240 Final

Experience in clinical delegation Application of theory to practice Development of clinical judgment Engagement with a nursing mentor (Clinical delegation experiences foster professional self-confidence in the early career of an RN. The nursing practicum experiences of applying theory to practice and developing clinical judgment will also advance the RN's ability to become a successful delegator and foster professional self-confidence. Engagement with a nursing mentor fosters professional self-confidence in the early career of an RN. The RN must have the ability to comprehend the legal authority of delegation decisions.)

A newly promoted registered nurse (RN) is about to start delegation for the first time in her career. Which experiences foster professional self-confidence in the early career stage for an RN? Select all that apply. Inability to comprehend Experience in clinical delegation Application of theory to practice Development of clinical judgment Engagement with a nursing mentor

a. Assist the patient in getting cleaned up. (The goal of delegation of any assignment is to provide efficient, patient-centered care. In this case, the patient is angry and upset, and the nurse should first see to the patient's needs and address the issue with the UAP after the situation is resolved.)

A nurse delegates a bed bath to unlicensed assistive personnel (UAP). After lunch, the patient rings for the nurse and complains that he has not yet been cleaned up. He is very upset and angry. What should the nurse's next action be? a. Assist the patient in getting cleaned up. b. Write up the UAP for not carrying out the assignment. c. Report the UAP to the unit manager. d. Go find the UAP, and tell her to complete the bath immediately.

c. "You sound anxious about being a single parent." (Therapeutic communication includes active listening and honesty. This statement demonstrates that the nurse recognizes the client's distress and has provided an opening for discussion. Extending sympathy and offering to call the chaplain do not give the client the opportunity to discuss feelings. Stating that the children still have one parent discounts the client's feelings and situation.)

A nurse is caring for a client whose wife died in a recent mass casualty accident. The client says, "I can't believe that my wife is gone and I am left to raise my children all by myself." How should the nurse respond? a. "Please accept my sympathies for your loss." b. "I can call the hospital chaplain if you wish." c. "You sound anxious about being a single parent." d. "At least your children still have you in their lives."

d. Multiple fractured ribs and shortness of breath (Clients who have an immediate threat to life are given the highest priority, are placed in the emergent or class I category, and are given a red triage tag. The client with multiple rib fractures and shortness of breath most likely has developed a pneumothorax, which may be fatal if not treated immediately. The client with the hip and leg problem and the client with the clavicle fracture would be classified as class II; these major but stable injuries can wait 30 minutes to 2 hours for definitive care. The client with facial wounds would be considered the "walking wounded" and classified as nonurgent.)

A nurse is field-triaging clients after an industrial accident. Which client condition should the nurse triage with a red tag? a. Dislocated right hip and an open fracture of the right lower leg b. Large contusion to the forehead and a bloody nose c. Closed fracture of the right clavicle and arm numbness d. Multiple fractured ribs and shortness of breath

Sucking chest wound (A sucking chest wound receives care first during a mass casualty. This type of injury is a red tag, or emergent, injury because it can be quickly resolved until further help can be given. Remember the A,B,Cs. Airway, breathing, and circulation always come first.The abdominal evisceration would be considered a black tag because of the amount of time it would require to provide adequate care. The open fracture of the left forearm would be yellow tagged. The injury requires care but can wait. The sprained ankle would be green tagged and considered "walking wounded.")

During a mass casualty, which injury receives care first? Abdominal evisceration Open fracture of the left forearm Sprained ankle Sucking chest wound

a. Partial-thickness burns covering both legs c. Neck injury and numbness of both legs d. Small pieces of shrapnel embedded in both eyes f. Bruising and pain in the right lower abdomen (Clients with burns, spine injuries, eye injuries, and stable abdominal injuries should be treated within 30 minutes to 2 hours, and therefore should be identified with yellow tags. The client with the open fractures and the client with the head injury would be classified as urgent with red tags.)

Emergency medical services (EMS) brings a large number of clients to the emergency department following a mass casualty incident. The nurse identifies the clients with which injuries with yellow tags? (Select all that apply.) a. Partial-thickness burns covering both legs b. Open fractures of both legs with absent pedal pulses c. Neck injury and numbness of both legs d. Small pieces of shrapnel embedded in both eyes e. Head injury and difficult to arouse f. Bruising and pain in the right lower abdomen

Assesses his or her own individual feelings (After injuries have been taken care after a random shooting at a high school, the high school nurse needs to first assess his/her own individual feelings. One cannot be an effective caregiver if one's own needs are not also met. Active listening, allowing students to express their feelings, and facilitating community cohesion are important, but are not what needs to be done first.

How does the high school nurse react directly after a random shooting at a high school after injuries are taken care of? Actively listens to students Assesses his or her own individual feelings Encourages students to vent feelings Facilitates community cohesion

d. Speak to the peer privately to prevent further occurrences (Alerting the peer who has acted disrespectfully in a private setting is the most professional way to approach this situation. It is never appropriate for a professional to belittle or reprimand a peer in front of others. Ignoring disrespectful behavior may only perpetuate its occurrence. Seeking help from a clinical instructor would be appropriate if the peer does not respond to the initial intervention from the fellow student.)

If a student nurse overhears a peer speaking disrespectfully about a patient, nurse, faculty member, or classmate, what is the most ethical first action for the student nurse to take? a. Discuss the peer's actions during group clinical conference b. Ignore the initial occurrence and observe if it happens again c. Report the actions of the classmate to the clinical instructor d. Speak to the peer privately to prevent further occurrences

d. "You seem upset. I have time to talk if you'd like." (Clients should be allowed to ventilate their feelings of anger and despair after a catastrophic event. The nurse establishes rapport through active listening and honest communication and by recognizing cues that the client wishes to talk. Asking whether the client is in pain as the first response closes the door to open communication and limits the client's options. Simply telling the client to stop yelling and to gain control does nothing to promote therapeutic communication.)

A client who is hospitalized with burns after losing the family home in a fire becomes angry and screams at a nurse when dinner is served late. How should the nurse respond? a. "Do you need something for pain right now?" b. "Please stop yelling. I brought dinner as soon as I could." c. "I suggest that you get control of yourself." d. "You seem upset. I have time to talk if you'd like."

)Perform jaw-thrust maneuver. Administer supplemental oxygen. Apply direct pressure with a sterile dressing. Measure client's level of consciousness. Remove the client's clothing to perform a thorough physical examination. (Facial trauma can obstruct the airway and cause respiratory compromise. Therefore opening the airway using jaw-thrust maneuver is priority for this client. Once the airway is opened, adequate ventilation should be ensured by administering supplemental oxygen. After ensuring the airway patency, circulation should be assessed and direct pressure applied with a sterile dressing on the bleeding site. After ensuring respiration and circulation, the client's level of consciousness should be determined. Then all clothing should be removed to perform thorough physical assessment.)

