LEADERSHIP ATI EXAM QUESTIONS WITH COMPLETE
SOLUTIONS VERIFIED GRADED A+
Hip arthroplasty
The nurse should implement foam wedge between legs to prevent dislocation
Because the muscle surrounding the hip joint has been cut to expose and replace the
diseased joint
clients are at risk for hip dislocation
Proper body alignment after total hip arthroplasty includes keeping the affected leg
slightly abducted
A major complication of total hip arthroplasty is subluxation (partial dislocation) or total
dislocation
In some facilities, abduction devices such as foam wedges and pillows are placed
between legs
Adduction of the hip should be avoided to prevent dislocation.
Venous thromboembolism
Wearing elastic stockings or a sequential compression device (SCD) will help prevent
another complication, venous thromboembolism
To prevent venous thromboembolism, the nurse should also teach leg exercises;
encourage fluid intake; observe for redness, swelling, pain, or changes in mental status;
and administer prescribed anticoagulants
,Monitor for shortening of the affected leg with Hip arthoplasty
Monitoring for shortening of the affected leg is a nursing action that identifies dislocation
Signs of dislocation include shortening of the extremity
pain and external rotation of the extremity
These findings should be reported immediately
The nurse should check neurovascular status, which includes pain, pallor, pulse,
paresthesia, paralysis, and pressure
A major complication of total hip replacement
A major complication of total hip replacement is subluxation (partial dislocation) or total
dislocation
In addition to preventing adduction, the client should avoid flexing the hips more than
90°, not 60°
The nurse should use diagrams or demonstrate correct positioning to help reinforce this
information prior to the surgical procedure
continuous quality improvement (CQI) program
to review the events leading up to each medication administration error
The purpose of CQI is to evaluate outcomes of care based on standards of practice
In CQI, once a problem is identified, data collection and analysis should take place
before intervening to fix the problem
Evaluation consists of reviewing the events leading up to the errors
, Remove an NG tube
( always very order before removal of the NG tube)
- Discontinuing a NG tube requires a provider order Therefore, confirmation of an order
would be a priority before removal of the tubeNasogastric tubes can be used to provide
enteral nutrition, to administer medication, and to provide gastric decompression
- NG tube requires only clean technique
- One purpose of NG tubes is to provide gastric decompression
-The NG tube is connected to suction, which is connected to a canister to collect gastric
drainage
Prior to discontinuing the NG tube, the suction should be turned to the off position to
prevent damage to the gastric mucosa during removal of the tube
It would be important to turn off the suction
- Part of the nursing process is to observe and record the color and amount of gastric
drainage
sanguineous
Sanguineous drainage is bright red and indicates active bleeding
serosanguineous
Serosanguineous drainage is pink (light red), watery, and a mixture of serum and blood
Iron
Food sources of iron fall into two categories:
1- heme iron (from lean red meat, poultry, and fish)
2- nonheme iron (from fruit, vegetables, grains, and dried peas and beans)
SOLUTIONS VERIFIED GRADED A+
Hip arthroplasty
The nurse should implement foam wedge between legs to prevent dislocation
Because the muscle surrounding the hip joint has been cut to expose and replace the
diseased joint
clients are at risk for hip dislocation
Proper body alignment after total hip arthroplasty includes keeping the affected leg
slightly abducted
A major complication of total hip arthroplasty is subluxation (partial dislocation) or total
dislocation
In some facilities, abduction devices such as foam wedges and pillows are placed
between legs
Adduction of the hip should be avoided to prevent dislocation.
Venous thromboembolism
Wearing elastic stockings or a sequential compression device (SCD) will help prevent
another complication, venous thromboembolism
To prevent venous thromboembolism, the nurse should also teach leg exercises;
encourage fluid intake; observe for redness, swelling, pain, or changes in mental status;
and administer prescribed anticoagulants
,Monitor for shortening of the affected leg with Hip arthoplasty
Monitoring for shortening of the affected leg is a nursing action that identifies dislocation
Signs of dislocation include shortening of the extremity
pain and external rotation of the extremity
These findings should be reported immediately
The nurse should check neurovascular status, which includes pain, pallor, pulse,
paresthesia, paralysis, and pressure
A major complication of total hip replacement
A major complication of total hip replacement is subluxation (partial dislocation) or total
dislocation
In addition to preventing adduction, the client should avoid flexing the hips more than
90°, not 60°
The nurse should use diagrams or demonstrate correct positioning to help reinforce this
information prior to the surgical procedure
continuous quality improvement (CQI) program
to review the events leading up to each medication administration error
The purpose of CQI is to evaluate outcomes of care based on standards of practice
In CQI, once a problem is identified, data collection and analysis should take place
before intervening to fix the problem
Evaluation consists of reviewing the events leading up to the errors
, Remove an NG tube
( always very order before removal of the NG tube)
- Discontinuing a NG tube requires a provider order Therefore, confirmation of an order
would be a priority before removal of the tubeNasogastric tubes can be used to provide
enteral nutrition, to administer medication, and to provide gastric decompression
- NG tube requires only clean technique
- One purpose of NG tubes is to provide gastric decompression
-The NG tube is connected to suction, which is connected to a canister to collect gastric
drainage
Prior to discontinuing the NG tube, the suction should be turned to the off position to
prevent damage to the gastric mucosa during removal of the tube
It would be important to turn off the suction
- Part of the nursing process is to observe and record the color and amount of gastric
drainage
sanguineous
Sanguineous drainage is bright red and indicates active bleeding
serosanguineous
Serosanguineous drainage is pink (light red), watery, and a mixture of serum and blood
Iron
Food sources of iron fall into two categories:
1- heme iron (from lean red meat, poultry, and fish)
2- nonheme iron (from fruit, vegetables, grains, and dried peas and beans)
