Leadership practice 2019 a
A charge nurse is supervising the care of several clients. Which of the following actions requires intervention by the charge nurse? A. A nurse photocopying their assigned clients diagnostic test results B. AP documents a client VS on clients paper-based graph record C. Unit secretary faxing clients lab results to the provider D. RN stays with client who is reading the medical records that were requested
A. Nurse photocopying their assigned clients diagnostic test results
A nurse is caring for four clients. Which of the following assessment findings is the priority? A client who has facial drooping following a stroke 8 hr ago A client who has a femur fracture and reports feeling short of breath A client who had an appendectomy 12 hr ago and reports pain as 5 on a scale of 0 to 10 A client who had an open cholecystectomy 4 days ago and has serosanguineous drainage on the wound dressing
A client who has a femur fracture in reports feeling SOB - When using the urgent vs. nonurgent approach to client care, the nurse determines that the priority finding is a client who has a femur fracture and reports feeling short of breath. Clients who have a fracture can develop a deep-vein thrombosis, which can lead to pulmonary embolism. - Facial drooping 8 hr following a stroke is nonurgent because it is an expected finding. Therefore, there is another finding that is the priority. Presence of pain is nonurgent because it is an expected finding for a client following surgery. Therefore, there is another finding that is the priority. The nurse should continue to monitor for the presence of serosanguineous drainage on the dressing because drainage exceeding 5 days can be an indication of dehiscence. However, there is another finding that is the priority.
A nurse walks into the nurses station and see several staff members looking at the EMR record of a celebrity client on another unit. Which of the following actions should the nurse take first? A. Remind the staff members that this is a breach of confidentiality B. Discuss the issue with the nurse manager C. Request that administrative restriction be placed on the clients record access D. Prepare a memo for facility ethics committee
A. Remind the staff members that this is a breach of confidentiality
A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the following actions should the nurse plan to take? A. Assess clients incision Q8 hours for first 48 hours B. Inform AP of clients weight bearing status C. Instruct client to cross legs at ankles when sitting D. Teach clients partner to assist the client to flex the hip at least 120° each hour
B. Inform the AP of the clients weight bearing status
A nurse is developing a plan of care for a school age child whose family is homeless. Which of the following findings should the nurse identify as a priority? A. Child has red fissures at the corners of their mouth B. Child has several small bruises on both legs C. Child sleeps for 13 H hour each night D. Child is not regularly attending school
A. Child has red fissures at the corners of the mouth. use Maslow's hierarchy of needs, This can indicate a vitamin B deficiency which is a physiological need
An AP tells a charge nurse that it is unfair that they have to take care of all the clients who are in continent. Which of the following responses should the charge nurse make? A. I delegate tasks to personnel based on their job descriptions B. Everyone working here has to care for clients who are in continent C. Let's talk about organizing the workflow so you care for fewer of these clients D. Why do you not want to care for clients who are in continent.?
A. I delegate tasks to personnel based on their job descriptions
A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take to verify the client gave informed consent? Verify that the client understands the risks of the surgery. Ask the client to explain the procedure that is being performed. Answer the client's questions about the outcomes of the surgery. Determine if the client understands the benefits of the procedure.
Ask the client to explain the procedure that is being performed
A nurse received notification of a fire on the unit which of the following actions should the nurse take first question
Assist clients who are in immediate danger to a safe location
A nurse is caring for a client who is terminally ill and receiving nutritional support. The clients adult children disagree about continuing nutritional support. The dilemma is referred to the ethics committee. Which of the following actions should the nurse expect the committee to take?
Assist in weighing the options involved in the decision. Ethics committees are members of the interprofessional team who assist with problem solving related to ethical dilemmas. The ethics committee examines all of the facts and provides support for the clients and caregivers.
