ATI Question with complete solution 2023
Delegating - correct answer The process of transferring the authority and responsibility to another member of the health care team to complete a task while retaining the accountability.
What kind of pump is required for intestinal tube feedings? - correct answer An infusion pump
Supervising - correct answer The process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team.
When should you discard feeding formula? - correct answer After 24 hrs
How often should you check gastric residual? - correct answer Every 4 to 8 hr
What should you do when gastric residual exceeds 250 mL for each of two consecutive assessments? - correct answer Withhold the feeding
Notify the provider
Maintain semi-Fowler's position
Recheck residual in 1 hr
What should you do when patient on feeding has diarrhea three times or more in a 24-
hr period? - correct answer Notify the provider
Confer with dietician Provide skin care and protection
What should you do when patient has nausea or vomiting on feeding? - correct answer Withhold the feeding
Turn the client to side
Notify the provider
Check the tube's patency Aspirate for residual Auscultate for bowel sounds Obtain a chest x-ray
What should you do if your patient aspirates the feeding formula? - correct answer Withhold the feeding
Turn the client to the side
Suction the airway
Provide oxygen if indicated Monitor vital signs for elevated temperature
Monitor oxygen saturation or increased respiratory rate Auscultate breath sounds for increased congestion Notify the provider Obtain a chest x-ray
A licensed nurse is responsible for... - correct answer providing clear directions when delegating a task initially and for periodic reassessment and evaluation of the outcome of the task
RNs cannot delegate... - correct answer the nursing process, client education, or tasks that require nursing judgment to LPNs or AP
5 rights to delegation - correct answer 1. Right task
2. Right circumstance 3. Right person
4. Right direction/communication
5. Right supervision/evaluation
Tasks delegated to LPNs - correct answer Monitoring findings (as input to the RN's ongoing assessment); reinforcing client teaching from a standard care plan; performing tracheostomy care; suctioning; checking nasogastric tube potency; administering enteral feedings; inserting urinary catheter; administering medications (excluding IV medications in some states)
Tasks delegated to APs - correct answer ADLs; bathing; grooming; dressing; toileting;
ambulating; feeding (without swallowing precautions); positioning; bed making; specimen collection; intake and output (I&O); vital signs (for stable clients)
Criminal law - correct answer A subsection of public law and relates to the relationship
of an individual with the government. A nurse who falsifies a record to cover up a serious mistakes may be guilty of breaking a criminal law.
Civil law - correct answer Protects individual rights; one type of civil law relates to the provision of nursing care is tort law.
Negligence - correct answer A nurse fails to implement safety measures for a client at risk for falls.
Malpractice - correct answer A nurse administers a large dose of medication due to a calculation error; the client has cardiac arrest and dies.
Breach of confidentiality - correct answer A nurse releases a client's medical diagnosis to a member of the press.
Defamation of character - correct answer A nurse tells a coworker that she believes the client has been unfaithful to her spouse. Assault - correct answer The conduct of one person makes another person fearful and
apprehensive.
> A nurse threatens to place an NG tube in a client who is refusing to eat.
Battery - correct answer Intentional and wrongful physical contact with a person that involves an injury or offensive contact. > A nurse restrains a client and administers an injection against her wishes.
False imprisonment - correct answer A person is confined or restrained against his will.
> A nurse uses restraints on a competent client to prevent his leaving the health care facility.
Professional negligence - correct answer The failure of a person who has professional
training to act in a responsible and prudent manner.
Nurses role in clients' rights - correct answer Must ensure that the clients understand their rights and protect their clients' rights
Client have the right to... - correct answer Understand the aspects of care to be active in the decision-making process; accept, refuse, or request modification of the care plan; receive care from competent individuals who treat the client with respect
Informed consent - correct answer A legal process by which a client has given written permission for a procedure or treatment.
Consent is informed when a provider explains and the client understands: - correct answer The reason the client needs treatment or procedure; how the treatment or procedure will benefit the client; risks involved; other options to treat the problem, including not treating the problem
The nurse's role in the informed consent process is to... - correct answer witness the client's signature on the informed consent form and to ensure that the provider obtained informed consent appropriately
Implied consent - correct answer Clients provide this when they adhere to the instructions the nurse provides > When the nurse performs a tuberculosis skin test, and the client holds out his arm for the nurse
For an invasive procedure or surgery, the client must... - correct answer provide written consent
Who can sign the form for informed consent? - correct answer A competent adult that is capable of understanding the information from the health care professional who will perform the service and must be able to communicate with the health care professional.
