ATI PN Fundamentals 2020 with NGN Practice

ATI PN Fundamentals 2020 with NGN Practice A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells him she will put a diaper on him if she does not use the urinal more carefully next time. Which of the following torts is the AP committing? A. Assault B. Battery C. False Imprisonment D. Invasion of Privacy A. Assault Rationale: By threatening the client, the AP is committing assault. Her threats could make the client become fearful and apprehensive. A nurse is caring for a competent adult client who tells the nurse that he is thinking about leaving the hospital against medical advice. The nurse believes that this is not in the client's best interest, so she prepares to administer a PRN sedative medication the client has not requested along with his usual medication. Which of the following types of tort is the nurse about to commit? A. Assault B. False Imprisonment C. Negligence D. Breach of Confidentiality B. False imprisonment Rationale: The nurse gave the med as a chemical restraint to keep the client from leaving the facility against medical advice. This is false imprisonment bc the client neither requested nor consented to receiving the sedative. A nurse in a surgeon's office is providing preoperative teaching for a client who is scheduled for surgery the following week. The client tells the nurse that he will prepare his advance directives before he goes to the hospital. Which of the following statements made by the client should indicate to the nurse an understanding of advance directives? a. "I'd rather have my brother make decisions for me, but I know it has to be my wife" b. "I know they won't go ahead with surgery unless I prepare these forms" c. "I plan to write that I don't want them to keep me on a breathing machine" d. "I will get my regular doctor to approve my plan before I hand it in at the hospital" C. "I plan to write that i don't want them to keep me on a breathing machine." Rationale: The client has the right to decide and specify which medical procedures he wants when a life threatening situation arises. A nurse is caring for a client who is about to undergo an elective surgical procedure. The nurse should take which of the following actions regarding informed consent? (select all that apply.) a. Makes sure the surgeon obtained the client's consent b. Witness the client's signature on the consent form c. Explain the risks and benefits of the procedure. d. Describe the consequences of choosing not to have the surgery. e. Tell the client about alternatives to having the surgery. A. Make sure the surgeon obtained the client's consent. B. Witness the client's signature on the consent form. Rationale: 1. It is the nurse's responsibility to verify that the surgeon obtained the client's consent and that he understands the information the surgeon gave him. 2. It is the nurse's responsibility to witness the client's signing of the consent form, & to verify that he is consenting voluntarily & appears to be competent to do so. 3. The nurse also should verify that he understands the information the surgeon gave him. When entering a client's room to change a surgical dressing, a nurse notes that the client is coughing and sneezing. Which of the following actions should the nurse take when preparing the sterile field? C. Place a mask on the client to limit the spread of micro-organisms into the surgical wound. Rationale: Placing a mask on the client prevents contamination of the surgical wound during the dressing change. A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following flaps should the nurse unfold first? D. The flap farthest from the body Rationale: The priority goal in setting up a sterile field is to maintain sterility and thus reduce the risk to the client's safety. Unless the nurse pulls the top flap (the one furthest from her body) away from her body first, she risks touching part of the inner surface of the wrap and thus contaminating it. A nurse is wearing sterile gloves in preparation for performing sterile procedure. Which of the following objects can the nurse touch without breaching sterile technique? (Select all that apply) The inner wrapping of an item on the sterile field. Rationale: The inner wrappings of any objects the nurse dropped onto the sterile field are sterile. The nurse may touch them with sterile gloves. D. An irrigation syringe on the sterile field Rationale: Any objects the nurse dropped onto the sterile field during the setup are sterile. The nurse may touch the syringe with sterile gloves. E. One gloved hand with the other gloved hand Rationale: One sterile gloved hand may touch the other sterile gloved hand because both are sterile. A nurse is reviewing hand hygiene techniques with a group of assistive personnel (AP). Which of the following instructions should the nurse include when discussing handwashing? (Select all that apply) Wash the hands with soap and water for at least 15 seconds. Rationale: This is the amount of time it takes to remove transient flora from the hands. For soiled hands, the recommendation is 2 min. Use a clean paper towel to turn off hand faucets. Rationale: If the sink does not have foot or knee pedals, the APs should turn off the water with a clean paper towel and not with their hands.