leadership questions

•A patient with human immunodeficiency virus (HIV) who has been started on antiretroviral therapy is seen in the clinical for follow-up. Which test will be best to monitor when determining the response to therapy? • A.CD4 level B.Complete blood count C.Total lymphocyte percent D.Viral load

Answer D Viral load testing measures the amount of HIV genetic material in the blood, so a decrease in viral load indicates that the antiretroviral therapy is effective. The CD4 level, total lymphocytes and compete blood count will also be sued to assess the impact of HIV on the immune function but will not directly measure the effectiveness of antiretroviral therapy.

The nurse implements a plan of care for a client receiving a chemotherapy treatment with intravenous bleomycin sulfate. The nurse should document which priority intervention in the plan? 1 Monitor for dyspnea. 2 Monitor for alopecia. 3 Monitor for anorexia 4 Monitor for a change in bowel patterns.

ANSWER: 1 Rationale: Bleomycin sulfate, an antineoplastic medication, can cause interstitial pneumonitis that can progress to pulmonary fibrosis. The nurse needs to monitor for dyspnea and monitor lung sounds for adventitious sounds that indicate pulmonary toxicity. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. Also, the nurse needs to notify the primary health care provider immediately if pulmonary toxicity occurs. Alopecia (hair loss) can occur, but monitoring for it is not a priority intervention. Monitoring for anorexia and bowel pattern changes are important but are not the priority.

A client is brought to the emergency department by emergency medical services after having seriously lacerated both wrists. The nurse should perform which action first? 1 Assess and treat the wound sites. 2 Contact the crisis intervention team. 3 Collect data on psychosocial aspects. 4 Encourage the client to talk about her or his feelings.

ANSWER: 1 Rationale: The initial action when a client has attempted suicide is to assess and treat any injuries. Although options 2, 3, and 4 may be appropriate at some point, the initial action would be to treat the wounds.

A client is being admitted to the neurological unit from the emergency department with a diagnosis of a cervical (C4) spinal cord injury. Which action should the nurse take first when admitting the client to the nursing unit? 1 Listen to breath sounds. 2 Check peripheral pulses. 3 Check for muscle flaccidity. 4 Determine extremity muscle strength.

ANSWER: 1 Rationale: Because compromise of respiration is a leading cause of death in cervical cord injury, collecting data on the respiratory system is the highest priority. Checking the peripheral pulses and muscle strength can be done after adequate oxygenation is ensured.

157. A postoperative client who underwent pelvic surgery suddenly develops dyspnea and tachypnea. The nurse suspects that the client has a pulmonary embolism and should prepare to take which action first? 1 Insert a urinary (Foley) catheter. 2 Administer low-flow oxygen through a nasal cannula. 3 Obtain an intravenous (IV) infusion pump to administer heparin 4 Increase the rate of the IV fluids infusing to prevent hypotension.

ANSWER: 2 Rationale: Pulmonary embolism is a life-threatening emergency. Maintenance of cardiopulmonary stability is the first priority. The nurse should prepare to administer low-flow oxygen by nasal cannula first. Hypotension is treated with fluids as prescribed. IV anticoagulation may be initiated. Some clients may require endotracheal intubation to maintain an adequate Pao2. A perfusion scan, among other tests, may be performed, and the electrocardiogram (ECG) is monitored for the presence of dysrhythmias. In addition, a urinary catheter may be inserted. However, the first nursing action is to administer oxygen.

The nurse notes redness, warmth, and a purulent drainage at the insertion site of a central venous catheter in a client receiving total parenteral nutrition (TPN). The nurse should take which priority action? 1 Change the intravenous tubing. 2 Slow the rate of infusion of the TPN 3 Notify the primary health care provider. 4 Call the pharmacy for a new bag of TPN solution.

ANSWER: 3 Rationale: Redness, warmth, and purulent drainage are signs of an infection. Infections of a central venous catheter site can lead to septicemia; therefore, the primary health care provider needs to be notified. Although the nurse may change the intravenous tubing and hang a new bag of TPN solution, these are not priority actions. The nurse should not adjust the rate of an intravenous solution without a specific prescription to do so. In addition, this action is unrelated to the client's complication.