A client with facial trauma is admitted to the emergency department. The client has dyspnea, cyanosis, and external bleeding. What is the correct order of nursing interventions that should be performed in this situation? Administer supplemental oxygen. Perform jaw-thrust maneuver. Measure client's level of consciousness. Apply direct pressure with a sterile dressing. Remove the client's clothing to perform a thorough physical examination.

Administering oral medications Administering intramuscular medication (LPNs are authorized to administer drugs via all routes, including oral and intramuscular, but not intravenous routes, under the supervision of an RN. Intravenous drug administration should be carried out by the RN. If the vital signs are fluctuating, the RN should not delegate this duty to the delegatee. Analyzing the case history of the client and making the appropriate nursing diagnosis also cannot be delegated.)

A client with hypoglycemia is admitted to the hospital. Which duties can the registered nurse (RN) safely delegate to the licensed practical nurse (LPN)? Select all that apply. Intravenous fluid intervention Administering oral medications Monitoring the fluctuating vitals Analyzing the case history of the client Administering intramuscular medication

a. Provide a calm location for the family to cope and discuss needs. (The nurse should first provide emotional support by encouraging relaxation, listening to the family's needs, and offering choices when appropriate and possible to give some personal control back to individuals. The family may or may not want the assistance of religious personnel; the nurse should assess for this before calling anyone. Visiting procedures should take into account the needs of the family. The family may want to see the victim immediately and do not want to wait until the body can be prepared. The nurse should assess the family's needs before assuming the body needs to be prepared first. The family may appreciate privacy, but this is not as important as assessing the family's needs.)

A family in the emergency department is overwhelmed at the loss of several family members due to a shooting incident in the community. Which intervention should the nurse complete first? a. Provide a calm location for the family to cope and discuss needs. b. Call the hospital chaplain to stay with the family and pray for the deceased. c. Do not allow visiting of the victims until the bodies are prepared. d. Provide privacy for law enforcement to interview the family.

Removing client's clothes and showering clients immediately (Clients who have been exposed to a radioactive explosion may carry radioactive substances along with them and pose danger to other clients and hospital staff. Therefore the emergency department staff should first implement decontamination measures such as removing the clothes and showering the clients to reduce the risk. The emergency department nurse can arrange blood transfusions for the clients, but only after implementing the decontamination measures. The emergency department team can start intravenous fluids to the clients only after showering the clients. The emergency department staff can perform total body assessments to clients only after implementing decontamination measures.)

A group of clients who work in a uranium mine are admitted to the emergency department after a radioactive explosion. What is the priority nursing intervention in this situation after collaborating with the emergency response team? Arranging blood transfusions for the clients immediately Starting intravenous fluid administration immediately Removing client's clothes and showering clients immediately Performing total body assessment of clients immediately

"I will take clients' vital signs after their procedures are over." (Monitoring vital signs after procedures is within the scope of a UAP's role. Registered professional nurses or licensed practical nurses, not UAPs, should perform turning off clients' intravenous (IV) infusions that have infiltrated. Using unit written materials to teach clients before surgery should be performed by registered professional nurses or licensed practical nurses, not UAPs. Helping by giving medications to clients who are slow in taking pills should be performed by registered professional nurses or licensed practical nurses, not UAPs.)

A nurse is working with an unlicensed assistive personnel (UAP) in caring for a group of clients. Which statement by the UAP indicates a correct understanding of the UAP's role? "I will turn off clients' IVs that have infiltrated." "I will take clients' vital signs after their procedures are over." "I will use unit written materials to teach clients before surgery." "I will help by giving medications to clients who are slow in taking pills."

b. Client who had open reduction and internal fixation of a femur fracture 3 days ago e. Client on the medical unit for wound care (The client with the femur fracture could be transferred to a rehabilitation facility, and the client on the medical unit for wound care should be transferred home with home health or to a long-term care facility for ongoing wound care. The client in the medical decision unit should be identified for dismissal if diagnostic testing reveals a noncardiac source of chest pain. The newly admitted client with pneumonia would not be a good choice because culture results are not yet available and antibiotics have not been administered long enough. The infant does not have a definitive diagnosis.)

A hospital prepares to receive large numbers of casualties from a community disaster. Which clients should the nurse identify as appropriate for discharge or transfer to another facility? (Select all that apply.) a. Older adult in the medical decision unit for evaluation of chest pain b. Client who had open reduction and internal fixation of a femur fracture 3 days ago c. Client admitted last night with community-acquired pneumonia d. Infant who has a fever of unknown origin e. Client on the medical unit for wound care

Nurses may have to assume roles in making decisions for the most appropriate treatment of casualties. (Nurses play key roles that extend to all areas of the health care facility during a disaster. They may have to assume roles in triage, patient transfers, discharge, or providing care for stable patients. Learning about the nurse's role in a disaster is essential. The nurse will play an active role during a disaster. If the nurse is out in the field during a disaster, basic skills will be applied.)

A new nurse is learning about the nurse's role in a disaster as part of her orientation. Which statement about the nurse's role in a mass casualty incident is accurate? Learning about disasters is nice to know, but not essential. Applying advanced skills out in the field can be very helpful until help arrives. Nurses take a passive role in helping others save lives and fulfill an important obligation. Nurses may have to assume roles in making decisions for the most appropriate treatment of casualties.

c. "In a disaster, extensive resources are not used for one person at the expense of many others." (In a disaster, military-style triage is used; this approach identifies the dead or expectant dead with black tags. This practice helps to maintain the goal of triage, which is doing the most good for the most people. Precious resources are not used for those with overwhelming critical injury or illness, so that they can be allocated to others who have a reasonable expectation of survival. Clients are not "sacrificed." Telling students to move on after identifying the expectant dead belittles their feelings and does not provide an adequate explanation. Clients are not black-tagged to allow volunteers to give comfort care.)

A nurse cares for clients during a community-wide disaster drill. Once of the clients asks, "Why are the individuals with black tags not receiving any care?" How should the nurse respond? a. "To do the greatest good for the greatest number of people, it is necessary to sacrifice some." b. "Not everyone will survive a disaster, so it is best to identify those people early and move on." c. "In a disaster, extensive resources are not used for one person at the expense of many others." d. "With black tags, volunteers can identify those who are dying and can give them comfort care."

"Nontraditional approaches to health care can be beneficial." (Studies demonstrate that some nontraditional therapies are effective. Culturally competent professionals should be knowledgeable about other cultures and beliefs. Many health care facilities are incorporating both Western and nontraditional therapies. The statement "Everyone should conform to the prevailing culture" does not value diversity. The statement "You are right because they may have a negative impact on people's health" is judgmental and prejudicial. Some cultural practices may bring comfort to the client and may be beneficial, and they may not interfere with traditional therapy.)

