Leadership and Management
The nurse observes an unlicensed assistive personnel (UAP) sharing extensive stories of her own mother's death with a dying client's husband. Which statement demonstrates appropriate feedback for the nurse to offer to the UAP?
"It is probably best to avoid talking about your personal experience very much; keep communication client-centered." Therapeutic communication is always purposeful, goal-directed, and client-centered. If self-disclosure is used by the nurse or the UAP, it should be very focused and limited to just enough to support further communication with the client. It is not always helpful (or educational) and often inappropriate to share personal stories with clients.
A client with pulmonary fibrosis is prescribed home oxygen therapy. Which health team member is responsible for evaluating the client's knowledge of home oxygen use?
Home health nurse The home health nurse is responsible for evaluating the client's knowledge of home oxygen use. The social worker is responsible only for coordinating the services. The hospital staff nurse and physician do not observe the client in the home, so they can't adequately evaluate the client's knowledge of home oxygen use.
The selection of a nursing care delivery system (NCDS) is critical to the success of client care in a nursing area. Which factor is essential to the evaluation of an NCDS?
The selection of a nursing care delivery system (NCDS) is critical to the success of client care in a nursing area. Which factor is essential to the evaluation of an NCDS? Determining who has responsibility for making decisions regarding client care is an essential element of all client care delivery systems. Dress code, salary, and scheduling planned staff absences are important to any organizations, but they are not actually determined by the NCDS.
Because of an outbreak of influenza among the nursing staff, the hospital is very short staffed. The nurse manager prioritizes client needs on the surgical unit by which strategy?
ensuring that clients receive medications but omitting full bathing when possible Daily bathing is not required to meet standards of care. Rescheduling surgeries is not a strategy for meeting nursing care needs of clients. Medications are required to be given as prescribed to maintain standards of care and efficacy of the medication. UAPs are not licensed to administer analgesics.
The nurse has asked the unlicensed assistive personnel (UAP) to ambulate a client with Parkinson's disease. The nurse observes the UAP pulling on the client's arms to get the client to walk forward. The nurse should:
explain how to overcome a freezing gait by telling the client to march in place. Clients with Parkinson's disease may experience a freezing gait when they are unable to move forward. Instructing the client to march in place, step over lines in the flooring, or visualize stepping over a log allows them to move forward. It is important to ambulate the client and not keep them on bed rest. A muscle relaxant is not indicated.
The nurse is making assignments for the next shift. Which client can be assigned to a licensed practical nurse/licensed vocational nurse (LPN/LVN)? Select all that apply.
A client who is receiving glargine subcutaneously A client who needs assistance with colostomy irrigation An LPN/LVN can perform colostomy irrigation and administer subcutaneous injections. A client who just had CABG is unstable and needs to be monitored by an RN. The initial admission assessment should also be performed by an RN. C3 to C5 injury may cause respiratory compromise. Possible paralysis of diaphragm due to phrenic nerve involvement may occur. This client is unstable and should be assigned to an RN.
Which task should a nurse choose to delegate to a nursing assistant? Select all that apply.
Documenting a client's oral intake Performing a blood glucose check Taking a client's vital signs Registered nurses are responsible for all phases of the nursing process. These responsibilities include assessing a client's pain and evaluating a client's response to treatment. A nurse may delegate tasks such as taking vital signs, documenting intake and output, and performing blood glucose checks if she follows the five rights of delegation. The five rights of delegation include: right task (the task is within the delegate's scope of practice), right person (the person is competent to perform the task), right communication (the nurse gives the right directions to complete the task), right feedback (the nurse works collaboratively with the delegate), and right follow-up (the nurse follows-up on the task after it has been completed).
A home health agency is seeing an increase in the number of clients with GI disorders. How can the staff education coordinator ensure that the staff is knowledgeable about advances in GI care? Select all that apply.
Incorporate bi-annual competencies Allow time off for educational programs and conferences Make instructional videos and educational materials accessible
A nurse is working with a student nurse who is caring for a client with an acute bleeding cerebral aneurysm. Which action by the student nurse requires further intervention?
Keeping the client in one position to decrease bleeding The student nurse shouldn't keep the client in one position. She should carefully reposition the client often (at least every hour). The client needs to be positioned so that a patent airway can be maintained. Fluid administration must be closely monitored to prevent complications such as increased intracranial pressure. The client must be maintained in a quiet environment to decrease the risk of rebleeding.