Quinapril hydrochloride is prescribed as an adjunctive therapy in the treatment of heart failure. After administering the first dose, the nurse should specifically monitor which parameter as the priority? 1 Respirations 2 Urine output 3 Lung sounds 4 Blood pressure

ANSWER: 4 Rationale: Quinapril hydrochloride is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension and as adjunctive therapy in the treatment of heart failure. Excessive hypotension ("first-dose syncope") can occur in clients with heart failure or in clients who are severely salt or volume depleted. Although respirations, urine output, and lung sounds should be monitored, the nurse should specifically monitor the client's blood pressure

156. The nurse is creating a plan of care for a postoperative client who is receiving morphine sulfate by continuous intravenous infusion for pain. The nurse should include monitoring of which item as a priority nursing action in the plan of care? 1 Constipation 2 Urine output 3 Temperature 4 Blood pressure

ANSWER: 4 Rationale: Morphine sulfate suppresses respirations and decreases the client's blood pressure; therefore, monitoring for both decreased respirations and decreased blood pressure are priority nursing actions. Although monitoring of options 1, 2, and 3 may be a component of the plan of care for this client, option 4 identifies the priority nursing action.

A nurse is caring for a patient who states, "I just want to die." For the nurse to comply with this request, the nurse should discuss: Living wills. Assisted suicide. Passive euthanasia. Advance directives.

Advance directives

The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as: 1. coercive. 2. expert. 3. legitimate. 4. reward.

Ans # 1 Coercive Rationale: French and Raven's five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply.

What personal quality that is admired in the person with referent power. 1. Problem solving 2. Authority 3. Knowledge 4. Coercive power

Ans # 1: Problem solving Rationale: Referent power comes from the affinity other people have for someone. They admire the personal qualities, the problem-solving ability, the style, or the dedication the person brings to the work.

Which power refers to relationships across subunit departments? 1. Vertical 2. Organizational 3. Horizontal 4. Exertional

Ans # 3 Horizontal Subunit or horizontal power pertains to relationships across departments

A common source of conflict in nursing occurs when the nurse wants to perform patient teaching or counseling, but there are competing priorities and the nurse has inadequate time to spend with the patient. This type of conflict is related to: 1. interpersonal conflict. 2. intergroup conflict. 3. intrapersonal conflict. 4. intragroup conflict.

Ans # 3 intrapersonal conflict. Rationale: Intrapersonal conflict means discord, tension, or stress inside—or internal to—an individual that results from unmet needs, expectations, or goals. It often is manifested as a conflict over two competing roles. A nursing example occurs when the nurse determines that a patient needs teaching or counseling, but the organization's assignment system is set up in a way that does not provide an adequate amount of time. When other priorities compete, an internal or intrapersonal conflict of roles exists.

Where do nurses derive much of their power from? 1. authority figures in emergent situations. 2. central to the delivery of health care services. 3. organized through public associations. 4. the care coordinator of the health care team

Answer # 2 central to the delivery of health care services. Rationale: Professional nurses have a high degree of centrality within health care organizations. They are critical to the operation of most health care organizations, and without nurses, many health care facilities would not be able to offer services. Nursing maintains power by being central to the actual delivery of health care services, which is the core business function.

A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action? Refuse to float in the ICU Call the hospital lawyer Call the nursing supervisor Report to the ICU and identify tasks that can be safely performed.

Answer: D Rationale: Floating is an acceptable and legal practice. The nurse floated to a unit will be given orientation and will be assigned to care for stable patients or those with conditions similar to his/her training experience

•Which client is most likely to receive opioids for extended periods of time? A.A client with fibromyalgia B.A client with phantom limb pain in the leg C.A client with progressive pancreatic cancer D.A client with trigeminal neuralgia

Answer: C Cancer pain generally worsens with disease progression, and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioids and adjuvant medications. Trigeminal neuralgia is treated with antiseizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

Which of the following statements regarding communication is not true? Communication is an essential skill for leaders. Effective communication can motivate and engage others. Poor communication affects care coordination. Communication is easy to measure.

Answer: D Rationale: Communication is not easy to measure and therefore requires the development of more standardized tools. Communication is an essential skill for leaders who must communicate their vision and expectations in a clear, structured, honest manner. Effective communication can motivate and engage others while ineffective communication can lead to poor patient care.

