EXAM 4 (3)

1. A nurse receives a change-of-shift report at 0700 for an assigned caseload of clients. Number the following clients in the order in which they should be seen. ____A client who has been receiving a blood transfusion since 0400 ____A client who has an every 4 hr PRN analgesic prescription and who last received pain medication at 0430 _____ A client who is scheduled for a colonoscopy at 1130 and whose informed consent needs to be verified _____ A client who needs rapid onset insulin before the breakfast trays arrive ____A client who is being discharged today and needs reinforcement of teaching regarding dressing changes

13425

2. The two CNAs have a history of problems with each other and usually don't work the same shift. Working together today is a fluke. The nurse should: 1.Separate the two and send each to a different area on the unit. 2.Ask them not to talk to each other for the remainder of the shift. 3.Ask questions about what triggered the upset.

3

5. A long-term acute-care hospital adopted an evidence-based protocol to reduce the rate of catheter-associated urinary tract infections. One year after the protocol was adopted with moderate success, a senior staff nurse continues to insist on calling the healthcare provider for an order to insert a urinary catheter. Which of the following characterizes the behavior of this individual in relation to the adoption of innovation? 1.Early adopter 2.Early majority 3.Late majority 4.Laggard

4

The ability of a client to make personal decisions, even when those decisions may not be in the client's own best interest

Autonomy

System of ethical decision-making based on moral rules and unchanging principles

Deontology

Problems for which more than one choice can be made, the choice is influenced by the values and beliefs of the decision-makers

Ethical Dilemma

Keeping one's promise to the client about care that was offered

Fidelity

The nurse's obligation to avoid causing harm to the client

Nonmaleficence

3. A nurse is preparing to initiate IV therapy for a client who has a prescription for morphine 10 mg IV bolus. Using time management principles, which of the following actions should the nurse take first? A. Mentally envision the procedure when collecting supplies. B. Enter the room and perform hand hygiene. C. Eject excessive medication from the prefilled syringe D. Explain the procedure to the client

a

4. A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following outlines the rights of individuals in health care settings? A. American Nurses Association Code of Ethics B. HIPAA C. Patient Self-Determination Act D. Patient Care Partnership

d

2. Being able to think systematically involves: 1. Being able to consider the "Big Picture," beyond the needs of your unit. 2. Considering what nursing tasks need to be completed before the next medication pass. 3. Focusing on the number of patients each nurse is assigned, unrelated to patient acuity. 4.Refusing to come to staff meetings on your day off.

1

3. The nurse educator of the pediatric unit determines that vital signs are frequently not being documented on children returning from surgery. According to total quality improvement (TQI), to correct the problem, the educator, in consultation with the patient care manager, would do which of the following? 1. Talk to the staff individually to determine why this is occurring. 2. Call a meeting of all staff to discuss this issue. 3. Have a group of staff nurses review the established standards of care for postoperative patients. 4. Document which staff members are not recording vital signs and write them up.

3

The fundamental standards of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development

Morals

The ethical system of utility. it is associated with two underlying principles: "the greatest good for the greatest number" and "the end justifies the means"

Utilitarianism

The nurse's duty to tell the truth

Veracity

2. A client is brought back to the unit after a total hip arthroplasty. The client is confused, is moving his leg into positions that could dislocate the new hip joint, and he repeatedly attempts to get out of bed. Which of the following actions should the nurse take? (Select all that apply.) A. Apply arm and leg restraints immediately. B. Get an order from the provider. C. Have a family member sign the consent for restraints. D. Use a square knot to secure the restraints to the bed frame. E. Ensure that only one finger can be inserted between the restraint and the client

ab

2. A nurse is caring for a client who is being prepared for surgery. The client hands the nurse information about advance directives and states, "Here, I don't need this. I am too young to worry about life-sustaining measures and what I want done for me." Which of the following actions should the nurse take? A. Return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time. B. Explain to the client that you never know what can happen during surgery and that he should fill the papers out "just in case." C. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives. D. Inform the client that surgery cannot be conducted unless he completes the advance directives forms.

c

Fair treatment in matters related to physical and psychosocial care and use of resources

Justice

2. A nurse manager wants to highlight the accomplishments of the nurses who are providing high-quality care on a medical unit in a tertiary care medical center. Which of the following is an example of a nurse-sensitive outcome that could be used for this project? 1. Pressure ulcer rate compared to a national benchmark rate 2. Patient satisfaction scores compared to other hospitals 3. Nurse satisfaction scores compared to other hospitals 4. Percentage of patients with heart failure who are prescribed an ACE inhibitor on hospital discharge