A nurse is working as part of team on the unit on a performance improvement initiative to address a concern that clients are not receiving adequate preoperative teaching. Now that the problem has been identified, which action would the nurse do next?
Meet with the parties involved to develop a strategy. Performance improvement involves four steps: discover a problem (which has already been identified); plan a strategy using indicators based on a meeting with the parties involved; implement a change; and last, assess the change, and if the outcome is not met, plan a new strategy or refocus the strategy to effect change.
A nurse arriving for duty notes that a nursing assistant (or unregulated care provider [UCP]) has been assigned to a complex client with treatments involving sterile technique. What is the responsibility of the nurse regarding the assignment of the UCP?
Reassign the UCP to a client requiring basic tasks that the UCP has mastered. The nurse is accountable for the delegation of tasks to UCPs. The nurse delegates tasks to UCPs consistent with their level of expertise and education, the job description, agency policy, legislation, and personal need. UCPs should not be assigned to clients who are complex or require skills that involve a higher level of knowledge. Based on the choices offered, if the nurse is confident that the UCP has the appropriate knowledge regarding basic tasks, the tasks can be delegated. The other options are incorrect, as they do not ensure that the UCP has the knowledge and skill to provide the care or carry out the task.
A staff nurse is caring for a child with a urinary tract infection. The nurse is 1 hour late administering the child's prescribed antibiotic therapy and pain medication. The charge nurse challenges the staff nurse about the lateness of the medications. The staff nurse responds, "It's no big deal; at least the child got the medication." What is the best course of action for the charge nurse to take?
Speak to the unit manager and fill out a medication error report. Nurses are expected to demonstrate professional conduct, including safely administering medication. Administering scheduled medication 1 hour late is a medication error and should be identified to the unit manager to speak directly with the nurse as per his/her job responsibilities.
A nurse-manager on an oncology unit has been informed that she must determine which nursing care delivery system (NCDS)/nursing care delivery model (NCDM) is best for efficient client care, client satisfaction, and cost reduction. Knowing that two or three registered nurses, four licensed practical nurses, and five nursing assistants are generally on duty on each shift and that the clients can easily be grouped by geographic location and client care needs, the nurse-manager and her staff appropriately decide to implement which NCDS/NCDM?
Team nursing Team nursing is efficient and less costly to implement than primary or case management systems. Because staff members know each other well, they can function effectively as a team. Although functional nursing is the most cost-effective, care is commonly fragmented and clients are less satisfied. Case management and primary nursing require more registered nurses than are available.
The charge nurse is making client care assignments for the evening shift. One of the licensed practical nurses (LPNs) is a new graduate in orientation. Which client would be an appropriate care assignment for this LPN?
a 72-year-old client with diverticulitis The client with diverticulitis will need care that the LPN should be able to provide safely. The client with angina is unstable and requires a registered nurse for continuous assessment. The client receiving chemotherapy treatment requires a registered nurse who is certified in chemotherapy administration. A child with Kawasaki's disease must be watched closely for cardiac complications, and it would be best to assign the child to an experienced pediatric nurse, not a new graduate.
A client has a reddened area over a bony prominence. The nurse finds an unlicensed nursing personnel (UAP) massaging this area. The nurse should:
instruct the UAP that massage is contraindicated because it decreases blood flow to the area Massaging an area that is reddened due to pressure is contraindicated because it further reduces blood flow to the area. In the past, massaging reddened areas was thought to improve blood flow to the area, and some nursing personnel may still believe that massaging the area is effective in preventing pressure ulcer formation.
The nurse instructs the unlicensed assistive personnel (UAP) on how to care for a client with chest tubes that are connected to water-seal drainage. The nurse should instruct the UAP to:
mark the time and amount of drainage on the collection container. It is appropriate for a UAP to mark the time of measurement and fluid level on the collection container. Milking of chest tubes is not routinely recommended but, if performed, would be the responsibility of the nurse. The collection container should not be raised to bed height because this can cause fluid to flow back toward the client. Chest tubes should not be secured to the bed linens because they could be pulled on and potentially disconnected when the client moves and turns in bed.
A client is being prepared for a bronchoscopy. The nurse can delegate which task to the unlicensed assistive personnel (UAP)?
placing the client on NPO status It would be appropriate for the nurse to instruct the UAP to place the client on NPO status. It is the responsibility of the health care provider performing the procedure to obtain the client's informed consent and have the form signed. It is the responsibility of the registered nurse to teach clients and evaluate their health status. These responsibilities cannot be delegated to a UAP.