A nurse on a MedSurg unit is caring for four clients. The nurse should recognize that which of the following clients is the priority? A. A client who is scheduled for a tubal ligation in two hours and is crying B. A client who has PVD and absent pulse in right foot C. A client who has T1DMN needs first dressing change for ulcer D. A client who has MR essay and axillary temp of 38°C
B. A client who has peripheral vascular disease and absent pulse in right foot
A nurse is planning DC care for a client who had a stroke and now has left side weakness. Which of the following interventions should the nurse include in the plan of care? A. Request purchase from DME B. Advise patient to install grab bars in bathroom at home C. Encourage client to allow HHA to perform ADLs discourages independence D. Contact Hospice to provide F/you care
B. Advise patient to install grab bars in bathroom at home
Which of the following instructions provided by a nurse reflects effective communication regarding delegation of a task to an AP? A. Take vital signs every two hours for the client you had a choleycystectomy in room 6122 B. Check the UO at 11 o'clock for John Doe and report it to me immediately C. Report to me if the chest tube drainage is excessive for Jane doe in room 2438 D. Please notify me of any clients who is vital signs or blood glucose levels are significant
B. Check the UO at 11 o'clock for John Doe and report it to me immediately This instruction follows the five rights of delegation by including the requirements for right direction/communication: the data to collect, client-specific information, a timeline for coat collection, and the expectation for communicating the findings back to the nurse
A case manager is planning interprofessional conference for a client who is three days postop following ORIF of right hip. Which of the following concerns is the priority for discussion at the conference? A. Client does not have transportation for DC home B. Client refuses to attend PT sessions C. Clients home health nurse has not completed the home assessment D. Client describes feelings of depression after family visits
B. Client refuses to attend PT sessions. The greatest risk to this client is postoperative complications due to immobility, such as atelectasis or pneumonia
A nurse is receiving report from the AP assigned to the nurses group of clients. Which of the following statements from the EAP indicates the client the nurse should assess first A nurse is receiving report from the AP assigned to the nurses group of clients. Which of the following statements from the AP indicates the client the nurse should assess first? A. Client who had ABD surgery three days ago and reporting feeling constipated B. Client who had hip surgery reports pain 4/10 C. Client indwelling urinary catheter removed eight hours ago reports inability to void D. Client who is scheduled for discharge today states they are ready to sign their paper
C. Client who had indwelling urinary catheter removed eight hours ago reports inability to void
A charge nurse is leading a committee that is revising the policy for client discharge. After developing the initial plan, which of the following actions should the nurse take next? A. Set target dates for completion B. Identify areas of support C. Determine goals and objectives D. Implement recommended strategies
C. Determine goals and objectives
A nurse is caring for a client who is recovering from a stroke. The provider recommends extracranial intracranial bypass, but the client tells the nurse that he will not have the surgery. Which of the following action should the nurse take? A. Informed the client of consequences of decreased cerebral circulation B. Initiate mental health consult to determine why client refuses surgery C. Discussed clients concerns about having the surgery D. Provide client with information on additional treatment options
C. Discuss clients concerns about having the surgery
A charge nurse recognizes a trend of poor attendance at monthly staff meetings. To address this issue, which of the following actions should the nurse charge nurse take first? A. Write a memorandum emphasizing the importance of attending staff meetings B. Appoint a task force to promote attendance at the meetings C. Explore the reasons that staff are not attending the meetings D. Reduce the number of meetings the staff are required to attend
C. Explore the reasons the staff are not attending the meetings
A charge nurse is observing a newly licensed nurses use of time management skills. Which of the following actions by the newly licensed nurse indicates effective use of the skill? A. Documents client tasks at end of shift B. Gather supplies as needed while completing activity C. Groups tasks that are in same location D. Skips breaks throughout the day to complete work on time
C. Groups tasks that are in same location The newly licensed nurse should group tasks that are in the same location to effectively use time. This prevents the nurse from going back and forth from one area to another. This action promotes effective time-management skills.