A nurse hired to work in a metropolitan hospital provides services for a culturally diverse population. One of the nurses on the unit says it is the nurses' responsibility to discourage "these people" from bringing all that "home medicine stuff" to their family members. Which response by the recently hired nurse is most appropriate? "Hospital policies should put a stop to this." "Everyone should conform to the prevailing culture." "Nontraditional approaches to health care can be beneficial." "You are right because they may have a negative impact on people's health."

b. Leadership (The nurse meets the criteria for leadership because the nurse is acting in an informal role, not as part of a managerial structure in an organization. Volunteerism and activism are not defined as management or leadership functions.)

A nurse is volunteering in the community to educate parents to increase the number of children in the school district who are immunized. The nurse oversees the activities of a group of volunteers. Which role best describes the nurse's activity in this situation? a. Management b. Leadership c. Volunteerism d. Activism

b. Guide the patient through a values clarification process to help him make a decision based on his values. c. Provide information the patient needs to help him make an informed decision. d. Ask for his permission to contact the kidney donation team to answer any questions he may have. (Encouraging the patient to make a decision based on his personal values, providing necessary information, and offering consultation with individuals most familiar with the kidney donation process are all excellent interventions. It would be impossible to predict whether a patient will need dialysis in the future, making this type of statement misleading.)

A nurse is working with a 35-year-old patient who needs to decide whether to donate a kidney to his brother who has been in renal failure for 5 years. The patient shares with the nurse that the decision is especially difficult because he would not be able to continue to work in his current profession and would be unable to support his three small children if he ever needed dialysis. Which intervention(s) would be most appropriate for the nurse to implement in this situation? (Select all that apply.) a. Explain that it is unlikely that he will ever need dialysis even if he has only one kidney. b. Guide the patient through a values clarification process to help him make a decision based on his values. c. Provide information the patient needs to help him make an informed decision. d. Ask for his permission to contact the kidney donation team to answer any questions he may have.

Calling the team for a brief meeting (Communication is a very important aspect of any leader. Solving a client care-related issue such as increasing incidences of urinary tract infections may require discussion with team and input form the team members to arrive at any decision. Therefore a face-to-face meeting with the team would be the best communication practice. Texting or sending emails to the team members would not facilitate feedback. Addressing all the nursing staff of the facility would not be needed, as the issue is limited to the surgical unit.)

A nurse manager in a surgical unit finds that many clients are developing urinary tract infections post-operatively and wants to discuss the measures to prevent it with the team. Which action of the nurse manager reflects good communication practice? Calling the team for a brief meeting Texting every team member about the problem Sending a detailed email about preventive measures Requesting the nursing supervisor for a seminar to address all the nursing staff

b. Democratic (The nurse manager fits the description of the democratic style because the staff members have input into the solution of the problem. A bureaucratic manager develops policies and procedures to follow or reinforces existing policies and procedures. A laissez-faire manager presents the problem to the employees, but rather than offering a plan for addressing it, he or she asks employees to solve the problem on their own. An autocratic manager uses the threat of punishment or promise of rewards to solve the problem.)

A nurse manager is trying to improve patient satisfaction ratings for her area of responsibility. The manager meets with the staff and forms an ad hoc committee to address the issues around the problem. This is an example of what style of leadership? a. Bureaucratic b. Democratic c. Laissez-faire d. Autocratic

Beneficence (According to ethical principles, beneficence states that the actions one takes should promote good; it is the basic obligation to assist others. Therefore, by employing this principle, the nurse manager as a leader is encouraging employees to seek more challenges in clinical experiences and to take on additional responsibilities. Fidelity means fulfilling the promises or commitments made to others. Autonomy is the activity of addressing personal freedom and self-determination. Paternalism may be used to assist people in making decisions when they do not have sufficient data or expertise.)

A nurse manager promotes a staff nurse to assistant manager of the medical unit as the staff nurse had expressed interest in taking on more responsibilities. Which type of ethical principle is exhibited by the nurse manager by this activity? Fidelity Autonomy Paternalism Beneficence

c. Integrity (Integrity refers to the alignment of stated values and actions. Dedication is the ability to spend the time to accomplish the task. Magnanimity means giving credit where credit is due. Humility is the ability to recognize that no one person is superior to another.)

A nurse states she believes in the dignity of each patient. At break, she is overheard talking about a patient in a persistent vegetative state as a "lump." This represents an inconsistency in which quality of an effective leader? a. Dedication b. Magnanimity c. Integrity d. Humility

a. A 35-year-old female with severe chest pain: red tag d. A 60-year-old male with an open fracture with distal pulses: yellow tag (Red-tagged clients need immediate care due to life-threatening injuries. A client with severe chest pain would receive a red tag. Yellow-tagged clients have major injuries that should be treated within 30 minutes to 2 hours. A client with an open fracture with distal pulses would receive a yellow tag. The client with full-thickness body burns would receive a black tag. The client with a scalp laceration would receive a green tag, and the client with shortness of breath would receive a red tag.)

A nurse triages clients arriving at the hospital after a mass casualty. Which clients are correctly classified? (Select all that apply.) a. A 35-year-old female with severe chest pain: red tag b. A 42-year-old male with full-thickness body burns: green tag c. A 55-year-old female with a scalp laceration: black tag d. A 60-year-old male with an open fracture with distal pulses: yellow tag e. An 88-year-old male with shortness of breath and chest bruises: green tag

"I cannot afford expensive medications because I have to take care of my family." (When a client states that he or she cannot afford expensive medications because he/she has to take care of a big family, this statement is an example of a socioeconomic influence on health beliefs. When a client says that he or she is a vegetarian and cannot eat meat because of this tradition, this statement is an example of the influence of cultural background on health beliefs. When a client says that his or her family members always pray before a meal, this statement is an example of the influence of family practices. When a client says that he or she believes that infant vaccinations are sinful, this statement is an example of spiritual factors influencing health beliefs and practices.)

A nurse understands that the effects of different variables on client's health beliefs and practices can help healthcare providers to plan and deliver individualized care. Which statement made by the client is a socioeconomic influence on the client's health beliefs? "I am a vegetarian; I cannot eat meat because it is against my tradition." "I cannot afford expensive medications because I have to take care of my family." "My family members always pray before a meal because it is important to thank God." "I believe that giving vaccinations to infants is sinful."

a. The Medical Reserve Corps (The Medical Reserve Corps (MRC) consists of volunteer medical and public health care professionals who support the community during times of need. They may help staff hospitals, establish first aid stations or special needs shelters, or set up acute care centers in the community. The National Guard often performs search and rescue operations and law enforcement. The health department focuses on communicable disease tracking, treatment, and prevention. A Disaster Medical Assistance Team is deployed to a disaster area for up to 72 hours, providing many types of relief services.)

