2024 ATI RN LEADERSHIP PRACTICE EXAM WITH NGN QUESTIONS & ANSWERS, Exams of Nursing

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2024 ATI RN LEADERSHIP PRACTICE EXAM WITH NGN

QUESTIONS & ANSWERS

QUESTION 1

QUESTION 2

QUESTION 3

• QUESTION
• QUESTION

A. Provide an in service on medication administration to all the nurses. Rationale: A recommendation for staff education may be indicated, but this does not assist the committee to identify factors that lead to medication errors. B. Require staff nurses to demonstrate competency by passing a medication administration examination. Rationale: Ensuring competency in medication administration may be indicated, but this does not assist the committee to identify factors that lead to medication errors. C. Review the events leading up to each medication administration error. Rationale: After a sentinel event, the first step the committee should plan to take is to use root cause analysis to identify the underlying cause or causes that led to the medication errors. D. Develop a quality improvement program for nurses involved in medication administration errors. Rationale: Although development of a quality improvement program for nurses involved in medication errors may be indicated, this does not assist the committee to identify factors that lead to medication errors. 9.A charge nurse has access to the facility’s electronic client records. It is appropriate for the charge nurse to share her personal password with whom? A. The nurse manager Rationale: A nurse manager authorized to have access to a computer will have a personal password. B. No one Rationale: Computer passwords cannot be shared with others for any reason. Any facility employee authorized to have access to the database on a computer will have a personal password. C. A nursing student who is completing a preceptorship on the unit Rationale: A nursing student who is authorized to have access to the database on a computer will have a personal password. D. The unit clerk Rationale: A unit clerk authorized to have access to a computer will have a personal password. 10.A nurse on a medical-surgical unit is reconciling a newly admitted client’s medication. The nurse is reviewing the process of medication reconciliation with a newly licensed nurse. The nurse should include which of the following information? A. The American Hospital Association requires accredited facilities to have protocols in place requiring medication reconciliation. Rationale: The Joint Commission requires accredited facilities to have protocols in place requiring medication reconciliation. B. The purpose of medication reconciliation is to prevent adverse medication reactions.

Rationale: Medication reconciliation includes reviewing an accurate list of all medications the client is taking and comparing that list to new medications the provider has prescribed. This action decreases the risk of medication interactions and adverse outcomes. C. The nurse who performs medication reconciliation is demonstrating the ethical principal of veracity. Rationale: This action by the nurse does not demonstrate the ethical principal veracity, which means telling the truth. The nurse who performs medication reconciliation is demonstrating the ethical principle beneficence, which means the nurse takes action to promote good, and nonmaleficence, which means the nurse takes action to prevent harm. D. The International Council of Nurses Code of Ethics stipulates that the nurse performs medication reconciliation when a client is admitted to a facility, is transferred to another facility, and when a client is discharged from a facility. Rationale: The International Council of Nurses Code of Ethics stipulates that nurses have a responsibility to promote health and prevent illness, but it does not mandate medication reconciliation. The Institute for Healthcare Improvement recommends the nurse perform medication reconciliation when a client is transferred, and The Joint Commission requires medication reconciliation when a client is admitted and when a client is discharged. 11.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? A. Tell the client she will not be permitted to leave the facility until she has signed the against medical advice (AMA) form. Rationale: The nurse should attempt to get the client to sign the AMA form because this measure can help to defend the facility if a lawsuit ensues; however, the nurse should not tell the client she will not be permitted to leave the facility because this action could lead to charges of false imprisonment. B. Tell the client if she leaves without a written prescription for discharge, her insurance will not pay for the facility visit. Rationale: This action by the nurse is uncaring and the client could perceive it as a threat. C. Explain the risk the client faces if she leaves the facility. Rationale: The expected reference range for INR while a client is taking warfarin is 2 to 3. The nurse has an obligation to explain to the client that her INR is very high and she is at risk for bleeding. D. Ask the security department to guard the room to the client’s door. Rationale: This action could lead to charges of false imprisonment.