A nurse is reviewing a clients clinical pathway upon discharge following hip arthroplasty. Which of the following information can assist the nurse in evaluating the cost effectiveness of the care? A. The age of client B. Availability of community support groups C. Length of clients stay D. Type of insurance the client carries
C. Length of clients stay
A nurse manager is teaching about confidentiality requirements to the staff. Which of the following staff comments indicates an understanding of the teaching? "Change-of-shift report can be given at the client's bedside." "I can provide client information over the phone if the caller identifies themselves as family." "A client cannot see their medical record because it is considered to be property of the facility." "Access to client information is limited to direct care providers."
Change of shift report can be given at the clients bedside
A nurse from a medical unit is asked to work on an orthopedic unit. The medical nurse has no orthopedic experience. Which of the following client should be assigned to the medical nurse? A client who is in balanced skeletal traction A client who had a total hip arthroplasty 3 days ago A client who has a fractured femur with a new cast A client who had a right above-the-knee amputation 24 hr ago
Client you had a right above the knee amputation 24 hours ago -- A nurse from a medical unit can care for this client because the surgical dressing is usually left in place for 48 to 72 hr, so the residual limb does not require special care at this time.
A client who has back pain presented to the ER and is provided a prescription for oxycodone. A staff nurse tells the charge nurse that they think the client is seeking drugs and is not actually in distress. Which of the following responses should the charge nurse make?
Clients are the experts on their own pain
A nurse on a quality improvement team is implementing a plan to decrease the rate of pressure injuries in a long-term care facility. Which of the following action should the team take to evaluate the effectiveness of the plan? Compare data from clients' records regarding skin integrity with established criteria. Measure staff attendance at an educational program on managing pressure injuries. Interview clients regarding their satisfaction with their care. Monitor use of supplies used to prevent pressure injuries.
Compare data from clients records regarding skin integrity with established criteria
A client on a general surgical unit tells the nurse that staff members are not answering the call light promptly. The client request to be transferred to another unit. Which of the following actions should the nurse take first? A. Notify charge nurse of clients request to transfer B. Assured client that their concern has been shared with the staff C. Tell client that future calls will be answered in timely manner D. Ask client to verbalize their expectations
D. Ask client to verbalize their expectations
A nurse is assigning care for for clients. Which of the following task for the Nurse plan to tailgate to AP?
Determine the client intake and output
A nurse on a mental health unit is teaching a newly licensed nurse about client rights. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
D. Clients on a mental health unit can refuse their medication
A nurse is caring for a client who has osteoarthritis and reports difficulty buttoning their clothes. The nurse should recommend a referral for the client to which of the following members of the inter-professional team? A. Podiatrist B. Social worker C. Para medical technologist D. Occupational therapist
D. Occupational therapist The nurse should recommend a referral to an occupational therapist for a client who has osteoarthritis and reports difficulty with ADLs, such as buttoning clothing. Occupational therapy can assist the client with exercises to help the client complete these tasks. A podiatrist specializes in the care of clients who have conditions involving the feet and ankles. A social worker specializes in counseling and care of clients who have concerns related to psychosocial needs, such as financial or domestic issues. A paramedical technologist specializes in the performance of medical procedures such as phlebotomy or ECG monitoring.
A nurse manager is planning an in-service for a group of nurses about caring for clients following stem cell transplant. Which of the following instructions should the nurse manager include in the teaching? A. Assigned to clients who have had a stem cell transplant to the same room B. Obtain rectal temp Q4 hours C. Where an N 95 respirator mask while caring for these clients D. Place clients in positive pressure airflow rooms
D. Place clients and positive pressure airflow rooms. The patient requires protective equipment precautions following a stem cell transplant in a private, positive pressure airflow room. The room air is filtered through a HEPA filter and the air flow rate is set at more than 12 error exchanges per hour
A client is considering having a tubal ligation and reports being uncertain about if it is the right thing to do. Which of the following actions should the nurse take? Provide information about alternate birth control methods. Ask if the client has discussed the decision with their partner. Emphasize the benefits of having the procedure. Discuss the client's feelings about the procedure.