A nurse wants to become involved in community disaster preparedness and is interested in helping set up and staff first aid stations or community acute care centers in the event of a disaster. Which organization is the best fit for this nurse's interests? a. The Medical Reserve Corps b. The National Guard c. The health department d. A Disaster Medical Assistance Team

c. Providing more appropriate supervision of the UAP (Supervision is one of the five rights of delegation and includes directing, evaluating, and following up on delegated tasks. The nurse should either have asked the UAP about the vital signs or instructed the UAP to report them right away. An experienced UAP should know how to take vital signs and the nurse should not have to assess this at this point. Double-checking the work defeats the purpose of delegation. Vital signs are within the scope of practice for a UAP and are permissible to delegate. The only appropriate answer is that the nurse did not provide adequate instruction to the UAP.)

A nurse working on a cardiac unit delegated taking vital signs to an experienced unlicensed assistive personnel (UAP). Four hours later, the nurse notes the client's blood pressure is much higher than previous readings, and the client's mental status has changed. What action by the nurse would most likely have prevented this negative outcome? a. Determining if the UAP knew how to take blood pressure b. Double-checking the UAP by taking another blood pressure c. Providing more appropriate supervision of the UAP d. Taking the blood pressure instead of delegating the task

"Understand the client's cultural beliefs, values, and practices to determine their specific needs and interventions." (The nurse should understand the client's cultural beliefs, values, and practices to determine their specific needs and interventions to provide competent care for vulnerable populations. The nurse should learn about the culture of the clients to understand cultural practices and values that influence their health care practices. The nurse should not provide financial and legal advice to the clients as clients should be connected with someone qualified to help them. The nurse should refrain from evaluating client's beliefs and values about health in terms of the nurse's own culture, beliefs, and values to provide competent care to vulnerable populations.)

A nursing student is listing the steps that need to be followed to provide competent care for vulnerable populations. Which point listed by the nursing student is accurate? "Refrain from giving priority to cultural practices and values of the vulnerable populations." "Provide financial and legal advice to the vulnerable people as this may be more important to them." "Evaluate client's beliefs and values about health in terms of the nurse's own culture, beliefs, and values." "Understand the client's cultural beliefs, values, and practices to determine their specific needs and interventions."

Taking routine vital signs Answering clients' call lights Changing linens on an occupied bed (Taking routine vital signs is a universal activity that all healthcare workers are taught to perform regardless of the setting; it is within the job description for unlicensed health care workers. Answering call lights is a universal activity that all unlicensed healthcare workers are taught to perform regardless of the setting; it is within the job description for unlicensed healthcare workers. Making an occupied bed is a universal activity that all unlicensed healthcare workers are taught to perform regardless of the setting; it is within the job description for unlicensed healthcare workers. Unlicensed health care workers do not have the expertise or credentials to apply sterile dressings. Unlicensed healthcare workers do not have the expertise or credentials to administer intravenous solutions. Registered nurses are not permitted to delegate assessment.)

A nursing supervisor sends an unlicensed healthcare worker to help relieve the burden of care on a short-staffed medical-surgical unit. Which tasks can be delegated to the health care worker? Select all that apply. Taking routine vital signs Applying a sterile dressing Answering clients' call lights Administering saline infusions Changing linens on an occupied bed Assessing client responses to ambulation

"Be certain to use mouthwash containing sodium bicarbonate with the client." (Since the RN is accountable for the work of the UAP, she or he is giving instructions to the UAP before delegating the task. Sodium bicarbonate is slightly alkaline in nature and is soothing to the client. Alcohol will cause burning and aggravate ulcers, and is therefore contraindicated in clients with stomatitis. The oral cavity should be rinsed with sodium bicarbonate solution once every 2 to 3 hours. Sodium lauryl sulfate should be avoided as it is associated with the risk of stomatitis.)

A registered nurse (RN) delegates the task of oral care of a client with stomatitis, to an unlicensed assistive personnel (UAP). Which instruction should be given by the RN to the UAP? "Use a mouthwash containing alcohol with the client." "Teach the client to rinse the mouth once every 4 to 5 hours." "Avoid using toothpaste containing sodium lauryl sulfate with the client." "Be certain to use mouthwash containing sodium bicarbonate with the client."

Right circumstance (Questions such as, "Is the environment conducive to completing the task safely?" and, "Are the equipment and resources available to complete the task?" ensure the right circumstance for delegation. Right task is ensured with a question such as, "Is the task appropriate to the delegate, according to institutional policies and procedures?" Delegation is taking the right direction if the answer to a question such as, "Do the delegator and delegatee understand a common work-related language?" is positive. Right supervision is evaluated with a question such as, "Is the delegator able to monitor and evaluate the client appropriately?")

A registered nurse delegates a task to a licensed practical nurse (LPN). The nurse manager asks the registered nurse, "Are the equipment and resources available for the LPN to complete the task?" Which right of delegation is the nurse manager preserving? Right task Right direction Right supervision Right circumstance

Lack of health insurance (Health insurance is the most significant contributing factor to poor quality of care. Uninsured people are less likely to get adequate care for disease prevention (e.g., cancer screening, dental care, counseling about diet and exercise, and flu vaccination) and/or for disease management (e.g., diabetes care management) and more likely to visit the emergency department and be admitted to the hospital for ambulatory care-sensitive conditions. Many racial/ethnic, low socioeconomic status, and other minority groups lack adequate health insurance compared with their counterparts. For example, Hispanics and non-Hispanic African Americans have substantially higher uninsured rates, compared with Asian/Pacific Islanders and non-Hispanic whites. Also, minorities are disproportionately enrolled in lower-cost health plans that place greater per-patient limits on health care expenditures and available services.)

A student nurse demonstrates effective understanding of health disparities when stating that which disparity is the most significant contributing factor to poor quality of care? Language barrier Lack of transportation Lack of health insurance Provider-patient communication

c. Ask the nurse about the patient's personal history assessment data (The colleague should first ask the nurse to share information about the patient's background. This should encourage the nurse to consider the feelings and values of the patient and hopefully help the nurse to view the patient as a total individual. Ignoring the statement, offering to change assignments, or challenging the nurse's statement does not promote an enhanced nurse-patient relationship and may prevent the nurse from professional growth or make the nurse defensive.)

After admitting a homeless patient to the floor, the nurse tells a colleague that "homeless people are too dumb to understand instructions." What action should the colleague take first? a. Ignore the nurse's prejudicial comment without responding b. Offer to trade assignments and care for the homeless patient c. Ask the nurse about the patient's personal history assessment data d. Challenge the nurse's thinking, pointing out the ability of all people

Ethnocentrism (Ethnocentrism is the tendency of a person to hold his or her own beliefs superior to those of other people. It causes biases and prejudices in regard to people from other groups. This practice is transmitted by cultural groups from one generation to another. In multiculturalism, two cultures coexist and are accepted by the individual. In a cultural encounter, part of cultural competence, a nurse engages in cross-cultural interactions for effective communication. Cultural imposition occurs when a nurse or health care provider ignores the differences between his or her own culture and others and imposes his or her beliefs on people of other cultures.)

