ATI RN
Client Safety in Nursing Questions
Question 1 of 5
A nurse is caring for a client on the medical-surgical unit. The client has been taking warfarin at home and her laboratory values reveal her INR is 3.5. The client states she is checking herself out of the hospital and refuses to wait until her provider can discuss the situation with her. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Explain the risk the client faces if she leaves the facility. Rationale: 1. Warfarin is a blood thinner that requires close monitoring of the INR to prevent complications like bleeding. 2. An INR of 3.5 is above the therapeutic range, putting the client at risk for bleeding. 3. It is crucial for the nurse to educate the client about the potential consequences of leaving against medical advice. 4. By explaining the risks, the nurse can help the client make an informed decision about their health. 5. This action demonstrates the nurse's duty to ensure the client's safety and well-being. Summary of other choices: A: Forcing the client to sign an AMA form does not address the client's concerns or provide necessary education about the risks. B: Threatening the client with insurance consequences is coercive and does not prioritize the client's health. D: Involving security is not appropriate in this situation and does not address the client
Question 2 of 5
A nurse asks the assistive personnel (AP) to take a specimen to the laboratory and the AP refuses. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D because the nurse should first communicate with the AP to understand the reasons for refusal. By asking about concerns, the nurse can address any issues and provide clarification or support. This approach promotes open communication, teamwork, and problem-solving. Taking the specimen to the lab (A) may not address underlying concerns. Reporting to the charge nurse (B) or completing an incident report (C) should be done after understanding the AP's perspective to prevent unnecessary escalation.
Question 3 of 5
A nurse is teaching a newly licensed nurse about methods to reduce costs of client care. Which of the following statements by the newly licensed nurse indicates understanding of the teaching?
Correct Answer: C
Rationale: Rationale for Correct Answer (C): - Encouraging clients to receive annual flu immunization helps prevent flu-related illnesses, reducing healthcare costs associated with hospitalizations and treatments. - Annual flu immunization is a cost-effective preventive measure that can help avoid costly complications and reduce healthcare expenses in the long run. Summary of Incorrect Choices: - Choice A: Waiting to empty a colostomy bag until it is three-fourths full can lead to skin irritation and infection, increasing costs for treating complications. - Choice B: Delegating closed irrigation to assistive personnel can compromise quality of care and potentially lead to complications, increasing costs. - Choice D: Using sterile technique for ostomy care in clients with tracheostomy is irrelevant and does not contribute to cost reduction in client care.
Question 4 of 5
A nurse manager observes an unknown man in a laboratory coat making copies of a client's medical record. Which of the following actions should the nurse plan to take first?
Correct Answer: B
Rationale: The correct answer is B: Approach the man and ask why he is making copies. This is the first action the nurse should take to immediately address the situation and gather more information. By approaching the man, the nurse can assess the situation directly and potentially stop any unauthorized access to the client's medical record. This action allows for a real-time response and may prevent any further breach of confidentiality. Other choices are incorrect because: A: Notifying hospital security as the first action may cause a delay in addressing the situation directly. C: Informing the nursing supervisor may be appropriate but should not be the first action as it does not address the immediate concern. D: Reporting the observation to the nurse caring for the client may not be effective in stopping the unauthorized access and protecting the client's confidentiality.
Question 5 of 5
A nurse in an emergency department receives report from an emergency responder who states a client is being transported following exposure to a 'dirty bomb'. The nurse should prepare to care for a client that has been exposed to which of the following types of agents?
Correct Answer: C
Rationale: The correct answer is C: Radiologic. A 'dirty bomb' combines conventional explosives with radioactive material. Radiologic agents cause damage through exposure to ionizing radiation. The other choices are incorrect because: A: Chemical agents refer to toxic substances, B: Anthrax is a bacterial agent, and D: Sarin is a nerve agent. Thus, the nurse should prepare to care for a client exposed to a radiologic agent due to the nature of a 'dirty bomb' incident.