Leadership and Management of Care Quiz VATI

A client is seeking treatment for stress related to unexpected loss of employment and is engaging in the stress management technique of cognitive reframing. Which of the following statements would indicate to the nurse that the client understands this stress management technique? Select one: a. "I have excellent job skills; I just need to find a new employer." b. "When I do my daily yoga exercises, I feel so much better." c. "Once I decided what was most important to me, things got easier." d. "I can visualize the perfect interview and being offered a new job."

a. "I have excellent job skills; I just need to find a new employer." Cognitive reframing is a simple and effective technique for reducing stress by looking at things in a more positive light in order to experience them as less stressful. Cognitive reframing for this client would involve building confidence in job skills and searching for a new job.

The nurse is caring for four clients receiving chemotherapy. Which of the following clients should the nurse see first? Select one: a. A client with cervical cancer and a hemoglobin level of 8.2 mg/dL b. A client with breast cancer and a sodium level of 115 mEq/L c. A client with ovarian cancer with a white blood cell count of 4,500 cells/mcL d. A client with endometrial cancer and a potassium level of 5.0 mEq/L

b. A client with breast cancer and a sodium level of 115 mEq/L A sodium level less than 120 mEq/L is considered a medical emergency and needs immediate assessment and treatment.

A nurse is performing initial teaching with a client who will be receiving electroconvulsive therapy (ECT). Which statement by the client indicates a need for further teaching? Select one: a. "My Dilantin dose will be increased several days before the procedure." b. "Before the procedure, I will have an EKG to assess for heart irregularities." c. "I will need to continue taking my regular blood pressure medication." d. "I will stop taking my lithium for 2 weeks prior to my procedure."

a. "My Dilantin dose will be increased several days before the procedure." Because the therapeutic action of ECT is to induce seizures, any medications that affect the client's seizure threshold must be decreased or discontinued several days before the procedure. Any cardiac conditions, such as dysrhythmias, should be monitored and treated before the procedure

A daughter of a client with a terminal illness pulls a nurse to the side and says, "Although my mother's living will states she is not to be resuscitated, the family wants everything done to save her if she has a cardiac arrest." How should the nurse respond? Select one: a. "The living will documents your mother's wishes and must be followed." b. "I will contact the provider to make him aware of your request." c. "If your mother has a cardiac arrest, we will begin resuscitation if you wish." d. "Since the living will is a legal document a lawyer will have to make the changes."

a. "The living will documents your mother's wishes and must be followed." A living will is a document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. The client's wishes should be followed by the health care provider.

An elderly client is three days post-operative an anterior and posterior colporrhaphy. Which of the following assessments has the highest priority in this client's care? Select one: a. Abdomen firm and tender to palpation above the symphysis pubis. b. Oral temperature 100.8 F (38.2 C). c. Breath sounds decreased with fine crackles audible at bilateral bases. d. Apical pulse 90 and slightly irregular.

a. Abdomen firm and tender to palpation above the symphysis pubis. An assessment of an abdomen being firm and tender to palpation above the symphysis pubis has the most immediate implications for this post-op client. Urinary retention is possible complication of colporrhaphy and a firm and tender abdomen above the symphysis pubis is an indication of urine retention. The priority intervention for acute urinary retention is catheterization.

A client is hospitalized for multiple rib fractures following a motor vehicle accident (MVA). The results of an arterial blood gas (ABG's) are; pH 7.30, pCO2 48, HCO3 26 and pO2 91 on 2 L/min of oxygen per nasal cannula. Which of the following interventions has the highest priority? Select one: a. Assist the client to deep breathe, splinting with a pillow. b. Increase the client's O2 delivery to 4 L/min. c. Administer an anti-anxiety agent to calm the client. d. Notify the health care provider of the abnormal ABG's.

a. Assist the client to deep breathe, splinting with a pillow. The client is experiencing respiratory acidosis from hypoventilation caused by painful respirations due to fractured ribs. Splinting the chest wall with a pillow will decrease pain associated with deep breathing. Deeper breaths will allow for better gas exchange, which will correct the acidosis.

A nurse is preparing a client with terminal illness for discharge to a nursing home when he states: "I don't want to go to a nursing home to die. I would rather die at home." What would be the most appropriate action by the nurse? Select one: a. Contact the client's case manager. b. Continue to make the discharge arrangements. c. Assess the client's reasons for feeling this way. d. Inform the provider of the client's decision.

a. Contact the client's case manager. Contact the client's case manager would be the most appropriate action by the nurse. The case manger would be able to determine if the client's wishes could be carried out.