A. "There is such a shortage of organs in this country, so I think you should go ahead and consent to donate your spouse’s organs." Rationale: The nurse should avoid giving her personal opinion. B. "What do you think your spouse would have wanted?" Rationale: Federal law requires facilities to have policies and procedures in place about making a request for organ and tissue donation at the time of death. The request is made by an employee, often a social worker, who has advanced training and can request the donations in a caring, sensitive manner. The role of the nurse is to provide emotional support to the family. Family members should consider the deceased person’s wishes when making their decision. C. "Most religions support organ donation, so don’t let that stand in the way." Rationale: While it is true that most religions support organ donation, there is no indication that this is a concern felt by the client’s spouse. D. "Don’t you think you will feel a little better about the situation if you donate your spouse’s organs? " Rationale: The nurse should not provide the client’s spouse with false reassurance. 15.A nurse manager is reviewing the Good Samaritan laws with a group of newly licensed nurses. Which of the following statements by the nurse manager is appropriate? A. "If you render aid in an accident, do not leave the scene until another competent person can take over." Rationale: Once the nurse renders aid, she has entered a nurse-client relationship and must continue to provide care until competent help arrives. B. "Good Samaritan laws prohibit the victim from filing a lawsuit against the nurse." Rationale: Good Samaritan laws require the nurse to render the level of care expected by a competent, prudent nurse in a similar situation. To win a malpractice suit against the nurse, the victim must prove the nurse was grossly negligent or careless. C. "Federal laws require a licensed nurse to render aid in an emergency." Rationale: Good Samaritan laws are state laws. Only a few states have duty to rescue laws, for example: Vermont, Minnesota, and Wisconsin. The nurse should know the laws of the state. D. "A nurse who volunteers at a summer camp for children is covered by Good Samaritan laws." Rationale: Good Samaritan laws protect the nurse in an emergency. Even in volunteer situations, Good Samaritan laws do not provide protection because in most cases an emergency does not exist.

16.A nurse is caring for several clients. For which of the following situations should the nurse complete an incident report? A. The nurse identifies a broken piece of equipment. Rationale: This issue should be resolved by removing the equipment from the client care area and placing a work order for its repair. B. A staff member does not show up to work her assigned shift. Rationale: This is a staff problem that should be resolved between the staff member and the nurse manager. C. A client discovers that his dentures are missing. Rationale: This situation represents a variation from the normal standard of care. A change in the client's plan of care may be necessary if the client has difficulty eating or speaking without the dentures. In addition, the facility may be liable for replacing the missing dentures. D. The nurse has a disagreement with the nursing supervisor about inadequate staffing. Rationale: An incident report is not necessary for this situation. 17.A staff nurse has applied for a promotion. The hiring manager insinuates that if there was a sexual relationship between the two of them, the nurse's promotion request would get increased consideration. Which of the following actions should the staff nurse take first? A. Tell the hiring manager in clear terms that this conduct causes feelings of discomfort and that the behavior should stop immediately. Rationale: Sexual harassment is unwanted sexual advances made in the context of a relationship of unequal power or authority. It is experienced as offensive in nature. The nurse should first start by taking the most direct measure: confronting the hiring manager and insisting the harassment stop. B. Report the behavior to the nurse manager. Rationale: The nurse should report the behavior to the nurse manager; however, there is another action the nurse should take first. C. Create a written document of the incident and store the document in a safe place. Rationale: The nurse should create a written document of the incident and store the document in a safe place; however, there is another action the nurse should take first. D. Seek help from a trustworthy friend. Rationale: The nurse should seek help from a trustworthy friend; however, there is another action the nurse should take first.

20.A nurse overhears two assistive personnel (AP) from the medical-surgical unit discussing a hospitalized client while in the cafeteria. Which of the following is the priority nursing action? A. Quietly tell the APs that this is not appropriate. Rationale: The nurse has a professional duty to protect the client’s confidential information. When using the urgent vs. nonurgent approach to client care, the nurse determines the priority is to stop the APs before there is an additional breach of confidentiality. B. Ask the nurse manager to provide an inservice program about confidentiality to the staff on the unit. Rationale: Although it might be appropriate to ask the manager to review the importance of maintaining confidentiality with the staff on the unit, there is another action that is the priority. C. Complete an incident report. Rationale: Although the nurse has a responsibility to complete an incident report when there is an accident or unusual occurrence, there is another action that is the priority. D. Document the occurrence in a personal log. Rationale: Although the nurse should keep notes about the occurrence for legal protection, there is another action that is the priority. 21.A nurse has several tasks to delegate to an assistive personnel (AP). Which of the following tasks should the nurse ask the AP to perform first? A. Take an arterial blood gas (ABG) specimen to the laboratory. Rationale: When using the urgent vs. nonurgent approach to client care, the nurse should determine the priority action is to take the ABG blood sample to the laboratory. ABG samples are placed on ice and must be transported to the laboratory immediately or the specimen will deteriorate, making any results inaccurate. B. Transport a client to the radiology department for an x-ray. Rationale: It is appropriate to delegate this task to the AP, but there is another task that is the priority. C. Pass fresh water to clients on the unit. Rationale: It is appropriate to delegate this task to the AP, but there is another task that is the priority. D. Obtain a routine urine sample from a newly-admitted client. Rationale: It is appropriate to delegate this task to the AP, but there is another task that is the priority.