An African man presents to the emergency department to obtain pain medication. The nurse behaves judgmentally and labels the client a drug abuser. What is the nurse demonstrating? Ethnocentrism Multiculturalism Cultural encounter Cultural imposition

b. Stereotype (The patient's brother is making a generalization that is a stereotype, which is a belief about a person, group, or an event that is thought to be typical of all others in that group. Although it is true that people occasionally die during surgery, it does not always happen as the brother fears. Distress is incorrect; the male is distressed, but distress is not a higher-order belief. Prejudice is incorrect because a prejudicial belief is a preformed opinion, usually an unfavorable one, about an entire group of people based on insufficient knowledge. Denial is wrong because he is not in denial, which is defined as a behavior of refusing to admit something is true.)

As the nurse explained the preoperative instructions to the patient, the patient's older brother suddenly stepped into the doorway and yelled, "People who go under the knife always die. Don't do it! They're going to kill you." What type of higher-order belief is the patient's older brother displaying? a. Distress b. Stereotype c. Prejudice d. Denial

Beneficence involves taking positive actions to help other,s whereas nonmaleficence is the avoidance of harm or hurt. (Beneficence is the act of taking positive actions to help others; nonmaleficence is the avoidance of harm or hurt. Justice refers to fairness; fidelity refers to the agreement to keep promises. Both beneficence and nonmaleficence stand for all healthcare professionals. Advocacy refers to the support of a particular cause; responsibility refers to a willingness to respect one's professional obligations.)

How is the term "beneficence" in health ethics different from "nonmaleficence"? Beneficence refers to fairness, whereas nonmaleficence refers to the agreement to keep promises. Beneficence involves taking positive actions to help other,s whereas nonmaleficence is the avoidance of harm or hurt. Beneficence stands for all health care professionals, whereas nonmaleficence stands for nursing professionals. Beneficence refers to the support of a particular cause, whereas nonmaleficence refers to a willingness to respect one's professional obligations.

By providing care that fits the clients' cultural beliefs (When providing care to clients from different cultural backgrounds, nurses should be careful to provide care that fits the client's cultural beliefs. It helps provide effective nursing care to the satisfaction of the client. Advising clients against their cultural practices may offend them and should be avoided. Organization policies should be made flexible to incorporate cultural aspects of care. Ignoring the cultural aspect of client care may result in ineffective nursing care.)

How should nurses provide effective nursing care to clients from different cultural backgrounds? By advising clients that some cultural practices may be harmful to health By providing care that fits the clients' cultural beliefs By strictly adhering to organization policies regarding nursing care By ignoring the cultural aspect and focusing on the medical aspect of care

b. Ask the patient to explain what he believes. (The purpose of the question is contained in the stem, to determine whether the student can distinguish between a belief and a value. By asking the patient to explain what he or she believes, the nurse is asking an open-ended question to find out what part of what the nurse is saying the patient believes and what part he or she does not believe. Asking the patient to explain his or her values is incorrect because there is no mention in the stem about the patient saying his or her values are different from what the nurse is trying to say. Asking the patient about his or her prejudicial attitude is incorrect because there is nothing in the stem that indicates a prejudicial attitude. Confronting the patient about the values conflict he or she is experiencing is incorrect because there is nothing in the stem that indicates the patient is experiencing a values conflict. He or she simply does not believe the same thing the nurse believes.)

Nurses need to understand how beliefs and values are different. A nurse begins to offer information to a patient and the patient says, "I've already heard all of that before and I don't agree with any of it." How should the nurse proceed? a. Ask the patient to explain his values. b. Ask the patient to explain what he believes. c. Ask the patient about his prejudicial attitude. d. Confront the patient about the values conflict he's experiencing.

b. Demonstration of respect for all individuals with whom the student interacts c. Avoidance of behavior that shows disregard for the effect of those actions on others d. Accepting responsibility for resolving conflicts in a professional manner (Nursing students are expected to demonstrate respect, avoid hurting others by their actions, and take responsibility for resolving conflicts in a professional manner, much the same as professional nurses. Student nurses are not required to perform clinical skills at the level of expertise exhibited by an experienced nurse. Involving a patient's family in care without the patient's approval indicates a lack of respect for patient autonomy.)

Nursing students are held to which standard by the Code of Ethics for Nurses? (Select all that apply.) a. Clinical skills performance equal to that of an experienced nurse b. Demonstration of respect for all individuals with whom the student interacts c. Avoidance of behavior that shows disregard for the effect of those actions on others d. Accepting responsibility for resolving conflicts in a professional manner e. Incorporating families in patient care regardless of patient preference

Client who is unconscious with massive aortic bleeding from the chest (The client who is unconscious and has massive aortic bleeding is unlikely to survive and would be "black-tagged" and assigned to a UAP for comfort. The client with rib fractures and dyspnea, the client with chest pain, and the client with a femoral fracture with palpable pulses are likely to survive and would not be delegated to licensed staff members.)

The emergency department charge nurse is making client assignments and delegating care after a mass casualty event. Which of these clients could be delegated to an unlicensed assistive personnel (UAP)? Client who has multiple left rib fractures and reports dyspnea Client who reports severe left anterior chest pain Client who has a femoral fracture with palpable distal pulses Client who is unconscious with massive aortic bleeding from the chest

Assessing the respirations (Respiratory therapy is needed in clients who undergo surgery for lung cancer. Assessing respiration can be safely delegated to the respiratory therapist. Placing a Foley catheter, an IV catheter, or administering patient-controlled analgesia is within the scope of a registered nurse's practice.)

The healthcare team is caring for a client who has undergone surgery for lung cancer. The client needs respiratory therapy. Which task can be safely delegated to a respiratory therapist paired with a registered nurse? Placing a Foley catheter Assessing the respirations Placing an intravenous (IV) catheter Administering patient-controlled analgesia

Structural-constructivist (The structural-constructivist model is based on an assumption of dual nature of human existence. The model adopts a constructivist perspective that the reality of life is based on a mental representation constructed socially shared understandings within a society. This perspective/model strongly supports the idea of social and cultural construction of race/ethnicity that frequently results in health disparities observed in health care systems and gives direction for nursing research and practice in understanding health disparities in clinical settings and community settings.)

