changes we need to make so that you'll feel comfortable with the assignment.

This statement is an example of collaboration or problem-solving, where the charge nurse is inviting the staff nurse to express concerns and work together toward a resolution. It aims to solve the issue directly, which differs from smoothing, which is more about reducing tension rather than resolving the conflict.

C. I didn't mean to make you feel overwhelmed. Why don't you look over the assignments with me and suggest changes?

This statement reflects a collaborative approach to conflict resolution. The charge nurse is acknowledging the staff nurse's feelings and inviting them to work together on the assignment. While this is a positive approach, it is not smoothing because it is focused on solving the issue rather than minimizing the tension.

Summary:

The correct example of smoothing is when the charge nurse reassures the staff nurse by emphasizing their strengths and abilities, helping to reduce tension and avoid direct confrontation. The other responses involve problem-solving or collaboration, which focus more on addressing the conflict directly.

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:

A. The client requires assistance with completing oral hygiene.

Explanation:

Occupational therapists focus on improving a client’s ability to perform activities of daily living (ADLs) that are affected by physical limitations, such as fine motor impairments from rheumatoid arthritis. Difficulty with oral hygiene indicates a need for adaptive strategies or assistive devices to maintain independence and self-care. Referral to an occupational therapist allows the development of individualized interventions to enhance functional abilities, promote safety, and support participation in daily routines.

Correct answer A: You should set aside time to plan your day at the beginning of each shift.

Explanation of the correct answer:

A. You should set aside time to plan your day at the beginning of each shift.

This is a constructive and supportive statement that promotes effective time management, which is essential for completing client care tasks in a timely manner. By encouraging the new nurse to plan at the start of the shift, the charge nurse is teaching a proactive strategy that can help the nurse prioritize tasks, anticipate challenges, and organize care efficiently. This is a key principle in nursing time management and delegation.

Explanation of incorrect options:

B. You should not take a break until all of your tasks are completed.

This statement promotes unhealthy work habits. Nurses are entitled to breaks, and skipping them can lead to burnout, decreased productivity, and compromised patient safety. Time management should include scheduled breaks to maintain performance and well-being.

C. You should leave your hardest task for the end of the shift.

Delaying difficult or time-consuming tasks until the end of the shift is poor time management and increases the risk of incomplete care or errors due to fatigue or time constraints. Challenging tasks should be addressed when energy levels are higher and more support is available earlier in the shift.

D. You should save your charting for the end of the shift.

Charting throughout the shift is a best practice. Delaying documentation can lead to inaccuracies, forgotten details, and legal risks. It’s important to document as care is provided to ensure accuracy and timeliness.

Summary:

Helping the nurse develop time management skills by planning the day at the beginning of the shift (Option A) is the most appropriate and supportive action. It empowers the nurse to take control of their workflow and supports professional development in a positive way.

Correct answer B: A client who is 2 days postoperative and has a urine output of 20 mL/hr

Explanation of the correct answer:

B. A client who is 2 days postoperative and has a urine output of 20 mL/hr

This is the priority finding. Urine output less than 30 mL/hr is a critical indicator of possible decreased renal perfusion, hypovolemia, or acute kidney injury, especially in a postoperative client. Prompt evaluation and intervention are necessary to prevent serious complications such as renal failure or fluid imbalance. Therefore, this finding must be reported to the charge nurse immediately.

Explanation of why the other options are incorrect:

A. A client who has heart failure and 2+ edema of the lower extremities

This is an expected finding in a client with heart failure. While it should be monitored, it is not an immediate priority unless it worsens or is accompanied by acute symptoms such as shortness of breath, crackles in the lungs, or weight gain.

C. A client who started taking verapamil and has a heart rate of 75/min

This is a normal heart rate. Verapamil, a calcium channel blocker, can cause bradycardia, but a heart rate of 75/min is within the normal range (60–100 bpm) and does not require immediate reporting.

D. A client who is receiving morphine and reports nausea

Nausea is a common and non-urgent side effect of morphine. While it should be addressed for comfort and to prevent complications like vomiting, it is not a priority over decreased urine output, which may indicate a life-threatening condition.

Summary:

The nurse should prioritize and report the client with postoperative oliguria (20 mL/hr urine output) due to the potential for serious complications. While other findings are notable, they are either expected or manageable and do not take precedence over signs of compromised renal function.

Correct Answer:

B. Discuss the client's wishes with the interprofessional team.

Explanation:

The nurse’s role in advance care planning is to advocate for the client’s wishes while ensuring the healthcare team is aware and can incorporate the DNR order into the care plan. Discussing the client’s request with the interprofessional team facilitates coordinated care, respects the client’s autonomy, and ensures that all providers follow the client’s wishes during a medical emergency.

Correct Answer C: The Patient Self-Determination Act (PSDA) requires a nurse to give clients information about end-of-life options.

Detailed Explanation of the Correct Answer:

C. The Patient Self-Determination Act (PSDA) requires a nurse to give clients information about end-of-life options.

The Patient Self-Determination Act (PSDA) was enacted to ensure that clients are informed about their rights to make decisions regarding their health care, particularly related to end-of-life care. This law requires health care providers, including nurses, to provide clients with information about advance directives, living wills, and durable powers of attorney for health care. Nurses must ensure that clients understand their rights to accept or refuse medical treatment and make choices about end-of-life care, including the ability to refuse life-sustaining treatments.