1

4. Which of the following describes comparative effectiveness research? 1. A study designed to determine which of three strategies for teaching self-management works best for adolescents diagnosed with type 1 diabetes 2. A meta-analysis that evaluates strategies to prevent delirium in hospitalized patients 3. A qualitative study that examines family members' experience of being allowed to observe procedures being performed on their children 4. Determining whether the implementation of an evidenced-based protocol reduces the rate of catheter-associated bloodstream infection (CLABSI)

1

7. For years, a small community hospital had a wound/ostomy nurse who took all photographs of pressure ulcers and uploaded a picture to the patient's medical record. The nurse retired and now nursing administration is expecting that registered nurses should assume this responsibility. Which of the following should be included in planning to use evidence for this approach? (Select all that apply.) 1.Perform a literature search for the evidence for best practice for taking photographs of pressure ulcers. 2. Include staff members in planning for this policy change. 3. Determine whether the evidence demonstrates that staff nurses are reliable in taking photographs of pressure ulcers. 4.Organize a meeting with nursing administration to recommend that a wound/ostomy nurse be hired. 5.Demonstrate that the literature indicates that taking photographs of pressure ulcers is inappropriate unless the photographer is a wound/ostomy nurse.

123

8. A shared governance council has approved a new protocol for a delirium prevention program that is based on the latest evidence. Which of the following strategies might be included to enhance the effectiveness of this program? (Select all that apply.) 1. Assessment of nurses' attitudes about caring for elderly patients 2.Selecting individuals to serve as protocol champions 3.Disseminating evidence about the protocol in a journal club 4.Using academic detailing or educational outreach visits 5.Distributing education materials on the clinical units 6. Including only the early adopters in planning for the rollout of the program

1234

1. The nurses at a community hospital are selecting research articles to use for the development of a new protocol for the removal of indwelling urinary catheters in surgical patients. This would be characterized as which of the following? 1. Research 2. Review of the literature 3. Evidence-based practice 4. Implementation science

2

1. Which of the following best demonstrates the concept of followership? 1.Completing the tasks associated with your patient assignment without deviation with the intent of receiving praise from your manager 2.Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting 3. Assessing a clinical situation and following a set of guidelines in order to delegate tasks to unlicensed personnel 4. Administering medications to patients in conjunction with other nursing actions in order to make effective use of your time

2

1. Which of the following statements is true? 1.Decision making and problem solving are synonymous. 2.Decision making and problem solving are similar. 3.Although decision making and problem solving are similar, only problem solving requires critical thinking. 4.Although decision making and problem solving are similar, only problem solving can improve the practice of nursing.

2

2. A nurse manager wants to decrease the number of medication errors that occur within her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: 1. Explaining to the staff that disciplinary action will be taken for further errors. 2. Recommending that a multidisciplinary team assess the root cause of the medication errors. 3. Suggesting that the pharmacy department explore their role in the problem. 4.Changing the unit policy to allow a certain number of medication errors per year without penalty.

2

2. There are three types of decision-making style: paternalistic, informative, and shared decision making. A shared decision model has been shown to increase productivity and work performance because: 1. Just like the paternalistic model, it values the input of others and the staff may express and discuss options and preferences. 2.Unlike the paternalistic model, decisions are made through an interactive, deliberate process and the staff may express and discuss options and preferences. 3.It is identical to the informative model. 4. The managers decide what is best for the team since the managers have more experience and have the competency to make decisions for their respective teams.

2

2. When the leader observes the employee has a significant increase in errors and may have some emotional problems, the most appropriate response is: 1.Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. 2. Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. 3. Put the employee on the first steps of disciplinary action.

2

3. Recently, a medical center surveyed its patients who smoked about their desire to quit. A high percentage were "motivated smokers," interested in quitting in the next 30 days, but were not offered resources to help with quitting. The nursing research council at a large medical center wants to introduce an evidence-based protocol for smoking cessation. Which of the following would be an appropriate initial action? 1. Start a journal club to review the protocol. 2. Survey nurses to determine barriers and facilitators to using smoking cessation interventions. 3. Distribute the protocol to all staff nurses. 4. Collaborate with physicians to develop a standard set of orders to be implemented for all patients.

2

3. Susan discovers that the first CNA refused to help her co-worker ambulate a very obese, high-risk pregnant patient to the bathroom. Susan should: 1. Give them a lecture on working together as a team. 2.Ask questions about the safety of the patient. 3.Describe the anger and upset as inappropriate behavior.

