ATI RN LEADERSHIP PROCTORED 2025/2026 EXAM
delegation/supervision - ANSWER-*5 rights*
1. task
2. circumstance
3. person
4. direction and communication
5. supervision and evaluation
-based on individual client needs, facility policies and job descriptions, state NPA, professional
standards
-consider the individual's education, training, and experience
-RNs can delegate to:
>>other RNs
>>LPNs
>>APs
delegating to AP - ANSWER--ADLs
-bathing
-grooming
-dressing
-toileting
-ambulating
-feeding without swallowing precautions
-positioning
-bed making
-VS for stable clients
-specimen collection
-I&O
>>follow facility policies and stage practice guidelines
right task - ANSWER-repetitive, requires little supervision, and relatively noninvasive
right task: AP to assist pt with bedpan and pneumonia
wrong task: delegate AP to administer a nebilizer to a pt with pneumonia
right circumstance - ANSWER--assess health status and complexity of care required by the client
-match the complexity of care demands to the skill level of the health care team
-consider workload
right circustance: delegate to AP to measure VS on stable pt
wrong: delegate AP to measure VS on pt who is post-op and received naloxone to reverse respiratory
depression
right person - ANSWER--assess and verify competency of the health care team member
>>within scope of practice and necessary competence and training
-continual performance reviews
,right: delegate a LPN to adminster enteral to a client who has a head injury
wrong: delegate an AP to adminster enteral feedings to a client who has a head injury
right direction/communication - ANSWER--data that needs to be collected
-method and time line for reporting (when to report concerns/findings
right: delegate an AP to assist in room X with (something very specific) before X amount of time
wrong: delegate an AP to assist with (something nonspecific) in room x
right supervision/evaluation - ANSWER--directly or indirectly
-clear directions and expectations
-monitor performance
-provide feedback
-intervene if necessary
-evaluate and identify needs for quality improvement activities
right: delegate the ambulation of the client and provide positive feedback to the AP after completion
of task
wrong: delegate the ambulation of a client to an AP without supervision to determine the need for
intervntion and failing to provide feedback to the AP
delegating to LPN - ANSWER--monitoring client findings as input for the RNs ongoing assessment of
the client
-reinforcing client teaching from a standardized care plan
-performing tracheostomy care and suction
-perform uncomplicated wound care
-checking NG tube patency
-administering enteral feedings
-inserting urinary catheter
-administering medications
>>not IV meds
responding to inappropriate delegation - ANSWER-*DO NOT DELEGATE*:
-nursing process
-client education
-tasks that require clinical judgement to LPNs or APs
*CONSIDER*:
-predictability of outcome
-potential for harm
-complexity of care
-need for problem solving and innovation
-level of interaction with the client
when a nurse receives an unsafe assignment - ANSWER--bring the assignment to the attention of the
scheduling/charge nurse and negotiate a new assignment
-if unresolved take it up chain of command
-file a written protest to the assignment
>>assignment despite objection
>>document of practice situations
-failure to accept the assignment without following the proper channels can be considered client
abandonment
,inappropriate use of restraints - ANSWER-*assualt*: threatening to place a NG tube in a pt who is
refusing to eat
*battery*: restraining a pt and administering an injection against his wishes
*false imprisonment*: using restraints on a competent client to prevent his leaving the health care
facility
reporting information to the provider (ch. 2) - ANSWER-should be fostered to create a climate of
mutual respect and collaborative practice
*-assessment data integral to changes in client status
-recommendations for changes in the plan of care
-clarification of prescriptions*
*Qualities*:
-good communication
-assertiveness
-conflict negotiation skills
-leadership skills
-professional presence
-decision-making and critical thinking
Decision-making styles:
*decisive* - ANSWER-the team uses a minimum amount of data and generates one option
Decision-making styles:
*flexible* - ANSWER-the team uses a limited amount of data and generates several options
Decision-making styles:
*Hierarchical* - ANSWER-the team uses a large amount of data and generates one option
Decision-making styles:
*integrative* - ANSWER-the team uses a large amount of data and generates several options
breach of confidentiality (ch. 3) - ANSWER--nurses who disclose client information to an unauthorized
person can be liable for invasion of privacy, defamation, or slander
-*HIPAA rights of pts*
>>client is able to obtain a copy of their medical record and to submit requests to amend erroneous
or incomplete information
>>a requirement for health care and insurance providers to provide written information about how
medical information is used and how it is shared with other entities
-->permission must be obtained before information is shared
>>the pt has the right to privacy and confidentiality
*components of privacy rule* - ANSWER--only healthcare team members directly responsible for the
client's care are allowed access to the patients records.