The nurse conducting research on health disparities applies the idea that the reality of life is based on a mental representation developed from socially shared understandings within a society. Which theoretical framework model is the nurse using? Cultural competence Structural-constructivist Cultural awareness Cultural proficiency

Advocating on behalf of the client (The public depends on the nurse leaders to move forward the consumer advocacy agenda. Therefore as a leader, the nurse should advocate on behalf of the client. Discussing the client's problem with another nurse does not indicate leadership quality. Arranging a permanent accommodation and suggesting long-term healthcare facility for the client does not indicate leadership; instead it keeps the client in emotional distress.)

The nurse finds that an 80-year-old client's family is not caring for the client properly. Which action of the nurse indicates leadership quality? Advocating on behalf of the client Discussing the client's problem with the other nurse Arranging a permanent accommodation in the hospital Suggesting the family join the client in a long-term healthcare facility

RR 28, O₂ 70 (Client B should be given priority care as the client's respiratory rate is high and the client's O₂ is very low at 70%. The client requires immediate treatment. A normal respiratory rate is 12-20. A normal O₂ is 92-100%. Client A has normal vital signs and respiratory rate, so care is not required. Client C's respiratory rate is normal at 14 breaths/minute and blood pressure is normal at 140/86, and does not require an immediate intervention. Client D has normal vital signs and the O₂ sat of 90% is a bit lower than the normal sat, but this could be a normal range for this client. Also, clients with COPD have lower than normal O₂ sats below 92%.)

The nurse obtained vital signs from 4 different clients. Which client should the nurse care for first? RR 16, BP 128/62 RR 28, O₂ 70 RR 14, BP 140/86 RR 20, O₂ 90

Green tag (During a mass casualty event, nonurgent patients with minor injuries who do not require immediate treatment are given a green tag. The patients with an immediate threat to life are given a red tag. The patients who are expected to die are given a black tag. The patients with major injuries who require treatment without significant delay are given a yellow tag.)

The nurse should apply which color tag to nonurgent patients during a mass casualty event? Red tag Black tag Green tag Yellow tag

b. Ask the patient's mother to explain what she believes about smoking and asthma. (The nurse should begin by asking the mother what she believes because the nurse does not know at this point. When working with a patient who has an addiction, the nurse should begin at the assessment phase of the nursing process and attempt to build a trusting relationship with the patient. Asking the mother what she values more, her child or her habit, is incorrect because the issue is not about the mother's values but about what she knows and what she believes. Asking the mother about her prejudicial attitude toward smoking is incorrect because there is nothing in the stem to indicate the mother is prejudiced toward or against smoking. Confronting the mother about the values conflict she is experiencing is incorrect because there is nothing in the question to indicate the mother is having a values conflict. She may not believe what the health care professionals are telling her or she may not believe that she can quit smoking. She may need to be convinced that she can do it, and the best way to make that happen is to build a trusting relationship with her rather than alienate her with accusatory remarks.)

The nurse in the emergency department is caring for an 8-year-old who has had a serious asthma attack. When the nurse attempts to explain the problem to the child's mother, she smells cigarette smoke on the mother's breath. The nurse asks the mother if she has been smoking and the mother responds, "Yes, and I know they've told me before I can't smoke around him." What should the nurse do next? a. Ask the patient's mother what she values more, her child or her habit. b. Ask the patient's mother to explain what she believes about smoking and asthma. c. Ask the patient's mother about her prejudicial attitude toward smoking. d. Confront the patient's mother about the values conflict she's experiencing.

Delegation (Delegation is the process of transferring the authority to perform a selected task or activity to a competent person, like assigning unlicensed assistive personnel the task of helping a patient turn. Supervision is guidance or direction, evaluation, and follow-up to ensure the task or activity assigned to the nursing assistive personnel is appropriately performed. Collaboration entails planning, implementing, and evaluating patient care together using an interdisciplinary plan of care. Quality improvement is achieved using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.)

The nurse instructs unlicensed personnel to help the postoperative patient in turning and positioning. Which leadership action does this constitute? Delegation Supervision Collaboration Quality improvement

Arranging group discussion (Many hospitals and DMATs have a critical incident stress management unit, which arranges group discussions to allow participants to share and validate their feelings and emotions about the experience. This is important for emotional recovery. The nurse does not administer antianxiety medications to the participants, schedule individual therapy appointments, or document individual responses to the group session.)

The nurse is a member of the critical incident stress management unit that looks to meet the psychosocial needs of first responders after a mass casualty incident. Which action by the nurse is appropriate when conducting a session? Arranging group discussion Administering antianxiety medication Scheduling individual therapy appointments Documenting individual responses to the session

Age and gender (The health disparities that are unavoidable and acceptable should not be a concern for nurses. For example, in an emergency room, nurses could observe health disparities in emergency visits by age; in general, older people make more emergency visits compared with younger people. In this situation, age becomes a determinant of the disparity, and aging is unavoidable and acceptable. Gender is also unavoidable and acceptable. Alcohol use is avoidable. Diabetes and hypertension may be avoidable conditions dependent on the patient's lifestyle and diet choices.)

The nurse is caring for a Hispanic older adult in the emergency department who is intoxicated and was found unconscious on the ground outside of a local restaurant. The patient has a medical alert bracelet listing diabetes, hypertension, and epilepsy. Which health disparities in this patient does the nurse identify as unavoidable and acceptable? Alcohol use and ethnicity Diabetes and age Hypertension and gender Age and gender

Stabilize cervical spine. (A client with a head injury may suffer shortness of breath. Therefore the client's cervical spine should be stabilized immediately to maintain the airway. The client should be intubated if the Glasgow Coma Scale score is less than 8. Oxygen should be administered after stabilizing the cervical spine of the client. External bleeding should be controlled after ensuring a patent airway.)

The nurse is caring for a client with a head injury. The Glasgow Coma Scale score of the client is 9. Which nursing intervention should be performed in the client immediately? Intubate the client. Stabilize cervical spine. Administer oxygen via a nonrebreather mask. Control external bleeding with a sterile pressure dressing.

Using open-ended questions Avoiding prolonged eye contact Phrasing questions in a neutral manner (Open-ended questions should be used as frequently as possible during a health history interview. This is especially important for a family of Asian descent who tend to answer "yes" or anticipate the answer the nurse wants to hear. Direct or prolonged eye contact is often seen as a sign of disrespect when assessing a family of Asian descent. Phrasing questions in a neutral manner decreases the risk of the family anticipating the answer the nurse wants to hear, which often occurs for clients of Asian descent. Since the family speaks fluent English, there is no need to engage the services of an interpreter unless the family requests it. If an interpreter was used, the nurse would direct the questions directly to the family. One question should be asked at a time during the assessment process.)