2

3. Which of the following statements is true regarding complexity theory? 1.Complexity theory is used to predict the health and illness trajectory of critically ill patients. 2. Nurses can understand the dynamic nature of health care processes using complexity theory. 3.The need for additional staff can be justified based on complexity theory. 4. Complexity theory is used to explain the relationships among leading, managing, and following.

2

1. A new graduate is asked to serve on the hospital's Quality Improvement Committee. The nurse understands that the first step in quality improvement is to: 1. Collect data to determine if standards are met. 2. Implement a plan to correct the problem. 3. Identify the standard. 4. Determine if the findings warrant correction.

3

1. How can a leader deal fairly with employees who fail to meet established standards of care? 1. First, determine if the employee issue is a will or skill issue. 2. Conduct a chart review that reflects the care issue. 3.Ask questions of the employee that can reflect the employee's knowledge base.

3

1. James and Susan are new graduates employed in a small community hospital. They see that practices seem to be very physician driven and that patients have little input into their care. Families are seen as a nuisance rather than as partners in potential care provision. What is the best approach James and Susan might use to improve care in this setting? 1. Do nothing. They are too new to the organization to make change. 2.Share with the physician the recommendations from various IOM reports. 3.Share with their team members what they know about the aims of providing health care. 4.Report the team members to the chief nursing officer who is unlikely to know the lack of details on this unit.

3

1. Susan, a new nurse, discovers two of the certified nursing assistants (CNAs) in the utility room speaking loudly and pointing at each other. The most appropriate action is to: 1.Continue walking down the hall, believing they will work it out. 2. Walk into the utility room and tell them to stop or they will be reported to HR. 3. Make an observation about their behavior and ask what's going on.

3

2. Mr. Grandion was admitted to a rehabilitation center after discharge from a hospital. He has not walked in 5 days while he was hospitalized and is provided a wheelchair. Dining with other residents is expected, and staffing is limited on a holiday weekend. What is the best strategy to be sure Mr. Grandion has sufficient nutrition and exercise? 1. Tell Mr. Grandion to stay in bed and someone will bring a tray to his room because the staff can't get him to the dining room in time for dinner. 2.Assist Mr. Grandion into his wheelchair and remind him that in 2 hours he must be in the dining room if he wished to eat. 3.Request help from another unit before dinner and indicate the nature of help needed. 4. Order a lift device to transfer Mr. Grandion from his bed to the wheelchair.

3

6. Which strategy can be used with nurses who are in the late majority group for the adoption of an evidence-based innovation to increase breast-feeding rates? 1.Seeking and analyzing reviews that demonstrate the effectiveness of breast-feeding 2.Incorporating an assessment of breast-feeding implementation into annual performance reviews 3.Use of informal networks to foster positive attitudes 4. Assigning the late majority nurses to patients who have already been successful with breast-feeding

3

3. Group decision making offers the following advantages and disadvantages: 1. More ideas can be generated by groups and they have a synergistic effect. 2. Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. 3. The time required for making group decisions may not be appropriate, especially in a crisis situation. 4.Groups may be more concerned with maintaining group harmony than engaging in an active discussion on a particular issue. 5. All of the above statements are true.

5

When the leader observes the employee has a significant increase in errors and may have some emotional problems, the most appropriate response is: a. Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. b. Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. c. Put the employee on the first steps of disciplinary action.

b

4. An RN on a medical-surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LPN? A. Obtaining vital signs for a client who is 2 hr postprocedure following a cardiac catheterization B. Administering a unit of packed red blood cells (RBCs) C. Instructing a client in the performance of wound care D. Developing a plan of care for a newly admitted client

a

The care that is in the best interest of the client

Beneficence

4. An assistive personnel (AP) reports that a client's finger-stick blood glucose reading 30 min before lunch is 58 mg/dL. The client's morning finger-stick blood glucose was 285 mg/dL. The client is asymptomatic for hypoglycemia, and his next dose of insulin is scheduled to be administered at this time. Which of the following actions should the nurse take first? A. Recalibrate the glucometer, and recheck the client's blood glucose. B. Have the laboratory draw a stat serum glucose. C. Inform the AP to give the client 120 mL of orange juice. D. Administer insulin as prescribed.

a

8. A nurse witnesses an assistive personnel (AP) under her supervision reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if he 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

9. A nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nurse notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following conflict resolution strategies is the unit manager demonstrating? A. Avoidance B. Smoothing C. Cooperating D. Negotiating

a

1. A nurse manger is observing the actions of a nurse she is supervising. Which of the following actions by the nurse requires the nurse manager to intervene? (Select all that apply.) A. Reviewing the health care record of a client assigned to another nurse B. Making a copy of a client's most current laboratory results for the provider during rounds C. Providing information about a client's condition to hospital clergy D. Discussing a client's condition over the phone with an individual who has provided the client's information code E. Participating in walking rounds that involve the exchange of client-related information outside clients' rooms

abce

Ideals or concepts that give meaning to the individual's life. Values are derived most commonly from societal norms, religion, and family orientation and serve as the framework for making decisions and taking actions in daily life