Delegating - correct answer The process of transferring the authority and responsibility to another member of the health care team to complete a task while retaining the accountability.
What kind of pump is required for intestinal tube feedings? - correct answer An infusion pump
Supervising - correct answer The process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team.
When should you discard feeding formula? - correct answer After 24 hrs
How often should you check gastric residual? - correct answer Every 4 to 8 hr
What should you do when gastric residual exceeds 250 mL for each of two consecutive assessments? - correct answer Withhold the feeding
Notify the provider
Maintain semi-Fowler's position
Recheck residual in 1 hr
What should you do when patient on feeding has diarrhea three times or more in a 24-
hr period? - correct answer Notify the provider
Confer with dietician Provide skin care and protection
What should you do when patient has nausea or vomiting on feeding? - correct answer Withhold the feeding
Turn the client to side
Notify the provider
Check the tube's patency Aspirate for residual Auscultate for bowel sounds Obtain a chest x-ray
What should you do if your patient aspirates the feeding formula? - correct answer Withhold the feeding
Turn the client to the side
Suction the airway
Provide oxygen if indicated Monitor vital signs for elevated temperature
Monitor oxygen saturation or increased respiratory rate Auscultate breath sounds for increased congestion Notify the provider Obtain a chest x-ray
A licensed nurse is responsible for... - correct answer providing clear directions when delegating a task initially and for periodic reassessment and evaluation of the outcome of the task
RNs cannot delegate... - correct answer the nursing process, client education, or tasks that require nursing judgment to LPNs or AP
5 rights to delegation - correct answer 1. Right task
2. Right circumstance 3. Right person
4. Right direction/communication
5. Right supervision/evaluation
Tasks delegated to LPNs - correct answer Monitoring findings (as input to the RN's ongoing assessment); reinforcing client teaching from a standard care plan; performing tracheostomy care; suctioning; checking nasogastric tube potency; administering enteral feedings; inserting urinary catheter; administering medications (excluding IV medications in some states)
Tasks delegated to APs - correct answer ADLs; bathing; grooming; dressing; toileting;
ambulating; feeding (without swallowing precautions); positioning; bed making; specimen collection; intake and output (I&O); vital signs (for stable clients)
Criminal law - correct answer A subsection of public law and relates to the relationship
of an individual with the government. A nurse who falsifies a record to cover up a serious mistakes may be guilty of breaking a criminal law.
Civil law - correct answer Protects individual rights; one type of civil law relates to the provision of nursing care is tort law.
Negligence - correct answer A nurse fails to implement safety measures for a client at risk for falls.
Malpractice - correct answer A nurse administers a large dose of medication due to a calculation error; the client has cardiac arrest and dies.
Breach of confidentiality - correct answer A nurse releases a client's medical diagnosis to a member of the press.
Defamation of character - correct answer A nurse tells a coworker that she believes the client has been unfaithful to her spouse. Assault - correct answer The conduct of one person makes another person fearful and
apprehensive.
> A nurse threatens to place an NG tube in a client who is refusing to eat.
Battery - correct answer Intentional and wrongful physical contact with a person that involves an injury or offensive contact. > A nurse restrains a client and administers an injection against her wishes.
False imprisonment - correct answer A person is confined or restrained against his will.
> A nurse uses restraints on a competent client to prevent his leaving the health care facility.
Professional negligence - correct answer The failure of a person who has professional
training to act in a responsible and prudent manner.
Nurses role in clients' rights - correct answer Must ensure that the clients understand their rights and protect their clients' rights
Client have the right to... - correct answer Understand the aspects of care to be active in the decision-making process; accept, refuse, or request modification of the care plan; receive care from competent individuals who treat the client with respect
Informed consent - correct answer A legal process by which a client has given written permission for a procedure or treatment.
Consent is informed when a provider explains and the client understands: - correct answer The reason the client needs treatment or procedure; how the treatment or procedure will benefit the client; risks involved; other options to treat the problem, including not treating the problem
The nurse's role in the informed consent process is to... - correct answer witness the client's signature on the informed consent form and to ensure that the provider obtained informed consent appropriately
Implied consent - correct answer Clients provide this when they adhere to the instructions the nurse provides > When the nurse performs a tuberculosis skin test, and the client holds out his arm for the nurse
For an invasive procedure or surgery, the client must... - correct answer provide written consent
Who can sign the form for informed consent? - correct answer A competent adult that is capable of understanding the information from the health care professional who will perform the service and must be able to communicate with the health care professional.