Discuss the clients feelings about the procedure
Two nurses on a unit H contend that the other is not doing fair share of work. The conflict is affecting the functioning of the unit. A charge nurse should approach this conflict in which of the following ways? Schedule the nurses to work on alternating shifts. Organize a task force to evaluate the situation. Tell the nurses that it is their responsibility to cooperate with coworkers. Explore alternative solutions to address unit workflow with the nurses.
Explore alternative solutions to address unit workflow with the nurses
A nurse is caring for a client who requests pain medication. The nurse fulfills a promise to return with the med within 15 minutes. The nurse is demonstrating which of the following ethical principles? beneficence utility justice Fidelity
Fidelity; actions are taken to display loyalty and keep a promise made to the client. Beneficence; actions are taken to "do good" and promote goodness and kindness. Utility; actions are taken to bring the most to the greatest number of people, where the good of many will outweigh the needs of an individual client. Justice; actions are taken to seek fairness, where all clients are treated equally regardless of sex, sexual orientation, religion, ethnicity, disease, or social standing.
A charge nurse observes that a staff nurse's behavior has changed over the past few weeks. Which of the following behavior should the charge nurse identify as an indication that the staff nurse might be working while impaired? Spends free time conversing with other staff at the nurses' station Frequent use of restroom Asks other nurses to administer pain medication for their clients Delegates tasks to assistive personnel
Frequent use of restroom Frequent use of the restroom can indicate that the nurse might be working while impaired. Other indications can include frequent errors, mood swings, inability to focus, and excessive wasting of controlled substances.
A nurse is planning to do you see of a newborn who requires apnea monitoring at home. To which of the following community agencies should the nurse anticipate referring the guardian of the newborn? Child protective services Public health Home health Women, Infants, and Children
Home health
A nurse is caring for a 19-year-old client who has just been informed that her cancer has metastasized. The client tells the nurse that they do not want to continue chemotherapy. Which of the following responses should the nurse make? "I will have the provider discuss treatment options with your parents." "I will gather information about palliative care for you." "I will contact your spiritual advisor to discuss this decision with you." "I will contact your parents about becoming your designees in your durable power of attorney."
I will gather information about palliative care for you
Facility has been notified of a train do you rail meant resulting in multiple clients experiencing life-threatening injuries. The external disaster plan has been activated. Which of the following action should the charge nurse on the PACU take? Take extra wheelchairs to the emergency department. Send PACU assistive personnel to assist with triage. Identify stable clients for transfer to a surgical unit. Report to the command center for further instructions.
Identify stable clients for transfer to a surgical unit
A nurse is preparing to give medication to a client who has Crohn's disease. The client states I want to skip this dose of my med. I am too tired to take it. Which of the following actions should the nurse take? Leave the medication on the client's bedside table to take later. Return in 1 hr to administer the medication. Mix the medication in applesauce to administer to the client. Inform the client of the consequences of refusing the medication.
Inform the client of the consequences of refusing the medication
A nurse manager needs to address increased rate of client med errors. Which of the following strategies represents an authoritarian approach to managing the issue? Inform the staff of the penalties that can result from medication errors. Encourage the staff to have two nurses verify medication orders to prevent errors. Provide a suggestion box for the staff to submit ideas for error prevention. Ask three experienced nurses to help investigate common causes of the errors.
Inform the staff of the penalties that can result from medication errors - The nurse manager is using penalties to promote behavior change; this is characteristic of authoritarian leadership.
A nurse is providing preop teaching for a client who is scheduled for a TKA and speaks a different language than the nurse. Which of the following inter-professional team members should the nurse include in the discussion?
Interpreter
A nurse manager is auditing client charts and identifies an increase in ventilator associated pneumonia. Which of the following actions should the nurse manager take? Report the findings to the hospital ethics committee. Alert central supply. Fill out an incident report. Notify the quality improvement team.
Notify the quality improvement team
A nurse is caring for a client who reports vomiting and diarrhea for the past six hours. The nurse should identify that which of the following assessments is the priority? Auscultate the client's bowel sounds. Measure the client's temperature. Check the client's urine specific gravity. Obtain the client's serum potassium level.