A nurse is caring for four laboring clients. Each of the clients is requesting an epidural. Which of the following clients should receive her epidural first? Select one: a. Mulitipara with contractions occurring every 3 minutes, lasting 45 seconds. The cervical os is dilated 5 cms. b. Primipara with contractions occurring every 10-15 minutes, lasting 15 seconds. The cervical os is dilated 3 cms. c. Primipara with contractions occurring every 2 minutes, lasting 90 seconds. The cervical os is dilated 10 cms. d. Mulitipara with contractions occurring every 2 minutes, lasting 130 seconds. The cervical os is dilated 8 cms.

a. Mulitipara with contractions occurring every 3 minutes, lasting 45 seconds. The cervical os is dilated 5 cms. An epidural is indicated in the active phase of labor. Active labor is defined as: cervical dilation of 4-7 cms, contractions occurring every 3-5 minutes and lasting 30-60 seconds. transition phase of labor and is approaching second stage: cervical dilation of 8-10 cms, contractions every 2-3 minutes and lasting 45-90 seconds. Many clients in this phase of labor become exhausted. An epidural during this phase could prolong delivery as the epidural may interfere with the client's ability to push.

A nurse has accepted a new position and is attending the general nursing orientation. Which of the following topics will most likely NOT be included in the orientation? Select one: a. Rules of conduct b. Fire safety c. Health promotion d. Accident prevention

a. Rules of conduct Orientation activities are more specific for the position, whereas general employee orientation provides the employees with general information about the organization. Rules of conduct are employee indoctrination content and are not part of the nurse's orientation schedule The staff development department can provide the new employee with more inforamtion about aspects of concern such as health promotion.

A nurse is preparing a client who speaks limited English for surgery. Which of the following is the most appropriate nursing action in obtaining informed consent from this client? Select one: a. Seek the assistance of a nurse on the floor who is fluent in the client's language. b. The nurse should explain the procedures using pictures and hand gestures. c. Have the nurse respond to the client's concerns so the provider can prepare for surgery. d. Do nothing as this is the provider's primary concern.

a. Seek the assistance of a nurse on the floor who is fluent in the client's language. The nurse is responsible for ensuring that the client understands the information provided regarding the procedure.

At 0715 the nurse is assigned to care for the following four clients. Which of the following clients should the nurse plan to see first? Select one: a. A client who will be transferred to a skilled care facility at 0930. b. A client with diabetes mellitus type I waiting for a breakfast tray at 0745. c. A client scheduled for a bronchoscopy at the bedside at 0900. d. A client with pneumonia scheduled for a portable chest x-ray at 0730.

b. A client with diabetes mellitus type I waiting for a breakfast tray at 0745. The diabetic client waiting for breakfast should be assessed first. Prior to breakfast the client's blood glucose needs to be drawn and if insulin coverage is required it is administered before breakfast. Once the client begins to eat and digest food they will be at risk for increasing blood glucose levels without their insulin coverage.

Which of the following situations demonstrate a violation of the ethical principle veracity? Select one: a. A nurse tells a client that she will be back at 9am but doesn't return until 11am. b. A nurse tells a client that a medication will relieve pain when she knows that it will not. c. A nurse attempts an IV insertion at a site where no vein is seen or felt. d. A nurse does not allow a client to refuse a treatment.

b. A nurse tells a client that a medication will relieve pain when she knows that it will not. Veracity - the nurse's duty to tell the truth.

A nurse is triaging clients after a tornado disaster. A 22-year-old client being triaged has asymmetrical chest movement, shortness of breath and absent lung sounds on the left side. What category of triage should the nurse place this client at? Select one: a. Nonurgent Class III b. Emergent Class I c. Expectant Class IV d. Urgent Class II c. Expectant Class IV

b. Emergent Class I This client has manifestations of a pneumothorax and needs immediate treatment with a chest tube to re-expand lung.

A nurse is charting the morning assessments on the computer when a client calls for assistance from his room. What actions should the nurse take next? Select one: a. Complete the charting before assisting the client. b. Log off of the computer before responding. c. Take the computer to the client's door while assisting him. d. Have an assistive personnel stay with the computer.

b. Log off of the computer before responding. The nurse should always log off the computer when leaving the terminal to protect her user name as well as to protect client information.