>>nurses may not share information with other clients or staff not involved in the patient care
-clients have a right to read and obtain a copy fo their medical record, and agency policy should be
followed when the client requests to read or have a copy of the record
-no part of the client record can be copied except for authorized exchange of documents between
health care institutions
>>transfer from a hospital to an extended care facility
>>exchange of documents between a general practitioner and a specialist during a consult
-client records must be kept in a secure area to prevent inappropriate access to information
-client information may not be disclosed to unauthorized individuals, including family members who
request it and individuals who call on the phone
, >>many hospitals use a code system in which information is only disclosed to individuals who can
provide the code
>>nurses should ask any individual inquiring about a client's health status for the code and disclose
information only when that code is
-communication should only take place in a private setting where it can not be overheard by
unauthorized people
>>change of shift reports are to be done at the bedside as long as the patient does not have a
roommate and no unsolicited visitors are present
>>*DO NOT* use:
-->walking rounds or taped rounds
referral for home oxygen therapy (ch. 2) - ANSWER--begin discharge planning upon the client's
admission
-evaluate the client/family competencies in relation to home care prior to discharge
-involve the client and family in care planning
-discharge referrals are based on client needs in relation to actual and potential problems and can be
facilitated with the assistance of social services, especially if there is a need for:
>>specialized equipment:
-->cane, walker, wheelchair, grab bars in bathroom
>>specialized therapies
care of a client following a transfer (ch. 2) - ANSWER-
strategies for cost containment (ch. 4) - ANSWER-
priority nursing action for discharge (ch. 2) - ANSWER-
pacemaker education (ch. 4) - ANSWER-
principles of surgical asepsis
>>Fundamentals (ch. 10) - ANSWER-
time management (p. 7) - ANSWER-*WASTERS*:
-documenting at end of shift
-making repeated trips to the supply room for equipment
-providing care as opportunity arises regardless of other responsibilities
-missing equipment when preparing to perform a procedure
-being reluctant to delegate or underdelegate
-not asking for help when needed or truing to procide all client care independently
time savers (p. 7) - ANSWER--documenting throughout shift
-group activities
-estimate time needed and plan accordingly
-plan non-essential tasks
-delegate
-complete one task before beginning a second
Maslows - ANSWER-
interfacility transfer form - ANSWER-
transfer report form - ANSWER-
discharge summary - ANSWER-
float nurse assignments - ANSWER-
delegation/supervision - ANSWER-*5 rights*
1. task
2. circumstance
3. person
4. direction and communication
5. supervision and evaluation
-based on individual client needs, facility policies and job descriptions, state NPA, professional
standards
-consider the individual's education, training, and experience
-RNs can delegate to:
>>other RNs
>>LPNs
>>APs
delegating to AP - ANSWER--ADLs
-bathing
-grooming
-dressing
-toileting
-ambulating
-feeding without swallowing precautions
-positioning
-bed making
-VS for stable clients
-specimen collection
-I&O
>>follow facility policies and stage practice guidelines
right task - ANSWER-repetitive, requires little supervision, and relatively noninvasive
right task: AP to assist pt with bedpan and pneumonia
wrong task: delegate AP to administer a nebilizer to a pt with pneumonia
right circumstance - ANSWER--assess health status and complexity of care required by the client
-match the complexity of care demands to the skill level of the health care team
-consider workload
right circustance: delegate to AP to measure VS on stable pt
wrong: delegate AP to measure VS on pt who is post-op and received naloxone to reverse respiratory
depression
right person - ANSWER--assess and verify competency of the health care team member
>>within scope of practice and necessary competence and training
-continual performance reviews
,right: delegate a LPN to adminster enteral to a client who has a head injury
wrong: delegate an AP to adminster enteral feedings to a client who has a head injury
right direction/communication - ANSWER--data that needs to be collected
-method and time line for reporting (when to report concerns/findings
right: delegate an AP to assist in room X with (something very specific) before X amount of time
wrong: delegate an AP to assist with (something nonspecific) in room x
right supervision/evaluation - ANSWER--directly or indirectly
-clear directions and expectations
-monitor performance
-provide feedback
-intervene if necessary
-evaluate and identify needs for quality improvement activities
right: delegate the ambulation of the client and provide positive feedback to the AP after completion
of task
wrong: delegate the ambulation of a client to an AP without supervision to determine the need for
intervntion and failing to provide feedback to the AP
delegating to LPN - ANSWER--monitoring client findings as input for the RNs ongoing assessment of
the client
-reinforcing client teaching from a standardized care plan
-performing tracheostomy care and suction
-perform uncomplicated wound care
-checking NG tube patency
-administering enteral feedings
-inserting urinary catheter
-administering medications