A client with stage II Alzheimer's disease is admitted to the short stay unit after cardiac catheterization that involved a femoral puncture. The client is reminded to keep his leg straight. A knee immobilizer is applied, but the client repeatedly attempts to remove it. The nurse is responsible for three other clients who underwent cardiac catheterization. What's the best step the nurse can take?
Ask the staffing coordinator to assign a nursing assistant to sit with the client. The nurse should ask the staffing coordinator to assign a nursing assistant to sit with the client. This action promotes client safety while avoiding restraint use. Applying wrist restraints doesn't prevent injury to the lower leg. Also, restraints should be applied only after other less restrictive measures have been attempted. A client with stage II Alzheimer's disease has memory impairment that impedes his ability to remember repeated instruction. Sedation isn't indicated for this client.
A nurse is caring for a client with a fresh postoperative wound following a femoral-popliteal revascularization procedure. The nurse fails to routinely assess the pedal pulses on the affected leg, and missed the warning sign that the blood vessel was becoming occluded. The nurse manager is made aware of the complication and the nurse's failure to assess the client properly. What action should be taken by the nurse manager?
Address the nurse's omissions as negligent behavior. Negligence refers to careless acts on the part of an individual who is not exercising reasonable or prudent judgment. It also refers to the failure to do something that a reasonable person (another nurse) would do.
A float nurse is assigned to a surgical unit. The nurse is receiving 2 clients from the post anesthesia care unit (PACU) at the same time. When delegating tasks to other PACU personnel who are not known to the nurse, which question would be most important to ask?
Are you comfortable in performing the tasks being assigned? Since the float nurse is not familiar with staff, it is important to ask the worker if he/she is comfortable and had instruction in the task assigned. Principles of delegation state that the right task in the right situation by the right personnel is essential to client care. Asking the highest educational level, how long they worked on the floor, and who provided their training is not as important as if they are comfortable with performing the task.
The nurse is instructing an unlicensed assistive personnel (UAP) on how to correctly position a client who has had a recent total hip replacement. In which position should the nurse tell the UAP to place the affected leg when the client is lying on the nonoperative side?
abduction and extension After total hip replacement surgery, the leg should be maintained in a position of abduction and extension. A foam abduction pillow is usually placed between the legs to maintain this position. Placing the leg in an adducted and/or flexed position can lead to a dislocation of the prosthesis.
A nurse on the mental health unit tells the nurse manager, "Kids with conduct disorders might as well be jailed because they all end up as adults with antisocial personality disorder anyway." What is the best reply by the nurse manager?
"You sound really frustrated. Let us talk about the meaning of their behavior." The nurse manager needs to focus on the frustration that the nurse is expressing. Additionally, the nurse manager needs to correct any misinformation or misinterpretation that the staff nurse has. Saying that the nurse sounds burned out and asking about a vacation does not focus on the nurse's frustration or address the inaccuracy of the nurse's statement. There is no evidence to suggest that children with conduct disorder have more than the average adult's risk of depression or anxiety. Therefore, this response is inaccurate and inappropriate. Anecdotal information from personal experience does not supply the nurse with accurate, reliable information.
A nurse working in a blood conservation program is being mentored by a supervising nurse. A client asks for information about iron supplements and epoetin alpa as alternatives to a blood transfusion. Which of the following responses by the nurse causes the supervising nurse to plan a review of professional and ethical standards?
''You should take the unit of blood. It will help you feel better." This answer does not allow for client choice because the nurse is influencing the choice. This is a violation of professional and ethical standards. In order to give informed consent, the client must have all the information and understand it. All of the client's questions should be answered. The other options demonstrate that the nurse understands these factors.
A nurse, a licensed practical nurse (LPN), and a nursing assistant are caring for a group of clients. The nurse asks the nursing assistant to check the pulse oximetry level of a client who underwent laminectomy. The nursing assistant reports that the pulse oximetry reading is 89%. The client Kardex contains an order for oxygen application at 2 L/min should the pulse oximetry level fall below 92%. The nurse is currently assessing a postoperative client who just returned from the postanesthesia care unit. How should the nurse proceed?
Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy. Because it's important to get more information about the client with a decreased pulse oximetry level, the nurse should ask the LPN to obtain vital signs and administer oxygen as ordered. The nurse must attend to the newly admitted client without delaying treatment to the client who is already in her care. The nurse can effectively do this by delegating tasks to an appropriate health team member such as an LPN. The nurse doesn't need to immediately attend to the client with a decreased pulse oximetry level; she may wait until she completes the assessment of the newly admitted client. The physician doesn't need to be notified at this time because an order for oxygen administration is already on record.
A nurse caring for a group of clients on the neurological floor is working with a nursing assistant and a licensed practical nurse (LPN). Their client care assignment consists of a client with new-onset seizure activity, a client with Alzheimer's disease, and a client who experienced a stroke. While administering medications, the registered nurse receives a call from the intensive care unit (ICU), saying a client who underwent a craniotomy 24 hours ago must be transferred to make room for a new admission. The ancillary staff is providing morning care and assisting clients with breakfast. How should the nurse direct the staff to facilitate a timely transfer?
Ask the nursing assistant to finish providing care to the clients and the LPN to administer the remaining medications so the registered nurse can accept the client from the ICU. The registered nurse should use the ancillary staff to help effectively manage the group of clients. While the registered nurse accepts the client from the ICU, the nursing assistant can provide care for the clients, and the LPN can administer the remaining medications. Telling the ICU to wait or notifying the supervisor that she must assist are incorrect options because the nurse should assess the situation and use the ancillary staff appropriately. The nurse has adequate staff to safely provide care for this group of clients. The nurse shouldn't administer medications quickly because haste is an unsafe practice that could lead to a medication error. Instead of rushing, the nurse should delegate the responsibility to the LPN.
The staff of an outpatient clinic has formed a task force to develop new procedures for swift, safe evacuation of the unit. The new procedures haven't been reviewed, approved, or shared with all personnel. When a nurse-manager receives word of a bomb threat, the task force members push for evacuating the unit using the new procedures. Which action should the nurse-manager take?
Determine that the procedures currently in place must be followed and direct staff to follow them without question. In an emergency such as a bomb scare, the nurse-manager must determine, without hesitation, the best action for the safety and welfare of clients and staff. Allowing staff members to do whatever they think best will cause confusion and inefficient client evacuation because no one will know how to function effectively as a team during the crisis. A staff meeting would waste valuable time.
An infant received the wrong medication dose. What is the charge nurse's role in following up on the incident?
Objectively assess the circumstances surrounding the error. The charge nurse should objectively assess the circumstances surrounding the medication administration error. After completing her assessment, the charge nurse should develop a plan with the nurse to prevent future errors. The charge nurse doesn't need to suggest that the nurse speak with hospital lawyer or make sure the nurse has liability insurance until the circumstances surrounding the error are investigated. Nothing suggests that the nurse needs to attend a medication administration course.
A registered nurse (RN) is supervising an unlicensed assistive personnel (UAP). Which principle would the nurse follow when delegating tasks?
The RN delegates a task based on the UAP's skill set The RN must delegate tasks that are within the scope of practice of the unlicensed personnel. The RN need not directly supervise all delegated tasks, as this would negate the benefits of delegation. When a task is delegated, the RN retains responsibility for the successful completion of the task. The RN must always follow up with the UAP to ensure the task was completed appropriately.
A nurse who is a case manager is responsible for assigning client care to unregulated care providers (UCPs). The nurse is planning the care for a new client who requires several treatments. Which of the following UCPs should the nurse assign to the new client?
The UCP with the appropriate knowledge and skills to provide the care The nurse is accountable for the assignment of tasks to UCPs. The nurse must ensure that the care being assigned is consistent with the UCP's level of knowledge, skill, and judgment. Assignments must also consider the UCP job description, agency policy, legislation, and client need. The other options are incorrect because they do not ensure all the requirements for safely assigning client care. Supervising the skill does not ensure competency.
A nurse-manager in the office of a group of surgeons has received complaints from discharged clients about inadequate instructions for performing home care. Knowing the importance of good, timely client education, the nurse-manager should take which steps?
Work with the surgeons' staff and the nursing staff in the hospital and outpatient surgical center to evaluate current client education practices and make revisions as needed. Every nurse who provides client care should provide client education. Nurses must work together to establish the best methods of educating clients. The most appropriate response is to contact the facility's nurse-manager, not the nursing staff. Evaluating client education in only the surgeon's office doesn't consider the entire client education process and all of the staff providing it. Client education is an important nursing responsibility and every complaint deserves attention.