Leadership ATI Practice Test 4
A nurse is evaluating a newly licensed nurse who is administering a vitamin K injection
to a newborn. Which of the following actions by the newly licensed nurse indicates
understanding of the teaching? (SATA)
a. Applies gentle pressure at the site after injection
b. Aspirates the syringe for blood return after needle insertion
c. Selects the dorsogluteal site to administer the injection
d. Inserts the needle at a 45° angle - IM should be 90
e. Cleans the injection site with alcohol - Answer a. Applies gentle pressure at the site
after injection
b. Aspirates the syringe for blood return after needle insertion
e. Cleans the injection site with alcohol
A nurse manager is reviewing guidelines for informed consent with the nursing staff.
Which of the following statements by a staff nurse indicates that the teaching was
effective?
a. "Guardian consent is required for an emancipated minor."
b. "Consent can be given by a durable power of attorney."
c. "The nurse can answer any questions the client has about the procedure."
d. "A family member can interpret to obtain informed consent from a client who is deaf."
- Answer b. "Consent can be given by a durable power of attorney."
A nurse is teaching a client how to use a finger-stick glucometer at home. Which of the
following instructions should the nurse include?
a. Obtain the blood sample from the finger pads.
b. Elevate the arm for 1 min before taking the blood sample.
c. Cap the lancet prior to putting it in the trash.
d. Warm the hands prior to piercing the skin - Answer d. Warm the hands prior to
piercing the skin
A client is admitted with COPD. Which of the following findings should the nurse report
to the provider?
a. Report of dyspnea on exertion
b. Oxygen saturation 89% on room air
c. White blood cell count 9,000/mm3
d. Bilateral crackles on auscultation of lungs - Answer d. Bilateral crackles on
auscultation of lungs
,A client schedule for a tubal ligation procedure starts to cry as she is wheeled into the
surgical suite. Which of the following nursing statements is an appropriate nursing
response?
a. "You shouldn't be worried because the procedure is very safe."
b. "This won't take long and it will be over before you know it."
c. "Why did you make the decision to have this procedure?"
d. "It's not too late to cancel the surgery if you want to." - Answer d. "It's not too late to
cancel the surgery if you want to."
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?
a. Libel
b. False imprisonment
c. Battery
d. Assault - Answer c. Battery
A nurse manager overhears a provider and a staff nurse talking about a client's
diagnosis in the cafeteria. Which of the following actions should the nurse take first?
a. Provide a staff inservice about client confidentiality.
b. Fill out an incident report regarding the situation.
c. Remind them that client information is confidential.
d. Report the incident to the nursing supervisor. - Answer c. Remind them that client
information is confidential.
A nurse is serving on a committee that is revising the protocol for discharging clients.
After developing an initial plan, in which order should the nurse take the following
steps?
Implement recommended strategies
Determine goals
Evaluate the results
Revise the plan. - Answer Determine goals
Implement recommended strategies
Revise the plan.
Evaluate the results
A nurse is orienting to an emergency department. The nurse is asked to assist with
suturing of a laceration on a client's hand. Which of the following is the best resource for
this nurse?
a. The preceptor on the clinical unit
b. The provider suturing the client's injury
, c. The nursing supervisor
d. The information on the suture package - Answer b. The provider suturing the client's
injury
A client is brought to the emergency department (ED) following a motor-vehicle crash.
Drug use is suspected in the crash, and a voided urine specimen is ordered. The client
repeatedly refuses to provide the specimen. Which of the following is the appropriate
action by the nurse?
a. Assess the client for urinary retention.
b. Obtain a provider's prescription for a blood alcohol level.
c. Tell the client that a catheter will be inserted.
d. Document the client's refusal in the chart. - Answer d. Document the client's refusal in
the chart.
While auditing the medical records of clients currently on an oncology unit, the nurse
manager finds that six of the 15 records lack documentation regarding advance
directives. Which of the following is the priority action for the nurse to take?
a. Ask nurses who are caring for clients without this information in the medical record to
obtain it.
b. Remind nurses to obtain this information during the admission process.
c. Meet with nursing staff to review the policy regarding advance directives.
d. Reinforce the potential consequences of not having this information on record to the
nursing staff. - Answer c. Meet with nursing staff to review the policy regarding advance
directives.
A nurse who is precepting a newly licensed nurse is discussing the client assignment for
the shift. Which of the following actions should the nurse preceptor take first to
demonstrate appropriate time management?
a. Determine client care goals.
b. Review the client's new laboratory values.
c. Complete required tasks.
d. Document assessment data. - Answer a. Determine client care goals.
A facility provides annual staff education regarding ethical practice. A charge nurse
recognizes a need for further education when which of the following behaviors is
observed?
a. A nurse gives prescribed opioids to a client who has a terminal illness and
respirations of 8/min.
b. A nurse refuses to actively participate during an elective abortion procedure
scheduled for her client.
c. A nurse informs a confused client who wants to go home that he is going to stay at
the facility until he is better.
