a nurse is caring for a client who is refusing a blood transfusion for religious reasons the clients partner wants the client to have the blood transf

ATI RN

ATI Leadership Proctored

1. A client is refusing a blood transfusion for religious reasons. The client's partner wants the client to have the blood transfusion. Which of the following actions should be taken?

A. Ask the client to consider a direct donation
B. Withhold the blood transfusion
C. Ask the client to consider a direct donation
D. Request a consultation with the ethics committee

Correct answer: A

Rationale: In this situation, the nurse should ask the client to consider a direct donation. This option respects the client's autonomy by exploring alternative options that align with the client's beliefs. Withholding the blood transfusion (choice B) goes against the client's wishes and autonomy. Requesting a consultation with the ethics committee (choice D) should be considered if there is a disagreement that cannot be resolved at the bedside, but it is not the initial step. Choice C is a duplicate of choice A and does not provide a different or additional action to address the situation.

2. What should the nurse do after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?

A. Assess the patient for symptoms of hyperglycemia.
B. Give the patient a snack of peanut butter and crackers.
C. Have the patient drink a glass of orange juice or nonfat milk.
D. Administer a continuous infusion of 5% dextrose for 24 hours.

Correct answer: B

Rationale: After a patient treated with intramuscular glucagon for hypoglycemia regains consciousness, providing a snack of peanut butter and crackers is essential to prevent another episode of hypoglycemia. Peanut butter and crackers contain a combination of protein and carbohydrates, which can help stabilize the patient's blood glucose levels. This choice is the most appropriate immediate action to prevent recurrence of hypoglycemia in this scenario. Assessing for symptoms of hyperglycemia (choice A) is not the immediate priority after treating hypoglycemia. While orange juice or nonfat milk (choice C) can help raise blood sugar, they lack the sustained effect of protein found in peanut butter. Administering a continuous infusion of dextrose (choice D) is excessive and not indicated after the patient has already regained consciousness.

3. Which of the following is a characteristic of a well-written goal?

A. Goals should be vague
B. Goals should be unrealistic
C. Goals need to be measurable, realistic, and achievable
D. Goals should be easy to achieve

Correct answer: C

Rationale: The correct answer is C: Goals need to be measurable, realistic, and achievable. Well-written goals should be specific and quantifiable to provide clear direction and motivation. Choice A is incorrect as goals should not be vague but rather specific. Choice B is incorrect as goals should be realistic to be attainable. Choice D is incorrect as goals should challenge individuals and not be too easy to achieve to promote growth and development.

4. What is the primary responsibility of a clinical nurse leader (CNL)?

A. Supervise nursing staff
B. Coordinate patient care
C. Develop nursing policies
D. Implement evidence-based practice

Correct answer: B

Rationale: The main role of a clinical nurse leader (CNL) is to coordinate patient care. While CNLs may oversee aspects of nursing staff, the primary focus is on coordinating patient care to ensure effective treatment and outcomes. Developing nursing policies and implementing evidence-based practice are important aspects of nursing leadership but are not the main role of a CNL.