The nurse is providing care to a preschool-age client of Asian descent during a scheduled health maintenance visit. The family speaks fluent English. Which assessment strategies should the nurse implement with the child and family based on the current data? Select all that apply. Using open-ended questions Avoiding prolonged eye contact Phrasing questions in a neutral manner Asking all questions directly to the interpreter Asking several questions for time management purposes

Unsatisfying, low-paying job Frequent smoker Recently divorced African-American male (Determinants of health disparities can assist the nurse in identifying patients at risk. Exposure to stressful living, such as financial insecurity due to a low paying job, is a risk factor for health disparity. Smoking is an example of an unhealthy behavior that is chosen. Being recently divorced places the patient at risk due to high stress. Natural, biological variations such as being African-American can be risk factors as African- Americans are more prone to hypertension. Lack of health insurance is a disparity; but comprehensive health insurance is a positive attribute leading to improved health.)

The nurse should identify which potential health disparities when conducting an admission assessment on a hospitalized patient? Select all that apply. Unsatisfying, low-paying job Frequent smoker Comprehensive health insurance Recently divorced African-American male

Cardiac arrest, unstable (The condition of client B suffering from cardiac dysrhythmias is unstable, which indicates a life-threatening complication. Therefore client B should be provided with immediate treatment. An overdose with bradypnea is also a life-threatening complication, but the condition of client A is stable. Client C is categorized as second priority of care. Client D, suffering with a hip fracture, can have delayed treatment for 1 hour because it is not a life-threatening complication.)

The registered nurse is caring for four different clients in a healthcare facility. Which client should be given first priority of care? Overdose with bradypnea, stable Cardiac arrest, unstable Chest pain due to ischemia, unstable Hip fracture, stable

Severe malarial fever, monitor temperature hourly (The unlicensed assistive personnel (UAP) can monitor the temperature of client B every hour. Discharges from the surgical site of client A should be monitored, but the UAP may not have appropriate knowledge. Abdominal pain should be monitored in client C, but the UAP is not qualified to understand the condition of the client. Respiratory rate cannot be monitored by the UAP as it is the responsibility of the more qualified UNP.)

The registered nurse is delegating a task for unlicensed assistive personnel l (UAP). Which client's care would be suitable for delegation to the UAP? Surgical removal of anal fistula and hospitalized, monitor for discharges from fistula site Severe malarial fever, monitor temperature hourly Underwent appendectomy and hospitalized, monitor for abdominal pain Respiratory infections, monitoring respiratory rate

a. Right person b. Right circumstance d. Right supervision (The nurse is demonstrating all of the rights of delegation. Right time and right patient are not part of the Five Rights of Delegation. They are a part of the Rights of Medication Administration. The Five Rights of Delegation are: 1. Right task 2. Right person 3. Right circumstance 4. Right communication 5. Right supervision)

The registered nurse on an inpatient medical unit delegates vital signs and morning care to the unlicensed assistive personnel (UAP) for five stable patients. The nurse asks the UAP to document the vital signs and report any abnormal results immediately. Which rights of delegation is the nurse demonstrating? (Select all that apply.) a. Right person b. Right circumstance c. Right time d. Right supervision e. Right patient

d. Follow the administration and documentation procedures for medication errors. (Agency procedures must be followed after every medication error. Care must be taken to adhere to medication administration recommendations and documentation requirements to legally record the incident and provide patient safety. Documenting that the patient refused or already took the medication, when that is not factual, is illegal and unethical, regardless of the patient's condition. Administering the medication as soon as the error is discovered may not be recommended, depending on the medication's potency and frequency of administration.)

What action should nurses who demonstrate accountability take if they forget to administer a patient's medication at the ordered time? a. Document the medication as refused by the patient. b. Administer the medication as soon as the error is discovered. c. Record the medication as given after making sure the patient is okay. d. Follow the administration and documentation procedures for medication errors.

Encouraging the direct care nurses to provide input into decisions Ensuring that day-to-day activities of the staff are correctly planned and executed (The nurse leader should encourage the direct care nurses to provide input into the decisions being made. A proper plan should be executed by the nurse leader that ensures day-to-day activities of the staff are correctly planned and executed. A nurse manager has financial accountability. The process of selection, recruitment, and orientation of employees requires the attention of a nurse manager. The nurse leader may identify charge nurses who have a potential to become managers, but this is not one of the direct responsibilities of the nurse leader.)

What are the responsibilities of the nurse as a leader? Select all that apply. Being accountable for financial matters Encouraging the direct care nurses to provide input into decisions Identifying charge nurses who have a potential to become managers Being responsible for the selection, hiring, and orientation of employees Ensuring that day-to-day activities of the staff are correctly planned and executed

The nurse should be aware of his or her own cultural values and behavior patterns. The nurse should focus on understanding the client's traditions, values, and beliefs. The nurse should understand that unique cultural perceptions exist regarding health practices. (Nurses should be aware of their own cultural values and behavior patterns. This awareness enables them to understand a client's values and beliefs. Nurses should focus on understanding the client's traditions, values, and beliefs and the manner in which these aspects influence his or her health, wellness, and illness. When educating clients about their health issues and treatment plans, nurses should understand that unique perceptions exist about the cause of an illness and its treatment. A nurse should never stereotype clients on the basis of their cultural background and assume that they strictly adhere to cultural traditions and practices. A nurse should understand that the cultural background of a client also influences the nurse-client relationship.)

What points should a nurse keep in mind when caring for a client who belongs to a different culture? Select all that apply. The nurse should be aware of his or her own cultural values and behavior patterns. The nurse should focus on understanding the client's traditions, values, and beliefs. The nurse should understand that unique cultural perceptions exist regarding health practices. The nurse should know that every client strictly adheres to his or her cultural beliefs and traditions. The nurse should know that a client's cultural background does not influence the nurse-client relationship.

Supervision (Supervision is guidance or direction, evaluation, and follow-up to ensure the task or activity assigned to the unlicensed assistive personnel is performed appropriately. Delegation is the process of making that assignment. Collaboration entails planning, implementing, and evaluating patient care together using an interdisciplinary plan of care. Quality improvement is achieved by using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.)

When assigning a task to unlicensed assistive personnel, which process will the nurse undertake to ensure the task is performed appropriately? Delegation Supervision Collaboration Quality improvement

Chronosystem (The social-ecological model aims to explain dynamic interrelations among various personal and environmental factors. The chronosystem could be either external or internal. For instance, the timing of a family member's death could be an external chronosystem, and physiological changes due to aging could be an internal chronosystem. The mesosystem is beyond the dyad or two-party relation, and link over two systems that a person lives. Also, mesosystems link the structures of the person's microsystem. This model basically evolved from the ecological systems theory of child development proposing five socially organized subsystems related to human development: microsystem, mesosystem, exosystem, macrosystem, and chronosystem.)

When utilizing the social-ecological model, the nurse classifies physiological effects of aging within which system? Microsystem Mesosystem Chronosystem Exosystem

b. Sharing with unlicensed assistive personnel that typically Muslim patients do not eat pork (Muslims typically do not consume pork products. This generalization would be helpful to use as a baseline for caring for Muslim patients. It is always important, however, for nurses to ask patients to verify whether they adhere to cultural norms. Same-gender nurses need not be assigned to all patients. Making broad statements that are unkind regarding people of one culture is stereotyping and hurtful. The Amish, not Asians, typically share responsibility for medical bills.)