22.A nurse is caring for an older adult client who has a terminal illness and is ventilatordependent. The client is alert and oriented and he wants to discontinue use of the ventilator. The nurse should be aware that continued treatment against the client's wishes is a violation of which of the following ethical principles? A. Veracity Rationale: The ethical principle of veracity requires the nurse to tell the truth and not to intentionally deceive or mislead clients. B. Autonomy Rationale: The issue here is the client's right to choose. The ethical principle of autonomy applies to an individual's right to choose and control what happens to him. Respecting autonomy requires the nurse to recognize the client's choice is based on personal values and those values do not have to be shared by the nurse. C. Fidelity Rationale: The ethical principle of fidelity requires the nurse to keep promises by being faithful to agreements, commitments, and responsibilities. D. Justice Rationale: The ethical principle of justice requires the nurse to treat everyone fairly. 23.A nurse and an experienced licensed practical nurse (LPN) are caring for a group of clients. Which of the following tasks should the nurse delegate to the LPN? (Select all that apply.) A. Provide discharge instructions to a confused client's spouse. B. Obtain vital signs from a client who is 6 hr postoperative.

C. Administer a tap-water enema to a client who is preoperative.

D. Initiate a plan of care for a client who is postoperative from an appendectomy.

E. Catheterize a client who has not voided in 8 hr. Rationale: Providing discharge instructions to a confused client's spouse is incorrect. The nurse is responsible for delegating a task to the person who has proper training and skill. Client education is the responsibility of the registered nurse.
Obtaining vital signs from a client who is 6 hr postoperative is correct. Obtaining is a task that is appropriate to the education and skills of an LPN.
Administering a tap-water enema to a client who is preoperative is correct. Administering a tap-water enema is a task that is appropriate to the education and skills of an LPN.
Initiating a plan of care for a client who is postoperative from an appendectomy is incorrect. Planning care is the responsibility of the registered nurse.
Catheterizing a client who has not voided in 8 hr is correct. Urinary catheterization is a task that is appropriate to the education and skills of an LPN.
24.A nurse is caring for a client who is scheduled for surgery. The nurse’s role in regard to informed consent is which of the following?

26.A nurse in an acute care setting is serving on a committee whose charge is to use the auditing process to client care. Which of the following aspects of client care is measured by a process audit? A. Availability of resources, such as fire extinguishers Rationale: Structure audits evaluate the availability of resources. B. Nursing staff ratios Rationale: Structure audits measure staffing ratios. C. Quality of nursing care provided Rationale: Process audits evaluate the quality of care nurses provide. They also determine if the care provided by nurses is consistent with established facility policy. D. Length of facility stay for a cohort of clients Rationale: Outcome audits measure the outcome of the care provided and include elements such as morbidity, mortality, and length of facility stay. 27.Following a tornado, a nurse is determining which of the clients assigned to her care can be discharged to free up beds for injured clients. Which of the following clients should the nurse recommend for discharge? A. A young adult client who has Crohn's disease and is 1 day preoperative for an ileostomy Rationale: A client who is scheduled for an elective surgery is medically stable and is not bedridden; therefore, the nurse should recommend this client for discharge. B. An adolescent client who was admitted 24 hr ago due to a spontaneous pneumothorax Rationale: A client who has a pneumothorax is unstable and needs rest, oxygen, and observation. If the client’s condition becomes worse, a chest tube may be required. Therefore, the nurse should not recommend this client for discharge. C. A middle adult who is 36 hr postoperative from an open laminectomy Rationale: A client who is postoperative from an open laminectomy is at risk for complications, especially 24 to 48 hr after surgery. Therefore, this client is not stable and the nurse should not recommend this client for discharge. D. An older adult client who was admitted for diabetic ketoacidosis and his most recent ABGs show his pH is now 7. Rationale: Diabetic ketoacidosis is a serious complication of diabetes mellitus. It usually develops in conjunction with an infection, but it can also develop due to poor nonadherence to prescribed care. This client’s pH is below the expected reference range; therefore, this client is not stable and the nurse should not recommend this client for discharge.