Obtain the clients potassium level
A nurse manager finds that there has been an increase in UTIs on the unit. To address this problem, which of the following actions should the nurse manager take first? Conduct an in-service that reviews proper catheter insertion and maintenance. Perform a chart review to gather data about the clients who developed infections. Observe each staff nurse perform a urinary catheter insertion. Require completion of a self-paced instruction program.
Perform a chart review to gather data about the clients who developed infections. chart audit to gain important information about the factors responsible for the increased incidences of infection.
A nurse is observing a newly licensed nurse perform a sterile dressing change on a client who has a CVC. Which of the following action should the newly licensed nurse take? Open the top flap of the sterile package towards the body. Maintain a 1.25 cm (0.5 in) border around the edges of the sterile field. Pick up the first sterile glove by grasping the folded cuff edge. Remove soiled dressings using sterile gloves.
Pick up the first sterile glove by grasping the folded cuff edge The nurse should open the top flap of the sterile package away from the body. The nurse should maintain a 2.5 cm (1 in) border around the edges of the sterile field. The nurse should use clean gloves to remove soiled dressings.
A charge nurse is preparing to observe a newly licensed nurse perform a routine abdominal assessment. Which of the following action should the charge nurse expect the newly licensed nurse to take? Place the client in a dorsal recumbent position for the examination. Auscultate for vascular bruits with the diaphragm of the stethoscope. Begin the assessment by using light palpation over the abdomen. Ensure that the client has a full bladder before beginning the procedure.
Place the client in a dorsal recumbent position for the exam or supine position and ensure that the client relaxes her abdominal muscles
A home health nurse is planning her daily visits and receives lab results for four clients. The nurse should first visit the client who has which of the following lab values? Digoxin 1.0 ng/mL WBC 6,000/mm3 Platelets 100,000/mm3 Serum potassium 4.0 mEq/L
Platelets 100,000
I charge nurse is planning client care assignments for the unit. Which of the following tasks should the nurse assigned to LPN? Determine the swallowing ability of a client who has had a stroke. Provide an enteral feeding to a client who has Crohn's disease. Develop a teaching plan for a client who has a new diagnosis of type 2 diabetes mellitus. Weigh a client who is 3 days postoperative following coronary artery bypass grafting.
Provide entry feeding to a client who has Crohn's disease
A hospice nurse is planning care for a client who does not have advance directives. Which of the following intervention should the nurse include in the plan of care
Provide the client with information about advance directives
A nurse is reviewing safe use of wheelchair with a group of aAPWhich of the following instruction should the nurse include
Raise the foot plates of the wheelchair before transferring the patient
A nurse on a MedSurg unit is caring for a client transferred from another department. The nurse should verify that the client has given informed consent prior to which of the following procedures? Removal of staples from a surgical wound Providing a sputum specimen Receiving moderate sedation Collection of a blood specimen for ABGs
Receiving moderate sedation
A nurse asks a newly hired a P to remove a clients indwelling urinary catheter. Which of the following actions should the nurse take to ensure the AP is qualified to perform this task Show the AP how to remove an indwelling urinary catheter. Review the AP's skill competency checklist. Ask the AP if they know how to remove an indwelling urinary catheter. Pair the newly hired AP with an experienced AP.
Review the AP skill competency checklist
A nurse is caring for a client who is comatose. The client has a LivingWell that declines the use of artificial enteral nutrition as a life sustaining measure, but the clients family has requested that staff begin to feedings. Which of the following actions should the nurse take? Insert the tube and begin feedings per the family's request. Ask the provider to discuss the issue with the family. Report the dilemma to the facility's dietitian. Review the client's request with the family.
Review the clients request with the family The client's living will states that artificial enteral feedings should not be allowed, and the nurse should review the client's request with the family. Staff members should use the client's living will as the guide for treatment unless a durable power of attorney for health care has been created.