Explanation of Incorrect Answers:

A. Good Samaritan laws provide protection for nurses who are negligent when providing volunteer services.

Incorrect – Good Samaritan laws do not protect negligent actions. These laws are designed to protect health care professionals who provide emergency care in good faith and without gross negligence. If a nurse acts recklessly or negligently while offering volunteer services in an emergency situation, they are not protected by Good Samaritan laws. The key principle is that the nurse must act within their scope of practice and must provide care without gross negligence.

B. The Emergency Medical Treatment and Active Labor Act (EMTALA) provides nursing guidelines for providing client care outside the health care facility.

Incorrect – The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that requires emergency departments to treat all clients in an emergency situation, regardless of their ability to pay or their insurance status. EMTALA does not provide nursing guidelines for care outside the health care facility. It focuses on ensuring that emergency medical conditions and active labor are treated appropriately within the facility, and it mandates that clients must be stabilized before being transferred or discharged.

D. State nurse practice acts are informal guidelines that direct professional nursing practice.

Incorrect – State nurse practice acts are formal laws, not informal guidelines. These acts regulate the scope of practice for nurses, defining what nurses can and cannot do in their professional role. They are legally binding and ensure that nursing care is delivered safely and competently. These laws are created by state legislatures and enforce standards for nursing practice within each state.

Summary:

The Patient Self-Determination Act (PSDA) is the law that mandates nurses to provide clients with information about their rights regarding end-of-life care and decisions (C). The other options involve misunderstandings of the relevant health care laws, such as Good Samaritan laws (A), EMTALA (B), and nurse practice acts (D).

Correct answer D: Use a 60 mL syringe to flush out a clogged tube

Explanation of the correct answer:

D. Use a 60 mL syringe to flush out a clogged tube

This is the correct intervention. A 60 mL syringe is recommended because its size generates lower pressure than smaller syringes, which helps reduce the risk of damaging the nasogastric (NG) tube. When unclogging a feeding tube, using warm water and gentle pressure with a large syringe is the safest and most effective approach.

Explanation of the incorrect options:

A. Flush the tube every 8 hours with 0.9% sodium chloride irrigation

This is incorrect because feeding tubes are typically flushed with sterile or tap water (depending on facility policy and the client's condition) before and after feedings and medications—not every 8 hours regardless of usage. Regular flushing helps maintain patency. Sodium chloride is not routinely used for NG tube flushing unless specifically prescribed.

B. Use an acidic juice to unclog a blocked tube

This is not recommended. Acidic juices like cranberry or orange juice can interact with feeding formulas and medications, potentially worsening the clog. They can also damage the lining of the tube. Warm water is preferred; enzymes may be used if needed under guidance.

C. Add dissolved medications to the enteral feeding

This is inappropriate. Medications should never be added directly to the enteral feeding formula because of the risk of physical and chemical incompatibilities. Each medication should be administered separately with appropriate flushing before and after to prevent interactions and clogging.

Summary:

The correct intervention in a care plan for a client with a continuous NG tube feeding is to use a 60 mL syringe to flush out a clogged tube (D). This ensures safe pressure and helps maintain tube patency. Other options either pose risks or reflect incorrect practices.

Correct answer D: A patient who has a cast newly applied on the forearm and reports tingling in the fingers.

Explanation of the correct answer:

D. A patient who has a cast newly applied on the forearm and reports tingling in the fingers.

Tingling in the fingers after a new cast application can indicate compromised circulation or nerve function. This could be a sign of compartment syndrome, which is a medical emergency. Compartment syndrome occurs when increased pressure in a closed muscle compartment compromises blood flow, leading to tissue ischemia and nerve damage. The nurse should assess the patient's neurovascular status immediately and notify the provider if any signs of impaired circulation or nerve function are present.

Why the other options are incorrect:

A. A patient who is newly admitted and is scheduled for indwelling urinary catheter insertion.

While this patient requires a catheter insertion, it is a routine procedure and does not present an immediate concern or emergency. The nurse can attend to this task after addressing more urgent issues, such as the patient with the newly applied cast and possible nerve damage.

B. A patient who has kidney stones and reports flank pain of 6 on a pain scale of 0-10.

Although the patient is experiencing pain, it is rated as moderate (6/10) and is not considered an immediate life-threatening situation. The nurse can manage the pain with prescribed analgesics and continue to monitor the patient, but this does not take priority over the patient with the potential for nerve damage or impaired circulation.

C. A patient diagnosed with early-stage chronic kidney disease with a serum creatinine level of 2.0 mg/dL.

A creatinine level of 2.0 mg/dL is elevated, indicating kidney dysfunction, but early-stage chronic kidney disease does not present an immediate, life-threatening situation. The nurse should monitor the patient’s kidney function and coordinate care accordingly, but this patient does not need immediate intervention compared to the patient with a potential emergency in their casted arm.

Summary:

The patient with the newly applied cast who reports tingling in their fingers should be attended to first, as tingling can be a sign of compromised circulation or nerve function, potentially indicating compartment syndrome, which requires immediate intervention. Other patients, while they may require care, do not present an immediate emergency and can be addressed after this more urgent issue is resolved.