>>not IV meds
responding to inappropriate delegation - ANSWER-*DO NOT DELEGATE*:
-nursing process
-client education
-tasks that require clinical judgement to LPNs or APs
*CONSIDER*:
-predictability of outcome
-potential for harm
-complexity of care
-need for problem solving and innovation
-level of interaction with the client
when a nurse receives an unsafe assignment - ANSWER--bring the assignment to the attention of the
scheduling/charge nurse and negotiate a new assignment
-if unresolved take it up chain of command
-file a written protest to the assignment
>>assignment despite objection
>>document of practice situations
-failure to accept the assignment without following the proper channels can be considered client
abandonment
,inappropriate use of restraints - ANSWER-*assualt*: threatening to place a NG tube in a pt who is
refusing to eat
*battery*: restraining a pt and administering an injection against his wishes
*false imprisonment*: using restraints on a competent client to prevent his leaving the health care
facility
reporting information to the provider (ch. 2) - ANSWER-should be fostered to create a climate of
mutual respect and collaborative practice
*-assessment data integral to changes in client status
-recommendations for changes in the plan of care
-clarification of prescriptions*
*Qualities*:
-good communication
-assertiveness
-conflict negotiation skills
-leadership skills
-professional presence
-decision-making and critical thinking
Decision-making styles:
*decisive* - ANSWER-the team uses a minimum amount of data and generates one option
Decision-making styles:
*flexible* - ANSWER-the team uses a limited amount of data and generates several options
Decision-making styles:
*Hierarchical* - ANSWER-the team uses a large amount of data and generates one option
Decision-making styles:
*integrative* - ANSWER-the team uses a large amount of data and generates several options
breach of confidentiality (ch. 3) - ANSWER--nurses who disclose client information to an unauthorized
person can be liable for invasion of privacy, defamation, or slander
-*HIPAA rights of pts*
>>client is able to obtain a copy of their medical record and to submit requests to amend erroneous
or incomplete information
>>a requirement for health care and insurance providers to provide written information about how
medical information is used and how it is shared with other entities
-->permission must be obtained before information is shared
>>the pt has the right to privacy and confidentiality
*components of privacy rule* - ANSWER--only healthcare team members directly responsible for the
client's care are allowed access to the patients records.
>>nurses may not share information with other clients or staff not involved in the patient care
-clients have a right to read and obtain a copy fo their medical record, and agency policy should be
followed when the client requests to read or have a copy of the record
-no part of the client record can be copied except for authorized exchange of documents between
health care institutions
>>transfer from a hospital to an extended care facility
>>exchange of documents between a general practitioner and a specialist during a consult
-client records must be kept in a secure area to prevent inappropriate access to information
-client information may not be disclosed to unauthorized individuals, including family members who
request it and individuals who call on the phone
, >>many hospitals use a code system in which information is only disclosed to individuals who can
provide the code
>>nurses should ask any individual inquiring about a client's health status for the code and disclose
information only when that code is
-communication should only take place in a private setting where it can not be overheard by
unauthorized people
>>change of shift reports are to be done at the bedside as long as the patient does not have a
roommate and no unsolicited visitors are present
>>*DO NOT* use:
-->walking rounds or taped rounds
referral for home oxygen therapy (ch. 2) - ANSWER--begin discharge planning upon the client's
admission
-evaluate the client/family competencies in relation to home care prior to discharge
-involve the client and family in care planning
-discharge referrals are based on client needs in relation to actual and potential problems and can be
facilitated with the assistance of social services, especially if there is a need for:
>>specialized equipment:
-->cane, walker, wheelchair, grab bars in bathroom
>>specialized therapies
care of a client following a transfer (ch. 2) - ANSWER-
strategies for cost containment (ch. 4) - ANSWER-
priority nursing action for discharge (ch. 2) - ANSWER-
pacemaker education (ch. 4) - ANSWER-
principles of surgical asepsis
>>Fundamentals (ch. 10) - ANSWER-
time management (p. 7) - ANSWER-*WASTERS*:
-documenting at end of shift
-making repeated trips to the supply room for equipment
-providing care as opportunity arises regardless of other responsibilities
-missing equipment when preparing to perform a procedure
-being reluctant to delegate or underdelegate
-not asking for help when needed or truing to procide all client care independently
time savers (p. 7) - ANSWER--documenting throughout shift
-group activities
-estimate time needed and plan accordingly
-plan non-essential tasks
-delegate
-complete one task before beginning a second
Maslows - ANSWER-
interfacility transfer form - ANSWER-
transfer report form - ANSWER-
discharge summary - ANSWER-
float nurse assignments - ANSWER-