•The nurse is caring for a postoperative client who reports pain. Based on recent evidence-based guidelines, which approach would be best? A.Multimodal strategies B.Standing orders by protocol C.Intravenous patient-controlled analgesia (PCA) D.Opioid dosage based on valid numerical scale

Answer: A Multimodal therapies for postoperative clients include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies. This approach is thought to be the most important strategy for pain management for most postoperative clients. Standing orders are less optimal because there is no consideration of individual needs or characteristics. PCA is one important element, but not all clients can manage PCA devices. Assessment tools are an important part of overall management but basing opioid dose on numerical scale does not consider individual client circumstance.

•The nurse manager is a public health department is implementing a plan to reduce the incidence of infection with human immunodeficiency virus (HIV) in the community. Which nursing action will be delegated to unlicensed assistive personnel (UAP) working for the agency? A.Supplying injection drug users with sterile injection equipment such as needles and syringes. B.Interviewing patient about behaviors that indicate a need for annual HIV testing C.Teaching high-risk community members about the use of condoms in preventing HIV infection Assessing the community to determine which population groups to target for education

Answer: A Supplying sterile injection supplies to patients who are at risk for HIV infection can be done by staff member with UAP education. Assessing for high-risk behaviors, education and community assessment are RN-level skills.

11) The postoperative patient with anterior cervical laminectomy is complaining of tightness in his throat. His voice is raspy. The staff nurse asks the unit secretary to page the healthcare provider stat. This is an example of _____ leadership. Authoritarian Democratic Laissez-faire Servant

Answer: A Authoritarian leadership uses directive and controlling behaviors in which the leader determines policies and makes decisions in isolation. The leader orders subordinates to carry out the tasks or work. This style is helpful in crisis situations.

7) A medical-surgical unit reports higher rates of patient satisfaction coupled with high rates of staff satisfaction and productivity. Which of the following is attributed to the data findings: Effective leadership Management involvement Mentoring Rewards and recognition

Answer: A Effective leadership is important in nursing because of the impact on nurses' work lives, it being a stabilizing influence during change, and for nurses' productivity and quality of care.

•Which clients must be assigned to an experienced RN? (Select all that apply). • A.Client who was in an automobile crash and sustained multiple injuries. B.Client with chronic back pain related to a workplace injury C.Client who has returned form surgery and has a chest tube in place D.Client with abdominal cramps related to food poisoning E.Client with a severe headache of unknown origin F.Client with chest pain who has a history of arteriosclerosis

Answer: A, C, E & F These clients should be assigned to an experienced RN because all have acute conditions that require close monitoring for any developing complications. Abdominal cramps secondary to food poisoning is an acute condition; however, the cramping, vomiting and diarrhea are usually self-limiting. The client with chronic back pain would be considered physically stable. Although all clients will benefit form care provided by an experienced RN, the client with abdominal cramps and the client with back pain could be assigned to a new RN, and LPN or a float nurse.

6) Which of the following is true of management activities: Inspiring a vision is a management function. Management is focused on task accomplishment. Management is more focused on human relationships. Management is more important than leadership

Answer: B

Which postoperative client is manifesting the most serious negative effect of inadequate pain management? A. Demonstrates continuous use of call bell related to unsatisfied needs and discomfort. B. Develops venous thromboembolism related to immobility cause by pain and discomfort. C. Refuses to participate in physical therapy because of fear of pain caused by exercises. D. Feels depressed about loss of function and hopeless about getting relief from pain.

Answer: B Inadequate pain management for postsurgical clients can affect quality life, function, recovery, and postsurgical complication; thus, all manifestations are example of negative results. However, venous thromboembolism can lead to pulmonary embolism, and this is an immediate life-threatening concern. The nurse also needs to implement interventions to resolve unsatisfied needs, fear of pain, and hopelessness related to pain and function.

•The nurse is working in a hospice facility for patients with acquired immunodeficiency syndrome (AIDS). The facility is staffed with LPNs and unlicensed assistive personnel (UAP). Which action will the nurse assign to the LPN? A.Assessing patients' nutritional needs and individualizing diet plans to improve nutrition B.Collecting data about the patients' responses to medications used for pain and anorexia. C.Developing UAP training programs about how to lower the risk for spreading infections. Assisting patient with personal hygiene and other activities of daily living as needed

Answer: B The collection of data used to evaluate the therapeutic and adverse effects of medications is included in LPN education and scope of practice. Assessment, planning, and developing teaching programs are more complex skills that require RN educations. Assistance with hygiene and activities od daily living should be delegate to the UAP.

