a nurse is using an open irrigation technique to irrigate a clients indwelling urinary catheter which of the following actions should the nurse take
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Nursing Elites

ATI RN

ATI Leadership Practice B

1. When using an open irrigation technique to irrigate a client's indwelling urinary catheter, which of the following actions should the nurse take?

Correct answer: B

Rationale: When irrigating an indwelling urinary catheter, the nurse should use a 20-mL syringe for the procedure. This syringe size helps to provide adequate pressure for effective irrigation. Placing the client in a side-lying position is not necessary for this procedure. Instilling a specific amount of irrigation fluid into the catheter is not mentioned in the scenario. Subtracting the amount of irrigant used from the client's urine output is not a standard practice in catheter irrigation.

2. A nurse is initiating a protective environment for a client who has had an allogeneic stem cell transplant. Which of the following precautions should the nurse plan for this client?

Correct answer: A

Rationale: In a protective environment for a client with an allogeneic stem cell transplant, the nurse needs to wear an N95 respirator when providing direct care to the client. This precaution is essential to protect the client, whose immune system is compromised after the transplant, from exposure to potential pathogens. Placing the client in a private room with negative-pressure airflow (choice B) is more appropriate for clients with airborne infections. Ensuring the client's room has sufficient air exchanges (choice C) is important for maintaining air quality but is not the primary precaution for protecting an immunocompromised client. Making the client wear a mask when outside the room due to construction (choice D) focuses on external factors and does not directly address the risk of infection during direct care.

3. What is the term used for assigning a rating based on an overall impression?

Correct answer: D

Rationale: The correct answer is 'Halo error.' Halo error occurs when a rating is given based on a general impression rather than specific performance criteria. Choice A, 'Recency error,' refers to rating an employee based on recent events rather than the entire evaluation period. Choice B, 'Leniency error,' is when a manager consistently rates employees higher than they deserve. Choice C, 'Absolute judgment,' involves evaluating based on established standards rather than an overall impression.

4. A registered nurse (RN) is caring for a patient who is one of Jehovah�s Witnesses and has refused a blood transfusion even though her hemoglobin is dangerously low. After providing information about all the alternatives available and risks and benefits of each, the health-care provider allows the patient to determine which course of treatment she would prefer. The RN knows this is an example of which ethical principle?

Correct answer: A

Rationale: This is an example of the ethical principle of autonomy.

5. How does decision making differ from problem solving?

Correct answer: A

Rationale: The correct answer is A because decision making always involves selecting from a set of alternatives, while problem solving involves diagnosing a problem. Option B is incorrect as problem solving involves diagnosing a problem rather than selecting one of several alternatives. Option C is incorrect because decision making is often a part of problem-solving processes. Option D is incorrect as decision making may involve selecting from alternatives, not necessarily solving a problem.

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