A client is scheduled for a coronary artery bypass graft (CABG) in the morning using a saphenous vein. The physician does not use the internal mammary artery for the bypass graft, because the internal mammary artery:

Correct Answer: A

Rationale: Many physicians do not use the internal mammary artery because it is time consuming. Removing the internal mammary artery does not pose a greater risk of reocclusion. In fact, it may stay patent longer. The internal mammary artery is larger in diameter than the saphenous vein. The internal mammary artery does not have too many valves.

Correct Answer: A

Rationale: In the context of adult medical-surgical care, delegating tasks to nursing staff should align with their scope of practice and level of training. The appropriate task to delegate to a nursing assistant in this scenario is chest compressions (Option A). Nursing assistants are often trained in basic life support (BLS) which includes performing chest compressions during cardiopulmonary resuscitation (CPR). This task is within their skill set and responsibilities. Options B, C, and D involve more advanced skills that require specialized training and knowledge beyond what a nursing assistant typically possesses. Bag-valve mask ventilation (Option B), assisting with oral intubation (Option C), and placing defibrillator pads (Option D) are tasks that should be performed by licensed healthcare providers such as registered nurses or respiratory therapists who have the required expertise and training. Educationally, understanding the principles of delegation is crucial for nurses and nursing assistants to provide safe and effective patient care. Nurses must assess the competency of staff members before delegating tasks to ensure that the right task is assigned to the right person. This promotes patient safety, optimizes workflow, and enhances teamwork within the healthcare team. By knowing the scope of practice for different healthcare roles, nurses can delegate tasks appropriately, maximizing efficiency and quality of care.

Correct Answer: C

Rationale: In the context of adult medical-surgical care, the correct task to delegate to the LPN/LVN among the options provided is to wrap the amputated digits in sterile gauze moistened with saline (Option C). This task falls within the scope of practice for an LPN/LVN and aligns with principles of wound care and infection control. Option A, cleansing the amputated digits with Betadine solution, may require a higher level of assessment and decision-making, making it more appropriate for a registered nurse (RN) or above. Option B, placing the amputated digits directly into ice slurry, can potentially cause tissue damage due to extreme cold and is not recommended. Option D, storing the amputated digits in a solution of sterile normal saline, is not as appropriate as wrapping the digits in moistened gauze, which helps maintain tissue hydration and minimizes bacterial contamination. In an educational context, understanding delegation principles is crucial for nursing practice. LPNs/LVNs should be assigned tasks that align with their scope of practice and competency level, ensuring safe and effective patient care. Proper wound care techniques, such as moistening gauze with saline for amputated digits, contribute to optimal patient outcomes and prevent complications like infection. This rationale highlights the importance of delegation based on knowledge, skill level, and patient needs in the adult medical-surgical setting.

Correct Answer: B

Rationale: In this scenario, the correct answer is option B: "He pulled the stick out, just now, because it was hurting him." This option should be given first consideration because it indicates a recent action that could be potentially harmful to the patient. Prompt removal of a foreign object, especially if it was causing pain, is crucial to prevent further damage or complications. Immediate assessment and intervention are necessary in such cases to ensure the patient's safety and well-being. Option A ("There was a lot of blood and we used three bandages") is not the priority because although bleeding can be concerning, addressing the source of bleeding (the stick) takes precedence over managing the bleeding itself. Option C ("The stick was really dirty and covered with mud") is also not the priority as the cleanliness of the stick, while important to prevent infection, is secondary to addressing the immediate physical harm caused by the stick. Option D ("He's a diabetic, so he needs attention right away") is not the most urgent concern in this situation. While being a diabetic is significant for overall care, in this specific instance, the immediate focus should be on the recent action of pulling out a stick and the potential consequences of that action. Educationally, this question highlights the importance of prioritizing care based on the urgency of the situation. It reinforces the need for critical thinking in quickly assessing and addressing immediate threats to a patient's health and safety. Nurses and healthcare providers must develop the ability to triage effectively to provide timely and appropriate care in emergency situations.

Correct Answer: D

Rationale: In the context of an Adult Medical Surgical ATI exam, the correct answer is D) At least one representative from each group of ED personnel. This option is best suited because it ensures a comprehensive team approach by including diverse perspectives and expertise. In a high-pressure environment like the ED, having representation from all key personnel groups (physicians, RNs, LPN/LVNs, nursing assistants) promotes effective communication, collaboration, and holistic patient care. Option A) ED physicians and charge nurses may lack the full spectrum of skills and perspectives needed to address all aspects of patient care in a medical-surgical setting. While they are essential team members, their combination alone may not cover all bases. Option B) Experienced RNs and experienced paramedics bring valuable clinical experience, but they may still lack the breadth of knowledge and skills provided by including members from all ED personnel groups. Option C) RNs, LPN/LVNs, and nursing assistants represent important roles in patient care, but having only these groups without physicians or other key personnel may limit the team's ability to address complex medical-surgical cases effectively. By selecting option D, which includes at least one representative from each group of ED personnel, the team can leverage a wide range of expertise, experience, and skills to provide optimal care for adult medical-surgical patients. This approach aligns with best practices in healthcare teamwork and ensures a well-rounded team capable of addressing diverse patient needs effectively.