ATI Leadership management version 1 2021/2022

ATI Leadership management version 1 2021/2022 MY ANSWE The nurse should provide clear descriptions in terms the client can understand when providing written discharge instructions. The nurse should also ensure the client is aware of what complications to report to the provider. Resume Na-restricted diet. The nurse should avoid using abbreviations in written discharge instructions because the client can have difficulty understanding the information. Perform quadriceps setting exercises when supine. The nurse should provide step-by-step instructions on how to perform quadriceps setting exercises when lying supine and avoid using vocabulary that the client can have difficulty understanding in the written discharge instructions. 4. A nurse is using the SBAR communication tool for reporting a client's condition to the provider. Which of the following information should the nurse include in the "S" portion of the tool? The client was medicated with morphine 2 mg IV 1 hr ago. This information provides medical information that is pertinent to the client's condition and is part of the background portion (B) of the SBAR communication tool. The client needs a change in pain medication prescription. MY ANSWER This information provides a potential solution for the client's current need and is part of the recommendation portion (R) of the SBAR communication tool. The client is reporting a pain level of 8 on a scale from 0 to 10. This information provides a brief explanation of the current situation and is part of the situation portion (S) of the SBAR communication tool. The client has a heart rate of 110/min and a BP of 148/88 mm Hg. This information provides recent assessment data indicating the client's current condition and is part of the assessment portion (A) of the SBAR communication tool. 5. A nurse manager is anticipating a period when staffing will be especially short. The nurse manager decides to reorganize the delivery of care on the unit until staffing improves by appointing a charge nurse, a medication nurse, and a treatment nurse. Which of the following delivery systems is the nurse manager using? Primary nursing Primary nursing is a form of total client care in which one nurse has 24-hr responsibility and accountability for the nursing care of specific clients for the duration of their stay at the facility. Primary nursing promotes clear communication among the health care team. Team nursing MY ANSWER Team nursing is the most common nursing care delivery system. The nurse manager divides the nursing staff into teams, including staff of various skills and licensure. Each team provides total care to a specific group of clients and has a team leader. Functional nursing Functional nursing, also called task nursing, involves the nurse manager breaking down the needs of the clients into tasks and assigning the tasks using the skill and licensure of each staff member appropriately and efficiently. This model of nursing is uncommon in acute care settings, except in crisis situations, or when there is a shortage in staffing numbers. Modular nursing Modular nursing is a type of team nursing in which a manager assigns a team of staff, often called care pairs, with various skills and licensure to a given geographic area, or module. An example of modular nursing is assigning a team to a group of clients' rooms. 6. A nurse manager is preparing a nurse's performance appraisal. Which of the following actions should the nurse manager take? Avoid using specific examples of client care to maintain confidentiality. The nurse manager should include specific examples that occur throughout the appraisal period and avoid generalities about the nurse's performance of client care during the performance appraisal. Focus on the nurse's most recent performance just before the evaluation. The nurse manager should focus on the nurse's performance throughout the appraisal period by collecting data systematically and on a regular basis. Otherwise, recent performance will likely be more heavily evaluated than past performance. Present goals to the nurse at the initial meeting. MY ANSWER The nurse manager should set goals together with the nurse during the performance appraisal. Use a formalized system to discuss important issues. The nurse manager should use a formalized system to determine the employee's level of meeting the objectives for their job. The goal of performance appraisal is to promote growth for the employee and provide recognition for areas of strength along with feedback for areas of concern. 7. A nurse in an acute care facility is caring for a client who is leaving against medical advice (AMA). Which of the following actions should the nurse take? (Select all that apply.) Attempt to detain the client. Request the client sign an AMA form. Notify the provider of client's intent. Sedate the client while waiting for the provider to arrive. Advise the client about the dangers of leaving. MY ANSWER Attempt to detain the client is incorrect. The nurse has no authority to detain a client. Furthermore, this action is considered a of type of restraint. Request the client sign an AMA form is correct. The nurse should ask the client to sign an AMA form to document the incident. A signed AMA form can assist with a counterclaim of negligence. Notify the provider of client's intent is correct. The nurse should immediately notify the provider of the client's intent to leave AMA. Sedate the client while waiting for the provider to arrive is incorrect. The nurse should not sedate the client while waiting for the provider to arrive because this could be considered the use of a chemical restraint and is in direct opposition to the client's wish to leave. Advise the client about the dangers of leaving is correct. The nurse should discuss the potential dangers of leaving AMA, such as complications of the client's medical condition. 8. A nurse is using the situation, background, assessment, recommendation (SBAR) format to provide hand-off report for a client. In which of the following components of the SBAR report should the nurse include information about the client's current vital signs? Situation The nurse should include the nurse's name, the client's name, the name of the facility, the client's medical diagnosis, and a general description of the client's situation in the situation (S) section of the SBAR report. Background The nurse should provide information relevant to the client's condition such as the client's admitting diagnosis and any surgical procedures in the background (B) section of the SBAR report. Assessment MY ANSWER The nurse should include findings such as current vital signs, pain level, and appearance of a wound dressing in the assessment (A) section of the SBAR report Recommendation The nurse should provide information on how to resolve a problem or improve client care in the recommendation (R) section of the SBAR report. 