The nurse manager observes a nurse placing several packages of suction catheters in her pocket to use as the nurse provides treatments to several clients with tracheostomies. Which of the following recommendations should the nurse manager make? Select one: a. Leave suction catheters in the supply room until needed b. Store suction catheters in a dedicated space at client's bedside c. Carry catheters in pocket but note how many catheters are used for each client d. Place suction catheters in a treatment tray rather than in a pocket

b. Store suction catheters in a dedicated space at client's bedside Storing suction catheters in a dedicated space at client's bedside is the best choice. While the cost of supplies must be considered, clients with new tracheostomies for example require frequent suctioning and the client may be placed in jeopardy if the necessary equipment is not readily available. Resource allocation is a responsibility of the unit manager as well as every practicing nurse. Providing cost-effective client care should be balanced with quality care.

A nurse is using silence to communicate with a client. Which of the following describes a therapeutic purpose of silence? Select one: a. Conveys the nurse's understanding of the client and assists with clarification. b. Encourages the client to discuss central issues and keeps communication goal-oriented. c. Allows the client time to gain insights and slows the pace of the interaction. d. Communicates the nurse's interest and concern for the well-being of the client.

c. Allows the client time to gain insights and slows the pace of the interaction. Silence gives the client time to think and gain insights, slows the pace of the interaction, and encourages the client to initiate conversation, while conveying the nurse's support, understanding, and acceptance.

A nurse is managing the nursing staff on a medical-surgical unit. When evaluating client care, which of the following statements represents correct implementation of the five rights of delegation by the nursing staff? Select one: a. A licensed practical nurse creates the nursing care plan for a client experiencing post-operative pain 2 days after an appendectomy. b. A licensed practical nurse delegates to the assistive personnel to teach the client about ambulating with a walker before discharge. c. An RN asks the assistive personnel to record the intake and output of a client who is admitted to the unit with heart failure. d. An RN asks the licensed practical nurse to administer total parenteral nutrition to a client who had minor surgery 2 days ago.

c. An RN asks the assistive personnel to record the intake and output of a client who is admitted to the unit with heart failure.

A community based nurse receives a client referral. Which of the following actions should be performed first? Select one: a. Encourage the client to contact appropriate agencies. b. Obtain information about community resources accessible to the client. c. Collaborate with the health care team and the referring agency to assess client needs. d. Educate the client about the community resources that are available

c. Collaborate with the health care team and the referring agency to assess client needs. The nurses who receive the referrals need to work collaboratively with the health care team and the referring agency or persons. Continuous coordinated care among all health care providers involved in a client's care is essential to avoid duplication of effort by the various personnel caring for the client. Understanding client needs is the first step in the referral process.

The nurse is caring for a client admitted with diverticulitis. The client reports severe abdominal pain and assessment reveals that the client's abdomen is rigid and tender. The client's vital signs are: T: 101.8 F (38C); HR: 120; B/P: 100/50. Urine output was less than 300 ml during the previous eight hours. The client states the pain is "worse than before". What is the priority nursing intervention for this client? Select one: a. Encourage the client to increase fluids b. Administer the prescribed scheduled antibiotic c. Notify the client's health care provider d. Administer bisacodyl suppository as needed

c. Notify the client's health care provider The client is febrile, tachycardic and hypotensive with verbalization of increased worsening abdominal pain. These are signs of possible rupture of the diverticulum, pelvic abscess, or bowel obstruction and the provider needs to be notified.

A client is admitted to the hospital for suspected infective endocarditis. The client is reporting chills, fatigue, myalgia and dyspnea upon exertion. When assessing the client the nurse notes a heart murmur and a temperature of 102.3 F (38.2 C). Which of the following orders should the nurse implement first? Select one: a. Order the EKG b. Administer acetaminophen 325 mg by mouth c. Obtain the blood cultures from three sites d. Administer IV Penicillin G, 2 million units

c. Obtain the blood cultures from three sites Obtaining blood cultures is the priority intervention. Cultures must be drawn prior to initiation of antibiotics so sensitivity results are not influenced. Obtaining specimens from three sites increases the reliability of the results. Clients at risk for endocarditis should be treated with prophylactic antibiotics prior to dental procedures; respiratory and GI diagnostic procedures; GU and Cardiac surgeries. Administering an antipyretic medication should follow the administration of antibiotics. Temperatures may be as high as 102-104 degrees F. in clients with infective endocarditis. Antipyretics are a priority for this client, but it is a lower priority than blood cultures and antibiotic administration. Clients at risk for endocarditis should be treated with prophylactic antibiotics prior to dental procedures; respiratory and GI diagnostic procedures; GU and Cardiac surgeries.