9) During a staff meeting, a group of RNs has complained that medications are not arriving to the unit in a timely manner. The nurse manager suggests that the group resolve this issue through the development and work of a multidisciplinary team led by one of these RNs. This scenario demonstrates: adaptation. empowerment. flexibility. relationship management.

Answer: B Empowerment is the giving of authority, responsibility, and the freedom to act. In this situation, the manager has given authority, responsibility, and the freedom to act in the investigation and resolution of this issue.

SBAR is used in health care institutions to improve health team communication. Which patient population benefits most from clinicians who use SBAR? Acute care patients Long-term care patients Surgical patients Rehabilitation patients

Answer: B Rationale: SBAR has been demonstrated to be particularly useful in long-term care settings because these patients may experience subtle changes that can predict a worsening condition. Acute care and surgical patients are more apt to develop significant changes in acuity while hospitalized. Rehabilitation patients typically improve status instead of experiencing a worsening condition

•A patient who has received a kidney transplant has been admitted to the medical unit with acute rejection and is receiving IV cyclosporine and methylprednisolone. Which staff member is best to assign to care for this patient? A.RN who floated to the medical unit from the coronary care unit for the day. B.RN with 3 years of experience in the operating rom who is orienting to the medical unit. C.RN who has worked on the medical unit for 5 years and is working a double shift today. D.Newly graduate RN who needs experience with IV medication administration.

Answer: C To be most effective, cyclosporine must be mixed and administered in accordance with the manufacturer's instructions, so the RN who is likely to have the most experience with the medication should care for this patient or monitor the new graduate carefully during medication preparation and administration. The coronary care unit float nurse and the nurse who is new to the unit would not have experience with this medication.

8) A nurse is caring for an elderly patient who was admitted after sustaining a fall at home. When creating a care plan for the patient, she requests that the doctor order a home health visit to assess for home safety and medication compliance. In addition, the nurse is concerned about the nutrition of the patient and requests a dietitian evaluation. The nurse is demonstrating which of the following leadership skills: Care provider Business principles Care coordination Change management

Answer: C Care coordination is the delivery of nursing services that involves the organization and coordination of complex activities. The nurse uses managerial and leadership skills to facilitate delivery of quality care

10) Leadership is best defined as: an interpersonal process of participating by encouraging fellowship. delegation of authority and responsibility and the coordination of activities. inspiring people to accomplish goals through support and confidence building. the integration of resources through planning, organizing, and directing.

Answer: C Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers.

The nurse notes that an advance directive is in the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case? A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. The client cannot make changes in the advance directive once the client is admitted into the hospital.

Answer: C Rationale: A living will directs the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.

In an effort to improve glycemic control of hospitalized patients, a hospital puts together a team of doctors, nurse managers, nurses, and pharmacists. The goal of the group is to implement a standardized glycemic management protocol to be used throughout the hospital. This type of a team is an example of a: Primary work team Leadership team Ad hoc team Dysfunctional team

Answer: C Rationale: An ad hoc team is formed to solve a specific problem. When the problem has been solved, the team dissolves. In this scenario, a team was formed to improve glycemic management by implementing a standardized glycemic management protocol. A primary work team includes all types of patient care teams (e.g., IV team) while a leadership team consists of leaders at the executive or unit levels. A dysfunctional team is not one of the types of teams

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: a. Seek out the nursing supervisor in conflicting situations b. Work to understand the law as it applies to the client's clinical condition c. Assess the client's point of view and prepare to articulate this point of view d. Document all clinical changes in the medical record in a timely manner

Answer: C Rationale: Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.

The nurse manager calls a meeting of unit staff members to discuss ways to improve the timeliness of patient discharge. The nurse manager and group decide that the use of an admit/discharge nurse would help improve patient flow. This is an example of what kind of decision procedure? Autocratic Consultative Joint Delegated

Answer: C Rationale: Since the manager and staff decided on a course of action together, this scenario is an example of a joint decision procedure. An autocratic decision procedure in which the leader makes all of the decisions. A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the final decision alone. A delegated decision procedure occurs when the committee chair or leader allows participants to make the final decision

The home health nurse is interviewing an older client with a history of mild heart failure and rheumatoid arthritis. The client reports "feeling pretty good, except for the pain and stiffness in my joints when I first get out of bed." Which member of the health care team would be the most appropriate to aid in the client's report of pain? A.Health care provider to review the dosage and frequency of pain medication. B.Physical therapist for evaluation of function and possible exercise therapy. C.Social worker to locate community resources for complementary therapy. D.Unlicensed assistive personnel to help client with a warm shower in the morning.