9. A charge nurse in an acute care facility is teaching a newly licensed nurse about caring for an adult client who is cognitively impaired. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? "I will let the client sit at the nurses' station during the day." The newly licensed nurse should place the client in a location where she can be frequently observed. However, the newly licensed nurse should not place the client at the nurses' station. Confidential information about other clients is kept at the nurses' station and the client should not be allowed into this area. The area behind the desks is for facility personnel only. "I will assign the client to a room close to the nurses' station." MY ANSWER The newly licensed nurse should assign the client to a room close to the nurses' station so the newly licensed nurse can closely monitor the client. "I will elevate full-length bed rails while the client is in bed." The newly licensed nurse should lower the bed to the lowest level and apply 1/4- to 3/4-length bed rails to prevent the client from climbing over the rails and falling. "I will place a red wrist band on the client to indicate fall risk." The newly licensed nurse should place a yellow wrist band on the client, which is the standard color for fall risk recommended by the America Hospital Association. Red bands are recommended for allergy information. 10. A nurse manager on a maternal newborn unit is completing a chart audit to determine the percentage of clients over the past 3 months who breastfed their newborns successfully prior to discharge. Which of the following standards is the nurse using to complete this audit? Structure Structure standards focus on the internal characteristics of a facility and its staff. These standards help determine if a facility has a structure that promotes high-quality care. An example of a structural standard is ensuring a nursing department provides opportunities for staff development . Outcome MY ANSWER Outcome standards measure whether the services the nurses provide make any difference in a client's health status. The outcome would be a change in clients' current or future health status as a result of the care they received. Other examples of outcome standards include clients ambulating without assistance or clients who have clear breath sounds. Process Process standards focus on how well a facility conducts its activities. An example of a process standard is staff measuring vital signs every hour unless otherwise specified. Practice Practice standards are guidelines for professional performance that address a wide variety of aspects of nursing care delivery. Practice standards focus on the nurse as a provider, are process- oriented, and relate to expectations for the provider to achieve the standard of care. An example of a practice standard is basing care planning on client assessment and identification of specific nursing diagnoses. 11. A nurse manager is changing the ratio of registered nurses (RNs) to licensed practical nurses (LPNs) on a unit to decrease costs. Which of the following strategies should the nurse manager implement to reduce resistance from the staff? Send a memo to each staff member announcing the new RN/LPN ratio. Announcing a change is not a strategy to reduce staff resistance. Staff should also have the opportunity to provide input related the change. Assign the staff to read research articles about the process of change. Although assigning research articles for the staff to read can help the nursing staff understand how change happens, it is not a strategy to reduce staff resistance. Most resistance is related to individual values, background, experience, and education levels. Formulate a sample staffing schedule covering 1 month. MY ANSWER The nurse manager should include the staff in the process by formulating a sample staffing schedule covering 1 month so that the staff can view the schedule and provide feedback. Resistance to change is an integral part of the process of change. A common reaction to scheduling changes is a fear of loss of hours and lack of trust of the employer. Discuss the planned change with other nurse managers. The nurse manager can discuss the change with other nurse managers if the other nurse mangers have implemented similar changes. However, this does not help reduce the staff's resistance to the change. 12. A nurse is preparing a client for a surgical procedure to continue the revision of a large burn scar on the left arm. The client tells the nurse that they want to cancel the procedure. Which of the following responses should the nurse make? "This procedure will improve the appearance of your arm." The nurse should not offer opinions or pass judgment about the client's decision to refuse treatment. The nurse should encourage the client to make his own decisions regarding his care. "Why have you changed your mind about this procedure?" The nurse should not question or challenge the client's decision to refuse treatment. This can cause the client to feel defensive, and it blocks open communication about the client's concerns. "I will inform the provider of your decision." MY ANSWER The nurse should recognize that the client has the right to refuse treatment at any time. Therefore, the nurse should notify the provider of the client's decision to refuse treatment. "Don't worry, this is a routine procedure." The nurse should not offer false reassurance. This can block communication about the client's concerns about the procedure. 13. A nurse is receiving change-of-shift report for a group of clients. Which of the following clients should the nurse assess first? A client who requests sumatriptan for a migraine The nurse should check this client's pain level and administer the medication if it is indicated to treat the client's migraine and to relieve pain. However, there is another client the nurse should assess first. A client who is postoperative and has respiratory rate of 10/min MY ANSWER When using the airway, breathing, circulation approach to client care the nurse should assess the client who is postoperative and has a respiratory rate of 10/min first. A respiratory rate of 10/min is below the expected reference range of 12 to 20/min and can indicate that the client is experiencing an adverse effect from anesthesia or pain medication. A client who is immobile and has a reddened coccyx The nurse should further assess the condition of this client's skin to determine the level of injury. However, there is another client the nurse should assess first. A client who is scheduled for a sterile dressing change The nurse should perform the scheduled sterile dressing change for this client. However, there is another client the nurse should assess first. 14. A nurse manager suspects that a staff nurse on the night shift has a substance use disorder. Which of the following actions should the nurse manager take? Discuss the situation with the facility administrator. The nurse manager should discuss the situation with the nurse supervisor rather than the facility administrator.