Which action taken by a nurse would reflect application of an appropriate generalization in a patient care setting? a. Assigning same-gender nurses to all patients admitted to the unit b. Sharing with unlicensed assistive personnel that typically Muslim patients do not eat pork c. Telling the radiology technician that every Latino family is late for appointments d. Assuming that Asians share financial responsibility for medical bills

Green (An emergency triage system uses colored tags to designate both the seriousness of the injury and the likelihood of survival. Green would be used for minor injuries such as the victim who is able to ambulate independently. Red indicates life-threatening injuries requiring immediate attention. Black indicates that the victim is expected to die. Yellow indicates urgent but not life-threatening injuries.)

Which color should the nurse use to triage a victim of a train derailment who is able to walk independently to the first aid station? Black Red Yellow Green

Strains Abrasions (A green tag is issued for clients who are nonurgent or classified under class III. Strains and abrasions are considered minor injuries and nonurgent. Walking wounded clients with minor injuries are triaged under this category. Clients with open fractures and who can wait some time for care are issued yellow tags and triaged under class II. Clients with airway obstruction are issued red tags and triaged under class I. Clients with high cervical spinal cord injury are issued black tagsas they are expected to die and are categorized under class IV.)

Which conditions are given a green tag according to triage disaster tag system? Select all that apply. Strains Abrasions Open fractures Airway obstruction High cervical spinal cord injury

Feeding a client whose hands are affected by rheumatoid arthritis (Although all of these actions may sometimes be delegated to UAPs, the client with rheumatoid arthritis is the most stable of the clients described here. The client who needs an increase in oxygen, the client who just underwent hip surgery, and the client with chest pain have clinical manifestations that indicate a need for assessment or intervention by licensed nursing personnel, who have broader education and scope of practice than do UAPs.)

Which nursing activity is best for the charge nurse on the medical-surgical unit to delegate to staff members who are unlicensed assistive personnel (UAPs)? Feeding a client whose hands are affected by rheumatoid arthritis Increasing the oxygen flow rate for a client who has wheezes Positioning a client who has just returned from hip surgery Taking vital signs for a client who is having acute chest pain

c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain (Advocacy requires a nurse to work on behalf of others who may be unable to speak for themselves. When a patient is in pain and the physician or primary care provider is not present, a nurse must advocate for the patient's needs by initiating contact with the person responsible for addressing an immediate need. In this case, an order for additional pain medication is needed, which requires collaboration with the patient's physician. Collecting blood samples, assessing vital signs, and assisting a patient with ambulation are primary responsibilities of the nurse that do not require advocacy to meet the patient's need.)

Which nursing intervention is the best example of patient advocacy? a. Collecting blood samples according to the physician's order each morning b. Assessing the vital signs of a patient who is receiving a blood transfusion c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain d. Accompanying an ambulating patient who is walking for the first time after undergoing surgery

The nurse should keep the client adequately hydrated. (The best practice of the nurse to improve perfusion of the wound to promote healing for an older client after surgery is to keep the client adequately hydrated. The nurse should minimize the use of tape on the skin to protect the fragile skin of the client. The nurse should also change the dressing as soon as they get wet during the protection of fragile skin. The nurse should provide rest to the client throughout the day to conserve the energy required for healing.)

Which of the following nursing interventions promotes perfusion and healing of the surgical wound for an older adult? The nurse should minimize the use of tape on the skin. The nurse should keep the client adequately hydrated. The nurse should change the dressings as soon as they get wet. The nurse should provide rest for the client throughout the day.

c. Throughout life from first-hand experiences and information provided by authority figures (Individuals develop first-order beliefs beginning in childhood and continue to acquire them throughout life from first-hand experiences and what they are told by various authority figures. Therefore, first-order beliefs are acquired throughout life and not just in infancy, the first years of life, or adolescence. They form as the result of life experiences and from information provided by people perceived as having authority.)

Which statement best describes for new parents how and when children develop first-order beliefs? a. During infancy, and once developed, such beliefs seldom change b. From life experiences during the toddler and preschool years c. Throughout life from first-hand experiences and information provided by authority figures d. From teen and young-adult peer interaction and mentorship of professional role models

a. The emergency room manager takes a vote on holiday coverage and then responds to a Code Blue by directing orders at the nursing staff. (Situational leadership adjusts leadership styles to fit the situation. In the correct option, the manager moved from a democratic to an authoritarian leadership style to fit the change in situation. The manager in surgery follows a bureaucratic style by strictly following policy and procedure. The vice president of nursing is following a laissez-faire style, because responsibility for the decision is abdicated, and he or she does not support the policy when needed. The CEO of the hospital is following an authoritarian style of leadership because input of the staff is not valued.)

Which statement is an example of the use of situational leadership? a. The emergency room manager takes a vote on holiday coverage and then responds to a Code Blue by directing orders at the nursing staff. b. The manager in surgery uses the vacation policy to grant time off and then performs a surgical count in an operating room using a checklist. c. A vice president of nursing allows the department directors to make a decision about a hospital policy on holiday time and then sides with a nurse who does not want to work the required time. d. The CEO of the hospital instructs the nursing senate to develop a dress code and then changes the dress code after determining he does not like it.

c. Nurse leaders rely primarily on interpersonal skills to accomplish goals. (Leaders influence others to effect change. They rely on personal characteristics to convince others that what they envision is worthwhile. Managers get their power from formal positions. Leaders may or may not be in formal positions of authority. Transactional leadership employs reward and punishment to gain the cooperation. Nurse leaders use a variety of leadership and management styles. Nurse managers maintain accountability and responsibility for their decisions.)

Which statement most closely reflects the differences between nurse leaders and managers? a. Nurse leaders are always in formal positions of authority. b. Nurse managers use transactional principles to accomplish goals. c. Nurse leaders rely primarily on interpersonal skills to accomplish goals. d. Nurse managers rely on supervisors for accountability and responsibility.

Positioning the bed (The UAP should be assigned tasks that are simple and do not involve any complications. Positioning the bed at 30 degrees or more is one of the essential tasks that can be assigned to the UAP under supervision. Evaluating vitals is the duty of the registered nurse. Tube feeding the client is a very sensitive procedure that can be done by a registered nurse or trained licensed practical nurse. Determining the calorie needs of the client is the job of a dietician.)

Which task can the registered nurse safely delegate to the unlicensed assistive personnel (UAP) while caring for a client with gastroesophageal reflex disease? Positioning the bed Evaluating the vitals Tube feeding the client Determining calorie needs