A nurse is caring for a client recently diagnosed Hepatitis C. He asks the nurse to promise him his wife will find not out about his diagnosis. What is the best response by the nurse? Select one: a. "I can't promise you because your provider may inform her anyway." b. "Your wife has the right to know about your condition because she may be at increased risk." c. "I'll place a note in your chart concerning your request for your wife not to be informed." d. "Your medical information is considered confidential to be shared only if you agree."

d. "Your medical information is considered confidential to be shared only if you agree." The client must give consent for health care information, including laboratory results, diagnosis, and prognosis, to be shared with anyone that is not involved in the client's care. This includes sharing the information with family members. Even though the wife may be at an increased risk for Hepatitis C, she cannot be informed without the client's consent.

The following clients have been assessed in the emergency department. Which of the following clients requires immediate attention? Select one: a. An 81 year-old client with a history of heart failure and new onset pneumonia with a respiratory rate of 32 and a temp of 101 F (38). b. A 6 year-old client with an open tibial fracture that occurred two hours ago after being hit by a car. c. A 19 year-old client who is vomiting and complaining of new onset right lower quadrant pain with rebound tenderness. d. A 48 year-old male complaining of chest pain, cardiac monitor showing sinus tachycardia with occasional PVC's.

d. A 48 year-old male complaining of chest pain, cardiac monitor showing sinus tachycardia with occasional PVC's. While all of these clients require nursing care, the 48 year-old male with c/o chest pain and a cardiac rhythm of sinus tachycardia with occasional PVC's needs immediate attention! Chest pain is an indication of myocardial ischemia and this client has other factors that put him at risk for sudden death: gender, age and PVC's. PVC's are not normal in a 48 year old. PVC's occur when the myocardium is irritated, usually from hypoxia but also from electrolyte imbalance, usually involving K+. This client is young and as a result has not had sufficient time to develop adequate collateral circulation.

A provider informs the wife of a comatose client with terminal cancer that she will need to sign the consent for insertion of a gastrostomy feeding tube. The nurse knows this is against the client's wishes. What is the appropriate action by the nurse? Select one: a. Inform the wife she cannot sign the consent b. Prepare the consent for the wife to sign. c. Ask the provider for an order for a NG tube instead. d. Consult the hospital's ethics committee.

d. Consult the hospital's ethics committee. If the nurse believes the provider's actions are directly against the client's wishes, the nurse should contact the hospital's ethics committee. These committees are typically multidisciplinary and are organized to consciously and reflectively consider significant and often difficult issues related to client care. Any nurse can consult the hospital's ethics committee when deemed necessary. Unless the client has designed another person as his health care power of attorney, the wife, as immediate next of kin, can legally sign the consent for the procedure if she wishes.

A nurse is preparing a client who speaks limited English for surgery. Which of the following is the most appropriate nursing action in obtaining informed consent from this client? Select one: a. Do nothing as this is the provider's primary concern. b. The nurse should explain the procedures using pictures and hand gestures. c. Have the nurse respond to the client's concerns so the provider can prepare for surgery. d. Seek the assistance of a nurse on the floor who is fluent in the client's language.

d. Seek the assistance of a nurse on the floor who is fluent in the client's language. The nurse is responsible for ensuring that the client understands the information provided regarding the procedure.

A nurse is caring for a client who has been committed to an acute Mental Health facility with an involuntary emergency commitment order. What should the nurse include when orienting the client to the facility? Select one: a. The client can leave the facility at any time if they sign a medical release form. b. Length of stay at the facility will be determined by the courts. c. Family will not be able to visit until their provider grants the visitation privileges. d. The client has the right to refuse treatment, unless he has been judged to be incompetent.

d. The client has the right to refuse treatment, unless he has been judged to be incompetent. Clients admitted under involuntary commitment are still considered competent and have the right to refuse treatment, unless they have gone through a legal competency hearing and have been judged incompetent. The client who has been judged incompetent has a temporary or permanent guardian, usually a family member if possible, appointed by the court. The guardian can sign informed consent for the client. The guardian is expected to consider what the client would want if they were still competent. This type of commitment is usually imposed by primary care providers, mental health providers, or police officers based on the client's need for psychiatric treatment, the risks of harm to self or other, or the inability to provide self- care.