after change of shift report which patient should the nurse assess first

ATI RN

ATI Leadership Proctored Exam 2019

1. After receiving change-of-shift report, which patient should the nurse assess first?

A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain

Correct answer: B

Rationale: The correct answer is B because the patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention. Hypoglycemia is an emergency situation that requires prompt intervention to prevent adverse effects such as seizures or loss of consciousness. Assessing and managing this patient first is crucial to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. While a high hemoglobin A1C level (choice A), an abnormal oral glucose tolerance test result (choice C), and acute abdominal pain (choice D) are important issues, they do not pose an immediate threat to the patient's life compared to severe hypoglycemia.

2. Which of the following best describes the role of a nurse advocate?

A. Direct patient care provider
B. Advocate for patient needs
C. Manage nursing staff
D. Ensure policy adherence

Correct answer: B

Rationale: The correct answer is B: 'Advocate for patient needs.' A nurse advocate's primary role is to stand up for the patient's rights and ensure their needs are met. Choice A, 'Direct patient care provider,' is incorrect as while nurses do provide direct patient care, the specific role of a nurse advocate goes beyond that. Choice C, 'Manage nursing staff,' is incorrect as this pertains to a nurse manager's role, not a nurse advocate. Choice D, 'Ensure policy adherence,' is also incorrect as this reflects more of a quality assurance or compliance role, rather than the advocacy role of a nurse advocate.

3. The charge nurse role has negatively affected your relationship with your friends and made you feel tense and isolated. You decide that you will delegate more time-consuming tasks to staff who are not your friends, who then complain to your nurse manager about your perceived unfairness. You decide to:

A. Talk with your friends individually to let them know that you will be assigning patients to all staff in an equitable manner.
B. Not express your angry feelings.
C. Talk about staff who are annoying you with staff on other units.
D. Ignore your feelings of uncertainty, hoping they will diminish.

Correct answer: A

Rationale: In this scenario, it is essential to address the perceived unfairness in task delegation. Talking with your friends individually to explain that patients will be assigned equitably is the most appropriate course of action. This approach promotes transparency and fairness in task allocation, helping to maintain professional relationships. Choices B, C, and D are not suitable responses. Choice B ignores the issue, choice C involves unprofessional behavior by gossiping about colleagues, and choice D neglects addressing the root cause of the problem.

4. Which of the following is one of the positive benefits of conflict within an organization?

A. Conflict leads to compromise on values and beliefs.
B. Conflict leads to intergroup competition.
C. Conflict helps people recognize differences and motivates people towards improved performance.
D. Conflict always leads to a win-win resolution.

Correct answer: C

Rationale: The correct answer is C. Conflict within an organization can help people recognize legitimate differences and motivate them towards improved performance. This recognition of differences can lead to constructive discussions and solutions. Choice A is incorrect because conflict does not necessarily always lead to compromising values and beliefs. Choice B is incorrect as conflict should not be about fostering intergroup competition but rather about addressing and resolving issues. Choice D is incorrect as conflicts do not always result in a win-win resolution; sometimes, compromises or trade-offs are necessary for resolution.

5. A nurse is caring for a client who is postoperative and is exhibiting signs of hemorrhagic shock. The nurse notifies the surgeon, who tells the nurse to continue to measure the client's vital signs every 15 min and to report back in 1 hour. Which of the following actions should the nurse take next?

A. Document the surgeon's instructions in the client's medical record.
B. Complete an incident report.
C. Consult the charge nurse.
D. Notify the nursing manager.

Correct answer: D

Rationale: In this scenario, the nurse should notify the nursing manager next. The surgeon's instructions are related to the client's condition, and it is crucial to inform the nursing manager about the situation. Option A is incorrect because documenting the surgeon's instructions in the medical record is not the immediate next step. Option B is also incorrect as completing an incident report is not warranted in this situation. Option C is not the best choice as consulting the charge nurse may cause a delay in escalating the situation to higher management, which is necessary in cases of emergency like hemorrhagic shock.