ATI RN
Client Safety Questions
Question 1 of 5
A nurse is working with an assistive personnel (AP) to care for a group of clients on the pediatric unit. Which of the following tasks should the nurse have the AP perform first?
Correct Answer: D
Rationale: The correct answer is D. The nurse should have the AP check to see if the elbow restraint is in place for the infant postoperative from cleft palate surgery first. This task is a safety priority to ensure the infant's postoperative care and prevent any complications related to the surgical correction. It requires immediate attention to prevent injury or complications. Choices A, B, and C are important tasks but not as urgent as ensuring the safety and well-being of a postoperative infant. Collecting a stool sample, engaging a toddler in play, and washing the hair of an adolescent can be done after ensuring the immediate safety and well-being of the postoperative infant.
Question 2 of 5
A nurse is preparing discharge instructions for a client receiving oxygen at home. What should the nurse include?
Correct Answer: A
Rationale: The correct answer is A: Do not adjust the oxygen flow rate. This is crucial for maintaining the prescribed oxygen therapy and preventing potential harm to the client. Adjusting the flow rate without medical guidance can lead to inadequate oxygenation or oxygen toxicity. Incorrect Choices: B: Checking oxygen equipment weekly is important for safety but not directly related to the client's immediate oxygen use. C: Storing oxygen tanks horizontally is incorrect as they should be stored upright to prevent leaks. D: Using wool blankets to reduce static is not recommended as they can generate static electricity, posing a risk of fire near oxygen.
Question 3 of 5
A client who fell and broke his hip while being assisted to the bathroom by a nurse states he plans to sue the nurse. The nurse should know that, in a legal proceeding, the standard that will be used to determine if the nurse was negligent is which of the following?
Correct Answer: B
Rationale: The correct answer is B: Another staff nurse provides testimony about how a reasonable, prudent nurse would have handled the situation. In a legal proceeding to determine if the nurse was negligent, the standard used is typically that of what a reasonable and prudent nurse would have done in the same situation. This standard is known as the "standard of care." It is important because it assesses the nurse's actions based on what is considered acceptable and appropriate within the nursing profession. Testimony from another staff nurse who can provide insight into how a reasonable and prudent nurse would have acted is crucial in establishing whether the nurse in question met this standard. Choice A is incorrect because testimony from an expert nurse about how the situation should have been handled differently may not necessarily reflect the standard of care for a reasonable and prudent nurse. Choice C is incorrect because the client's attorney stating that the injury could have been prevented does not establish the standard of care for a nurse in the situation. Choice D is incorrect because the client's provider
Question 4 of 5
A nurse checks with assistive personnel on the unit throughout the shift to determine if they are completing tasks. The nurse is demonstrating which of the following rights of delegation?
Correct Answer: D
Rationale: The correct answer is D: Right supervision. The nurse checking in with assistive personnel to ensure tasks are completed is an example of proper supervision, which is one of the rights of delegation. Supervision involves overseeing and guiding the work of others to ensure tasks are being carried out correctly and safely. This helps maintain accountability and quality of care. Summary of other choices: A: Right circumstances - This refers to ensuring the task is appropriate for delegation based on factors such as patient condition and complexity. B: Right communication - This involves clear and effective communication of tasks, responsibilities, and expectations between the nurse and assistive personnel. C: Right person - This focuses on selecting the most qualified and competent individual to perform the delegated task based on their skill level and training.
Question 5 of 5
A nurse is caring for four clients on a medical-surgical unit. Which of the following clients should the nurse assess first?
Correct Answer: B
Rationale: The correct answer is B. The nurse should assess the client who had an indwelling urinary catheter removed 5 hours ago and has not voided first. This is because urinary retention can lead to complications like urinary tract infection or bladder distention. It is important to monitor and address this promptly to prevent further issues. A: While a green gastric aspirate with a pH of 5.3 may indicate potential issues, it is not as urgent as urinary retention. C: A capillary refill time of 4 seconds in a client with COPD is concerning but does not require immediate attention compared to urinary retention. D: Fruity breath odor in a client with late-stage cirrhosis may indicate hepatic encephalopathy, which is serious, but urinary retention takes precedence due to the risk of immediate complications.