ATI FundamentalS B

1. Nurse observes assistive personnel (AP) reprimanding a client for not using urinal properly. The AP tells him she will put a diaper on him if he doesn't use urinal more carefully next time. Which of following torts is AP committing? A: Assault B: Battery C: False imprisonment D: Invasion of privacy A. Assult 2. Adult client who is competent tells the nurse that he is thinking about leaving the hospital against medical advice. Nurse believes that this is not in client's best interest, so she administers a PRN sedative med that the client has not requested along with his usual med. Which of following types of tort has nurse committed? A: Assault B: False imprisonment C: Negligence D: Breach of confidentiality B. False imprisonment 3.Client who will undergo neurosurgery in 1 week tells the nurse in office that he will prepare his advance directives before he goes to the hospital. Which of following statements by client indicates to nurse that he understands them? A: "I'd rather have my brother make decisions for me, but I know it has to be my wife." B: "I know they won't go ahead with the surgery unless I prepare these forms." C: "I plan to write that I don't want them to keep me on a breathing machine" D: "I will get my regular doctor to approve my plan before I hand it in at the hospital" C. "I plan to write that I don't want them to keep me on a breathing machine" 4. A Client is about to undergo an elective surgical procedure. Which of following actions are appropriate for nurse providing pre-op care regarding informed consent? (Select all that apply.) A: Make sure the surgeon obtained the client's consent B: Witness client's signature on consent form C: Explain the risks/benefits of procedure D: Describe consequences of choosing not to have surgery E: Tell client about alternatives to having surgery A. Make sure the surgeon obtained the client's consent, B. Witness client's signature on consent form 5. Nurse has noticed several times in past week when another nurse on unit seemed drowsy & unable to focus. Today, she found nurse asleep in chair in break room when she was not on a break. Which of following actions should nurse take? A: Remind nurse that safe client care is priority on unit B: Ask other s on team whether they have seen same behavior C: Report observations to nurse manager on unit D: Conclude her coworker's fatigue is not her problem to solve B. Report observations to nurse manager on unit 6. Nurse is preparing info for change-of-shift report. Which of following info should nurse include in report? A: Client's input & output for shift B: Client's blood pressure from previous day C: Bone scan that is scheduled for today D: Med routine from Med Admin Record C. Bone scan that is scheduled for today 7. Nurse enters a client's room & finds him sitting in his chair. He states, "I fell in the shower, but I got myself back up & into my chair." How should nurse document this in client's chart? A: Client fell in shower B: Client states he fell in shower & was able to get himself back into chair C: Nurse shouldn't document this info in chart b/c she didn't witness the fall D: Client fell in shower but is now resting comfortably B. Client states he fell in shower & was able to get himself back into chair 8.Nursing instructor reviewing documentation with students. Which of following legal guidelines should they follow when documenting in client record? (Select all that apply.) A: Cover arrows with correction fluid, & write in correct info B: Put date & time on all entries C: Document objective data, leaving out opinions D: Use as many abbreviations as possible E: Wait until the end of shift to document B. Put date & time on all entries, C. Document objective data, leaving out opinions 9.Nurse is receiving provider prescription by phone for morphine for client who is reporting moderate to severe pain Which of following actions are appropriate? (Select all that apply.) A: Repeat details of prescription back to provider B: Have another nurse listen to phone prescription C: Obtain prescribes signature on prescription within 24 hours D: Decline verbal prescription b/c it is not emergency situation E: Tell charge nurse that the provider has prescribed morphine by phone A. Repeat details of prescription back to provider, B. Have another nurse listen to phone prescription, C. Obtain prescribes signature on prescription within 24 hours 10. A nurse on med-surg unit has received change-of-shift report & will care for 4 clients. Which of following client's needs may nurse assign to AP? A: Feeding client who was admitted 24h ago with aspiration pneumonia B: Reinforcing teaching w/ client who is learning to walk using quad cane C: Reapplying a condom catheter for client who has urinary incontinence D: Applying sterile dressing to pressure ulcer C. Reapplying a condom catheter for client who has urinary incontinence 11. Nurse delegating ambulation of client who had knee arthroplasty 5 days ago to an AP. Which of following info should nurse share with the AP? (Select all that apply.) A: The roommate is up independently B: Client ambulates with his slippers on over his antiembolic stockings C: Client uses front-wheeled walker when ambulating D: Client had pain med 30 min ago E: Client is allergic to codeine F: Client ate 50% of his breakfast this morning B. Client ambulates with his slippers on over his antiembolic stockings C. Client uses front-wheeled walker when ambulating D. Client had pain med 30 min ago 12. RN is making assignments for client care to LPN at beginning of shift. Which of following assignments should LPN question? A: Assisting a client who is 24h post-op to use incentive spirometer B: Collecting clean-catch urine specimen from client who was admitted on previous shift C: Providing nasopharyngeal suctioning for client with pneumonia D: Replacing cartridge & tubing on PCA pump D. Replacing cartridge & tubing on PCA pump 13. Nurse is preparing in-service program about delegation. Which of following elements should she identify when presenting 5 rights of delegation? (Select all that apply.) A: Right client B: Right supervision/evaluation C: Right direction/communication D: Right time E: Right circumstances B. Right supervision/evaluation, C. Right direction/communication, E. Right circumstances 14. Nurse manager of med-surg unit is assigning care responsibilities for oncoming shift. Client is awaiting transfer back to unit from PACU following thoracic surgery. To which staff member should nurse assign to this client? A: Charge nurse B: RN C: LPN D: Assistive personnel (AP) C. RN 15. By 2nd post-op day, a client has not achieved satisfactory pain relief. Based on this evaluation, what should nurse do next according to nursing process? A: Reassess client to determine reasons for unsatisfactory pain relief B: See whether pain lessens during next 24h C: Change plan to ensure client achieves adequate pain relief D: Teach client about plan of care for managing his pain A. Reassess client to determine reasons for unsatisfactory pain relief