A nurse is evaluating a newly licensed nurse who is administering a vitamin K injection
to a newborn. Which of the following actions by the newly licensed nurse indicates
understanding of the teaching? (SATA)
a. Applies gentle pressure at the site after injection
b. Aspirates the syringe for blood return after needle insertion
c. Selects the dorsogluteal site to administer the injection
d. Inserts the needle at a 45° angle - IM should be 90
e. Cleans the injection site with alcohol - Answer a. Applies gentle pressure at the site
after injection
b. Aspirates the syringe for blood return after needle insertion
e. Cleans the injection site with alcohol
A nurse manager is reviewing guidelines for informed consent with the nursing staff.
Which of the following statements by a staff nurse indicates that the teaching was
effective?
a. "Guardian consent is required for an emancipated minor."
b. "Consent can be given by a durable power of attorney."
c. "The nurse can answer any questions the client has about the procedure."
d. "A family member can interpret to obtain informed consent from a client who is deaf."
- Answer b. "Consent can be given by a durable power of attorney."
A nurse is teaching a client how to use a finger-stick glucometer at home. Which of the
following instructions should the nurse include?
a. Obtain the blood sample from the finger pads.
b. Elevate the arm for 1 min before taking the blood sample.
c. Cap the lancet prior to putting it in the trash.
d. Warm the hands prior to piercing the skin - Answer d. Warm the hands prior to
piercing the skin
A client is admitted with COPD. Which of the following findings should the nurse report
to the provider?
a. Report of dyspnea on exertion
b. Oxygen saturation 89% on room air
c. White blood cell count 9,000/mm3
d. Bilateral crackles on auscultation of lungs - Answer d. Bilateral crackles on
auscultation of lungs
,A client schedule for a tubal ligation procedure starts to cry as she is wheeled into the
surgical suite. Which of the following nursing statements is an appropriate nursing
response?
a. "You shouldn't be worried because the procedure is very safe."
b. "This won't take long and it will be over before you know it."
c. "Why did you make the decision to have this procedure?"
d. "It's not too late to cancel the surgery if you want to." - Answer d. "It's not too late to
cancel the surgery if you want to."
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?
a. Libel
b. False imprisonment
c. Battery
d. Assault - Answer c. Battery
A nurse manager overhears a provider and a staff nurse talking about a client's
diagnosis in the cafeteria. Which of the following actions should the nurse take first?
a. Provide a staff inservice about client confidentiality.
b. Fill out an incident report regarding the situation.
c. Remind them that client information is confidential.
d. Report the incident to the nursing supervisor. - Answer c. Remind them that client
information is confidential.
A nurse is serving on a committee that is revising the protocol for discharging clients.
After developing an initial plan, in which order should the nurse take the following
steps?
Implement recommended strategies
Determine goals
Evaluate the results
Revise the plan. - Answer Determine goals
Implement recommended strategies
Revise the plan.
Evaluate the results
A nurse is orienting to an emergency department. The nurse is asked to assist with
suturing of a laceration on a client's hand. Which of the following is the best resource for
this nurse?
a. The preceptor on the clinical unit
b. The provider suturing the client's injury
, c. The nursing supervisor
d. The information on the suture package - Answer b. The provider suturing the client's
injury
A client is brought to the emergency department (ED) following a motor-vehicle crash.
Drug use is suspected in the crash, and a voided urine specimen is ordered. The client
repeatedly refuses to provide the specimen. Which of the following is the appropriate
action by the nurse?
a. Assess the client for urinary retention.
b. Obtain a provider's prescription for a blood alcohol level.
c. Tell the client that a catheter will be inserted.
d. Document the client's refusal in the chart. - Answer d. Document the client's refusal in
the chart.
While auditing the medical records of clients currently on an oncology unit, the nurse
manager finds that six of the 15 records lack documentation regarding advance
directives. Which of the following is the priority action for the nurse to take?
a. Ask nurses who are caring for clients without this information in the medical record to
obtain it.
b. Remind nurses to obtain this information during the admission process.
c. Meet with nursing staff to review the policy regarding advance directives.
d. Reinforce the potential consequences of not having this information on record to the
nursing staff. - Answer c. Meet with nursing staff to review the policy regarding advance
directives.
A nurse who is precepting a newly licensed nurse is discussing the client assignment for
the shift. Which of the following actions should the nurse preceptor take first to
demonstrate appropriate time management?
a. Determine client care goals.
b. Review the client's new laboratory values.
c. Complete required tasks.
d. Document assessment data. - Answer a. Determine client care goals.
A facility provides annual staff education regarding ethical practice. A charge nurse
recognizes a need for further education when which of the following behaviors is
observed?
a. A nurse gives prescribed opioids to a client who has a terminal illness and
respirations of 8/min.
b. A nurse refuses to actively participate during an elective abortion procedure
scheduled for her client.
c. A nurse informs a confused client who wants to go home that he is going to stay at
the facility until he is better.