Answer: D One of the common features of rheumatoid arthritis is joint pain and stiffness when first rising. This usually resolves over the course of the day. A nonpharmaceutical measure is to take a warm shower (or apply warm packs to joints if pain is limited to one or two joints). If pain worsens, then the nurse may elect to contact other members of the health care team for additional interventions.

A nursing student is employed and working as an unlicensed assistive personnel (UAP) on a busy surgical unit. The nurse knows that the UAP is enrolled in a nursing program and will be graduating soon. The nurse asks the UAP if they have performed a urinary catheterization on clients while in school. When the UAP says yes, the nurse asks them to help by doing a urinary catheterization on a post surgical client. What is the best response by the UAP? "Let me get permission from the client first." "Sure, which client is it?" "I can't do it unless you supervise me." "I can't do it. Is there something else I can help you with?"

Answer: D Rationale: A sterile invasive procedure that places the client at significant risk for infection is generally outside the scope of practice of a UAP. Even through the UAP is a nursing student, the agency job description should be followed.

Which statement is true regarding Kotter's model of change? It is a theory that involves nurse-to-nurse communication. It centers on conflict management. Patients are barriers to transformational processes. The vision of change should be communicated to employees.

Answer: D Rationale: Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Kotter's model is not a theory and it does not focus solely on nurse-to-nurse communication. Kotter's model does not center on conflict management, but it does believe that supervisors, not patients, can be a barrier to the change process

A hospital nurse manager is involved in conflict management between two staff members. The process of collaborating occurs when: 1. one person seeks to satisfy his/her own interests. 2. both sides strive to meet the interests of both parties. 3. a person chooses to withdraw from conflict. 4. one party seeks to appease the other.

Answer: both sides strive to meet the interests of both parties. Rationale: Collaborating ensues when the parties to conflict each desire to fully satisfy the concerns of all parties. The intention is to solve the problem by clarifying differences rather than by accommodating.

What are the two major content dimensions of power? Select all that apply 1. Influence 2. Integrity 3. Authority 4. Dominance 5. Control

Answers: 1, 3

Empowerment for nurses may consist of three components. Which three of the following components may help nurses become empowered to use their power for better patient care? Select all that apply 1. A state in which a nurse has assumed control over his or her own practice 2. Social relationship between two or more people 3. A workplace that promotes opportunities for growth 4. A nurse's sense of meaning as expressed in values and work role 5. Dependence of personnel

Answers: 1, 3, 4

Which of the following statements accurately describe the varying mechanisms of power? Select all that apply 1. Connection power is based on the perception that the influencer has access to powerful people or groups. 2. Legitimate power is based on fear. 3. Expert power results from expertise, special skill, or knowledge. 4. Information power refers to skill in making rational appeals. 5. Referent power is based on admiration for a person.

Answers: 1, 3, 5 Rationale: Connection power is based on another's perception that the influencer has access to powerful people or groups. Expert power results from expertise, special skill, or knowledge. Referent power is based on admiration for a person.

4) Which of the following traits describe a transactional leader? (Select all that apply.) Functions in a caregiver role. Surveys their followers' needs and sets goals for them. Uses charisma to produce greater effort in followers. Focuses on the maintenance and management of ongoing and routine work. Motivates followers to perform to their full potential.

Answers: A, B and D A transactional leader is a leader or manager who functions in a caregiver role and is focused on day-to-day operations. Such leaders survey their followers' needs and set goals for them based on expectations. They are also leaders who are focused on maintenance and management of ongoing and routine work. Transformational leaders use charisma to produce greater effort and are able to motivate followers to perform to their full potential over time

5) Which of the following behaviors build trust between leaders and employees in an organization? (Select all that apply.) Sharing relevant information Encouraging competition via winners and losers Reducing controls Meeting expectations Avoiding discussion of sensitive issues

Answers: A, C and D Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition

3) Which of the following definitions apply to management? (Select all that apply.) It is a process of inspiring people to accomplish goals through support and confidence building. It is the process of coordination and integration of resources to accomplish specific goals. It includes the activities of planning, organizing, coordinating, directing, and controlling. It is a process of planning and directing human effort to achieve established objectives. It is the directing of the organizations' money, facilities, and supplies to achieve results

Answers: B, C, D and E Management is defined as the process of coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific goals. Management is a process of planning and directing human effort to achieve established objectives while ensuring that the organizations' money, facilities, and supplies are directed in a manner that achieves the best results.