A nursing unit is undergoing changes to accommodate new bariatric services that will be available on the unit. Some staff members have verbalized displeasure with these changes. Which of the following action should the charge nurse take? Select all that apply -role model a positive approach to changes -redirect the conversation with staff make negative comments about the changes -encourage staff members who support the changes to discuss the issue with resistant staff -suggest that resistant staff members transfer to different unit -reprimand staff members who are resistant to the changes
Role model a positive approach to changes. encourage staff members who support the changes to discuss the issue with resistant staff
A nurse on a MedSurg unit has arrive late to work multiple times over the past several weeks. Identify the sequence the nurse manager should follow when disciplining the employee
Schedule a meeting with the nurse provide a written reprimand temporarily remove the nurse from scheduled shifts terminate the nurses employment
A nurse is serving on a committee that is considering the creation of a policy that will allow nurses to insert peripherally inserted central catheter's in the intensive care unit. Which of the following resources should the nurse consult in planning for this policy? National League for Nursing (NLN) American Academy of Nursing (AAN) Agency for Healthcare Research and Quality (AHRQ) State Nurse Practice Act (NPA)
State nurse practice act - The nurse should consult the NPA in this situation because the NPA defines the scope and boundaries of professional nursing practice. The NPA provides guidelines for developing standardized procedures within specific facilities where expanded nursing functions have been approved in collaboration with nurses, providers, and administration. The NLN is a national organization for faculty nurses and leaders in nurse education. It offers faculty development, networking opportunities, testing services, nursing research grants, and public policy initiatives. The AAN is a professional organization that generates, synthesizes, and disseminates nursing knowledge to contribute to health policy and practice for the benefit of the public and the nursing profession in general. The AHRQ is part of the United States Department of Health and Human Services, which supports research and is designed to improve the outcomes and quality of health care.
A nurse in ER is admitting client following earthquake. Emergency disaster plan has been implemented due to the anticipated arrival of a large number of casualties. Which of the following clients are the nurse recommend the provider evaluate first? A client who has a penetrating head injury and respiratory rate of 4/min A client who has a comminuted fracture of the femur A client who has a 15.2-cm (6-in) laceration to the scalp with clotted blood visible A client who has a sucking chest wound
The client who has a sucking chest wound;
A nurse is caring for a client who is three days postop following open heart surgery and will be transferred to the medical surgical unit. Which of the following information to the should the nurse include in the verbal report? The client's dressing change schedule The client's level of consciousness The client's vital signs from the previous shift The client's occupation
The clients level of consciousness
I charge nurse is observing a nurse perform a sterile dressing change. Which of the following actions should the charge nurse identify as demonstrating sterile technique The nurse places the sterile package with the top flap opening away from the body. The nurse pinches the flap on the inside of the package first to open it. The nurse reaches over the package to open the left flap. The nurse pulls the last flap of the package away from the body.
The nurse place is the sterile package with the top flap opening away from the body
A nurse is conducting an orientation class for new clients and their families at a long-term care facility. Which of the following client rights should the nurse address at the orientation? Select all that apply
The right to be treated with respect and dignity The right to refuse medications The right to leave regardless of provider recommendations The right to be fully informed of their health conditions
A nurse is caring for a client who was hospitalized and has expressive aphasia. The clients family reports that the nurse failed to obtain written informed consent before inserting a indwelling urinary catheter. Which of the following responses should the nurse make
This is a procedure that does not require written informed consent
A nurse is caring for a client who has a terminal illness and voice his concern about performing self-care after discharge. Which of the following statement should the nurse me "A social worker will address your concerns after discharge." "You should plan to go to a skilled nursing facility after discharge." "Your case manager will coordinate the resources you will need." "You will need hospice care until you feel stronger."
Your case manager will coordinate the resources you will need
A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge nurse should expect the newly licensed nurse to take which of the following actions? Place the client on droplet precautions. Place the client in a room with positive-pressure airflow. Wear a surgical mask when taking the client out of the room. Wear an N95 respirator mask when in the client's room.
where an N 95 respirator mask when in the clients room