28.A nurse is caring for a client who is preoperative. The nurse signs as a witness on the client's consent form. The nurse’s signature on the consent form indicates which of the following? A. Determines the client does not have a mental illness Rationale: Clients who have a mental illness have the right to make decisions about their health care unless they have been found to be incompetent by a court of law. B. Confirms the client appears competent to provide consent Rationale: By signing as a witness on a procedural consent form, the nurse is confirming the client was the one who signed the consent form and that he seems to be competent to give consent. C. Asserts the nurse has explained the risks and benefits of the procedure Rationale: It is the responsibility of the provider to explain the risks and benefits of the procedure to the client. D. Records that the client’s spouse agrees the procedure is necessary Rationale: Although support from the client’s spouse can be a factor when the client considers surgery, the ethical principle autonomy is a fundamental principle and it supports the client’s right to selfdetermination. 29.A nurse has been reassigned from her regular area of work to a unit that is short staffed. Which of the following actions should the nurse take first? A. Ask what she will be assigned to do. Rationale: Before accepting the assignment, the nurse should clarify the complexity of the assignment, such as how many clients she will be assigned to care for, what skills are needed, and what resources are available to her. B. Determine if she has the skills to complete the assignment. Rationale: The nurse should perform a self-evaluation to determine if there are discrepancies between expectations and skills. Discrepancies can lead to unsafe client care. C. Identify her options. Rationale: After the nurse gains knowledge about the assignment and completes a self-evaluation, the nurse can either accept or refuse the assignment. D. Notify the nurse manager about her concerns for client safety. Rationale: The nurse should not notify the nurse manager about her concerns for client safety until she has determined she has the skills to safely provide client care. 30.A nurse manager hears a staff nurse on the unit speak openly about her dislike of a recent policy change regarding client care. When discussing the issue with the nurse, which of the following statements by the nurse manager is appropriate? A. “Let’s talk about your concerns about the new policy.”

Incidence reports are confidential tools used by the facility to improve client care. They are never copied. B. Submit the incident report to the risk manager. Rationale: The purpose of an incident report is to provide information to the risk manager who will investigate the incident and work with other members of the health care team to control risks of client injury. C. Place the incident report in the client's chart. Rationale: Incident reports are confidential tools used by the facility to improve client care. They are never placed in the client's chart. If there is a lawsuit and the incident report is in the client’s chart, the attorney can subpoena the document and use its contents as evidence. D. Document in the chart that an incidence report has been filed. Rationale: Incident reports are confidential tools used by the facility to improve client care. They are never referred to in a client's chart. If there is a lawsuit and the incident report is referenced in the client’s chart, the attorney can subpoena the document and use its contents as evidence. 32.A volunteer assigned to the pediatric unit reports to the charge nurse for an assignment. Which of the following assignments is unsafe for the volunteer? A. Transporting a school-age client who is in traction to another department Rationale: To ensure client safety, the nurse is responsible for delegating tasks to the right people. The nurse should avoid assigning this task to the volunteer because the individual who performs this task must understand the principles of traction. A volunteer does not have the requisite skill to perform this task. B. Playing a computer video game with an adolescent who has sickle cell disease Rationale: This is an appropriate and safe assignment for the volunteer. It provides both socialization and diversional activity to the client in traction. C. Reading a book to a preschool client who has AIDS Rationale: This is an appropriate and safe assignment for the volunteer. It provides a diversional activity for the client. D. Rocking an infant who was admitted for croup Rationale: This is an appropriate and safe assignment for the volunteer. It provides comfort for the client. 33.A coworker puts an arm around a nurse and says, "I bet you are a great lover." Which of the following is an appropriate response by the nurse? A. "Let's talk about something else."