The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the most appropriate nursing response? A) I cannot discuss any client situation with you. B) If you want to know about Carol, ask her yourself. C) Only because you're worried about your friend, i'll tell you that she is approving. D) Being her friend, you know she is having a difficult time and needs her privacy.

Correct Answer: A Rationale: The nurse is required to maintain confidentiality regarding the client and the client's care. Confidentiality is basic to the therapeutic relationship and is a client's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal client information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain client confidentiality.

After initial assessment, the nurse determines the need to place a restraint on a patient. The patient refuses application of the restraint. What is the best nursing action for this patient? A. Apply the restraint anyway. B. Contact the primary health care provider. C. Compromise with the patient and then apply the restraint. D. Medicate the patient with a sedative and then apply the restraint.

Correct Answer: B Rationale: The use of restraints needs to be avoided if possible. If the nurse determines that a restraint is necessary, this should be discussed with the family and a prescription needs to be obtained by the primary health care provider. The primary health care provider's prescription protects the nurse from liability. The nurse should explain to the patient and family the reasons why the restraint is needed, the type of restraint, and how long the restraint will be in place. If the nurse applied the restraint after the patient refused, the nurse could face a battery charge.

Which identifies accurate nursing documentation notations? SATA A. Right leg dressing is dry and intact without drainage. B. The client is angry when woken up for routine morning vital signs. C. The client appears tired after the dinner trays are taken away. D. The client slept through the entire night. E. The clients lower medial right leg wound is 4 cm in length without an swelling, erythema, redness, and edema. F. The client appears anxious before being administered respiratory treatments from respiratory therapy.

Correct Answers: A, D, E Rationale: Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable because it can be misunderstood. The use of vague terms, such as seemed or appears is not acceptable because these words suggest that the nurse is stating an opinion.

Which of the following are examples of medical battery? SATA A. A child is placed in a papoose restraint for suturing of a facial laceration with the parent present B. Application of soft wrist restraints to the arms of a confused, adult client with a NG tube C. The nurse administers 2mg of morphine PRN to a difficult, alert client but tells the client it is saline D. The nurse inserts a needed urinary catheter even though a competent client refuses it E. The nurse threatens to put a client in restraints if the client does not stay in bed

Correct Answers: C, D Rationale: Any health care provider who performs a medical or surgical procedure without receiving the required informed consent from a competent client is committing battery and could be legally charged. Additionally, a competent client has the right to refuse any treatment, even if it is for the client's benefit. The nurse should help the client understand the need (eg, informed refusal), but the client's decision should be upheld. Proceeding to administer treatment to a competent client who has refused that treatment is medical battery

2) Relationship management is a key leadership skill because: Being liked by staff makes it easier to get things done. Patient care requires a high degree of interdependence on other care providers. Transferring negative moods to staff can decrease productivity. Helping staff cope with change is important.

Correct answer: B Rationale: The definition of relationship management is the "use of effective communication with others to disarm conflict, and the ability to develop the emotional maturity of team members." Without effective communication, real or perceived conflict can take hold of a work group and disrupt the flow of communication between and among other staff and disciplines. This can seriously impact care coordination, quality, and safety. Relationship management is not related to being liked, transferring negative moods to staff (self-management), or helping staff cope with change (social awareness).

1) Which statement regarding leadership and management is false? Leadership focuses on people while management focuses on systems and structures. Both leadership and management processes seek to accomplish goals. Strategies used to accomplish goals may be different in leadership and management. Leadership and management have discrete skill sets.

Correct answer: D Rationale: Leadership and management have several areas of overlap in regard to skill set. For example, both require excellent communication skills. Differences between leadership and management can be seen in regard to focus (people versus systems/structures) and strategies used to accomplish goals

If a nurse decides to withhold a medication because it might further lower the patient's blood pressure, the nurse will be practicing the principle of: A. responsibility. B. accountability. C. competency. D. moral behavior.

accountability

A student nurse employed as a nursing assistant may perform care: A. as learned in school. B. expected of a nurse at that level. C. identified in the hospital's job description. D. requiring technical rather than professional skills

identified in the hospital's job description

The nurse is preparing to administer an oral medication and questions the dosage. The nurse should: Administer the medication. Notify the physician. Withhold the medication. Document that the dosage appears incorrect.

withhold the medication