Values

2. A nurse manager is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following statements should the nurse manager include? (Select all that apply.) A. A description of the incident should be documented in the client's health care record. B. Incident reports should not be shared with the client. C. Incident reports include a description of the incident and actions taken. D. A copy of the incident report should be placed in the client's health care record. E. The risk management department investigates the incident.

abce

5. A nurse on a sixth-floor medical surgical unit is advised that a severe weather alert code has been activated. Which of the following actions should the nurse take? (Select all that apply.) A. Draw window shades and close drapes as protection against shattering glass. B. Move beds of nonambulatory clients away from windows. C. Relocate ambulatory clients into the hallways. D. Use the elevators to move clients to lower levels. E. Turn the radio on for severe weather warnings.

abce

7. A nurse manager is providing information about the audit process to members of the nursing team. Which of the following statements should the nurse manager include? (Select all that apply.) A. A structure audit evaluates the setting and resources available to provide care. B. An outcome audit evaluates the results of the nursing care provided. C. A root cause analysis is indicated when a sentinel event occurs. D. Retrospective audits are conducted while the client is receiving care. E. After data collection is completed, it is compared to a benchmark.

abce

1. A home health nurse is assessing the safety of a client's home. Which of the following factors may increase the client's risk for falls? (Select all that apply.) A. History of a previous fall B. Reduced vision C. Impaired memory D. Takes rosuvastatin (Crestor) E. Wears house slippers F. Kyphosis

abcef

6. A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following should the manger include in the plan? (Select all that apply.) A. Skill proficiency B. Assignment to a preceptor C. Budgetary principles D. Computerized charting E. Socialization into unit culture F. Facility policies and procedures

abdef

3. A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? (Select all that apply.) A. Verifying that a client understands what is done during a cardiac catheterization B. Discussing treatment options for a terminal diagnosis C. Informing members of the health care team that a client has do-not-resuscitate status D. Reporting that a health team member on the previous shift did not provide care as prescribed E. Assisting a client to make a decision about his care based on the nurse's recommendations

acd

2. A nurse is participating in an interprofessional conference for a client who has a recent C6 spinal cord injury. The client worked as a construction worker prior to his injury. Which of the following members of the interprofessional team should also participate in planning care for this client? (Select all that apply.) A. Physical therapist B. Speech therapist C. Occupational therapist D. Psychologist E. Vocational counselor

acde

4. A community experiences an outbreak of meningitis, and hospital beds are urgently needed. Which of the following clients should the nurse recommend for discharge? A. 58-year-old man admitted this morning with angina and a history of a coronary artery bypass grafting (CABG) 1 year ago B. 50-year-old adult with type 2 diabetes mellitus being admitted for rotator cuff surgery C. 70-year-old adult admitted yesterday with pneumonia and dehydration D. 65-year-old woman who fell and broke her hip and is scheduled for total hip replacement tomorrow

b

7. A newly licensed nurse is preparing to insert an IV catheter in a client. Which of the following sources should the nurse use to review the procedure and the standard at which it should be performed? A. Web site B. Institutional policy and procedure manual C. More experienced nurse D. State nurse practice act

b

5. A nurse on a telemetry unit is caring for a client who was admitted 2 hr ago and has chest pain. The client becomes angry and tells the nurse that there is nothing wrong with him and that he is going home immediately. The nurse should base her actions on which of the following? (Select all that apply.) A. The nurse should notify the risk manager immediately. B. In the event the client leaves the hospital without a discharge order, the nurse should document that the client left the facility "against medical advice" (AMA). C. It is the nurse's responsibility to explain to the client the risks involved if he chooses to leave. D. Most facilities have a form that clients are asked to sign if they leave the facility prior to discharge. E. A nurse who tries to prevent a client from leaving the hospital may be faced with legal charges

bcde

1. A nurse is preparing to transfer an older adult client who is 72 hr postoperative from a surgical procedure to a long-term care facility. Which of the following should the nurse include in the transfer report? (Select all that apply). A. Type of anesthesia used B. The client's advance directives status C. The client's vital signs on day of admission D. The client's medical diagnosis E. Need for special equipment