Rationale: While this appears to be a response meant to change the subject, this response does not make it clear that this type of sexually-oriented conversation and physical contact is undesired by the nurse. B. "Whether or not I am a good lover is irrelevant." Rationale: While this appears to be a response meant to change the subject, this response does not make it clear that this type of sexually-oriented conversation and physical contact is undesired by the nurse. C. "Speaking to me like that makes me uncomfortable." Rationale: This assertive response makes it clear that this type of sexually-oriented conversation and physical contact is undesired by the nurse. D. "You need to lower your voice. Others can hear you." Rationale: This response does not make it clear that this type of sexually-oriented conversation and physical contact is undesired by the nurse. In fact, it could be considered by the harasser as encouragement. 34.A nurse in a provider’s office is reviewing the laboratory findings for a client who is scheduled for surgery. Which of the following findings requires follow up by the nurse? A. BUN 15 mg/dL Rationale: This BUN level is within the expected reference range. It does not require follow up by the nurse. B. Platelet count 60,000/mm Rationale: This platelet count is below the expected reference range. A low platelet count places the client at risk for bleeding; therefore, the nurse should follow up on this finding. C. WBC 6,000/mm Rationale: This WBC is within the expected reference range and does not require follow up by the nurse. D. Hemoglobin 14 g/dL Rationale: This hemoglobin level is within the expected reference range and does not require follow up by the nurse. 35.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? A. Collect a stool sample for ova and parasites from a school-age child Rationale: Although the AP should collect a stool sample for ova and parasites, there is another task the AP should perform first. B. Engage a toddler in play.

B. Performing concise client assessment Rationale: In the triage setting, the nurse provides essential care; therefore, the nurse must conduct concise client assessments for triage purposes. C. Transferring a client to the discharge location Rationale: Nursing care in a disaster setting focuses on essential care. The nurse should recognize nonskilled interventions, such as transferring a client to the discharge location, can be performed by nonmedical personnel. D. Maintaining a client tracking system Rationale: It is imperative for the nurse to maintain a client tracking system in a disaster situation. Disaster tags are numbered and include information such as triage priority, name, address, medications given, and treatments provided. These tags should remain with the client throughout his movement within the facility. 38.A nurse on a medical-surgical unit is providing care for a group of clients. The nurse should delegate collection of which of the following specimens to the assistive personnel (AP)? A. Wound drainage for culture Rationale: Collecting drainage from a wound for culture requires the use of sterile technique; therefore, the nurse should not delegate this task to the AP. B. Urine from an indwelling catheter Rationale: Urine from an indwelling catheter requires the use of sterile technique; therefore, the nurse should not delegate this task to the AP. C. Blood for PaCO Rationale: PaCO 2 is one component of arterial blood gases (ABGs). Only individuals who are specially trained to draw blood from a radial, brachial, or femoral artery, such as nurses, medical technicians, and respiratory therapists, should perform this task; therefore, the nurse should not delegate this task to the AP. D. Random stool specimen Rationale: The nurse should delegate collection of a random stool specimen to the AP because it does not require the skills of a licensed nurse. However, the nurse, not the AP, should collect a stool specimen if a culture using a sterile swab is required. 39.A nurse on a medical-surgical unit is preparing to contact a provider about a client’s condition. The client is 6 hr postoperative from a total hysterectomy. The nurse notes the client’s postoperative oxygen saturation is 94%

and her apical heart rate is 110. The nurse should include information about the client’s oxygen saturation level and heart rate in which component of the SBAR report? A. Situation Rationale: The nurse should state his name, the client’s name, the name of the facility, the client’s medical diagnosis, and a general description of what is going on in this section of the report. B. Background C. Assessment The nurse should provide information about the client’s postoperative status in this section of the report. Rationale: The nurse should include his assessments in this level of the report. For example, the client’s oxygen saturation level and the client’s apical heart rate. The nurse can also include the amount of vaginal bleeding and the appearance of the wound dressing. D. Recommendation Rationale: The nurse makes a recommendation on how to resolve the problem in this section of the report. 40.A nurse manager is reviewing the admission history of four adults who were admitted to the medical-surgical unit during the shift. Which of the following situations is the nurse required to disclose information to an outside agency about the client or the client's circumstances? A. A dependent adult admitted for the treatment of a spiral fracture Rationale: Physical signs of dependent adult abuse include skeletal fractures, as well as burns, bruises, welts, and lacerations. Nurses are responsible for reporting suspicion of dependent adult abuse to the proper legal authorities within the state. It is important for the nurse to note that a competent older adult has the right to make his or her own decisions about pursuing legal action. Unless a client has been found to be legally incompetent, he or she is not classified as a dependent adult. B. A young adult client admitted for asthma and has track marks that may indicate IV drug abuse Rationale: Although the use of street drugs is illegal, the track marks may be present from scarring due to prior use. The nurse would not be required to report this finding to law enforcement. C. A young adult client admitted for acute glomerulonephritis following a viral infection Rationale: The nurse is responsible for reporting a number of infections as identified by the Centers for Disease Control as reportable to health authorities; however, acute glomerulonephritis following a viral infection is not a reportable infection.