bde

4. A nurse who has just assumed the role of unit manger is examining her skills in interprofessional collaboration. Which of the following actions support interprofessional collaboration? (Select all that apply.) A. Use aggressive communication when addressing the team. B. Recognize the knowledge and skills of each member of the team. C. Ensure that a nurse is assigned to serve as the group facilitator for all interdisciplinary meetings. D. Encourage the client and family to participate in the team meeting. E. Support team member requests for referral

bde

1. A nurse discovers that a client was administered an antihypertensive medication in error. Number the following actions in the appropriate sequence that the nurse should follow. A. Call the client's provider. B. Monitor the client's vital signs. C. Notify the risk manager. D. Complete an incident report. E. Instruct the client to remain in bed until further notice

beadc

10. A nurse has received a performance appraisal from the unit manager. Which of the following actions by the unit manager requires intervention? A. The evaluation was conducted in the unit manager's office. B. Data that was collected for the previous 12 months was presented. C. Verbal concerns provided by a staff member were incorporated into the data. D. The nurse was asked to review the performance appraisal tool and complete a self-evaluation.

c

2. An older adult client who is on fall precautions is found lying on the floor of his hospital room. Which of the following actions is most appropriate for the nurse to take first? A. Call the client's provider. B. Ask a staff member for assistance getting the client back in bed. C. Inspect the client for injuries. D. Ask the client why he got out of bed without assistance

c

3. A nurse is observing a newly licensed nurse and an assistive personnel (AP) pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates a need for further education? A. The nurse spreads his legs apart. B. The nurse uses his body weight to counter the client's weight. C. The nurse's feet are facing inward, toward the center of the bed. D. The nurse uses the muscles in his arms to lift the client off the bed using the drawsheet.

c

3. An individual approaches the door of the maternal newborn unit, states that he is the uncle of a newborn, and asks to be admitted to the unit. Which of the following actions should the nurse take? A. Admit the individual after he provides the mother's full name and the date and time of the infant's birth. B. Call security to remove the individual from the area. C. Instruct the individual to obtain the access code from the family and then return. D. Call a Code Pink because the man could be attempting to abduct the infant.

c

5. An LPN ending her shift reports to the RN that a newly hired assistive personnel has not calculated the intake and output for several clients. Which of the following actions should the RN take? A. Complete an incident report. B. Delegate this task to the LPN. C. Ask the AP if assistance is needed to complete the I&O records. D. Notify the nurse manager.

c

6. A toddler is being treated in the emergency department following a head contusion from a fall. History reveals the toddler lives at home with only her mother. The provider's discharge instructions include waking the child up every hour during the night to assess for indications of a possible head injury. In which of the following situations should the nurse intervene and attempt to prevent discharge? A. The mother states she does not have insurance or money for a follow-up visit. B. The child states her head hurts and she wants to go home. C. The nurse smells alcohol on the mother's breath. D. The mother verbalizes fear about taking the child home and requests she be kept overnight.

c

8. A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following will provide the most relevant information regarding the efficacy of the procedure? A. Frequency with which procedure is performed B. Client satisfaction with performance of procedure C. Incidence of complications related to procedure D. Accurate documentation of how procedure was performed

c

How can a leader deal fairly with employees who fail to meet established standards of care? a. First, determine if the employee issue is a will or skill issue. b. Conduct a chart review that reflects the care issue. c. Ask questions of the employee that can reflect the employee's knowledge base.

c

5. A staff nurse is reviewing the hospital's fire safety policies and procedures with newly hired assistive personnel. The nurse is describing what to do when there is a fire in a client's trash can. Which of the following statements should the nurse include? (Select all that apply.) A. The first step is to pull the alarm. B. Use a Class C fire extinguisher to put out the fire. C. Instruct ambulatory clients to evacuate to a safe place. D. Pull the pin on the fire extinguisher prior to use. E. Close all doors

cd

3. A nurse manager is working with a committee of nurses whose task is to update the policies for new employee orientation. The nurse manager directs the team to collect as much data as possible and recommend several options. Which of the following decision-making styles is being demonstrated by the nurse manager? A. Decisive B. Flexible C. Hierarchical D. Integrative

d

5. A nurse is reviewing a client's health care record and discovers that the client's do-not-resuscitate (DNR) order has expired. The client's condition is not stable. Which of the following actions should the nurse take? A. Assume that the client does not want to be resuscitated, and take no action if she experiences cardiac arrest. B. Write a note on the front of the provider order sheet asking that the DNR order be reordered. C. Anticipate that CPR will be instituted if the client goes into cardiopulmonary arrest. D. Call the provider to determine whether the order should be immediately reinstated.

d