Leadership Questions from PPTs

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The nurse is caring for a patient with multiple injuries sustained during a head-on car collision. Which assessment finding takes priority? 1.A deviated trachea 2.Unequal pupils 3.Ecchymosis in the flank area 4.Irregular apical pulse

** The nurse is caring for a child with juvenile idiopathic arthritis (JIA). The nurse should identify which problem as the priority? o 1 Complaints of acute pain o 2 Unsteadiness when ambulating o 3 Embarrassment about appearance o 4 Inability to perform self-hygienic measures

1 Rationale: All the problems presented are appropriate for the child with JIA. The priority problem relates to complaints of acute pain. Acute pain needs to be managed before other problems can be addressed.

A group of people arrive at the emergency department by private car. They all have extreme periorbital swelling, coughing, and tightness in the throat. There is a strong odor emanating from their clothes. They report exposure to a "gas bomb" that was set off in their house. Which action is the priority? 1.Measure vital signs and listen to lung sounds. 2.Direct patients to the decontamination area. 3.Alert security about possible terrorism activity. 4.Direct patients to cold or clean zones for immediate treatment.

The hospital administration issues a statement that surge capacity is likely to be exceeded because statewide measures have not been successful in "flattening the curve" of COVID-19 (coronavirus) cases. How is this information most likely to affect the nursing staff? 1.Nurses will be expected to revise infection control policies, as needed. 2.Nurses will be asked to work extra shifts or keep working beyond end-of-shift. 3.Nurses will be given priority usage for personal protective equipment. 4.Nurses can temporarily practice outside scope of practice, as needed.

A 56-year-old patient comes to the triage area with left-sided chest pain, diaphoresis, and dizziness. What is the priority action? 1.Initiate continuous electrocardiographic monitoring. 2.Notify the emergency department health care provider. 3.Administer oxygen via nasal cannula. Draw blood and establish IV access

The charge nurse in an emergency department (ED) must assign two staff members to cover the triage area. Which team is best for this assignment? 1.An advanced practice nurse and an experienced RN 2.An experienced LPN/LVN and an inexperienced RN 3.An experienced RN and an inexperienced RN 4.An experienced RN and an experienced assistive personnel (AP)

When a primary survey of a trauma patient is conducted, which action would be performed first? 1.Obtain a complete set of vital sign measurements. 2.Palpate and auscultate the abdomen. 3.Perform a brief neurologic assessment. 4.Check the pulse oximetry reading.

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

** The community health nurse is assisting residents involved in a hurricane and flood. Many of the older residents are emotionally despondent and refuse to evacuate their homes. With regard to rescue and relocation of the older residents, the nurse should plan to perform which action first? o 1 Contact families. o 2 Attend to emotional needs. o 3 Attend to nutritional and basic needs. o 4 Arrange for transportation to shelters.

3 Rationale: Attending to people's basic needs of food, shelter, and clothing is the priority. Options 1, 2, and 4 may or may not be needed at a later time.

** A staff nurse is facing a dilemma between meeting clinical ethical standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to focus on: 1.doing the right thing and taking the right action. 2.meeting clinical standards before organizational goals. 3.meeting organizational goals before clinical standards. 4.referring indecisive staff members for additional training.

1 Rationale: Although the domain of clinical ethics is the care of clients, the domain of organizational ethics is a facility's business-related activities. Together, clinical and organizational ethics reflect a health care facility's concern that, whether related to the continuum of care or the continuum of services related to that care, ethical dilemmas should be resolved based on values-centered principles that focus on doing the right thing and taking the right action.

** One mechanism that ensures autonomy in the nursing profession is the: 1.American Nurses Association (ANA). 2.Department of Health Professionals. 3.Nursing Code of Ethics. 4.Professional Regulatory Board.

1 Rationale: American Nurses Association's (ANA) Nursing's Social Policy Statement: The Essence of the Profession (2010, p. 25) indicates "competence is foundational to autonomy," with the profession ensuring nursing competence through professional regulation of nursing practice via standards and ethical codes of practice, legal regulation of nursing practice via state licensure requirements and law pertaining to criminal and civil wrongdoing, and self-regulation in which all nurses retain personal accountability for their own practice (Cooper, 2014).

** A patient who is not fully informed about his or her health status is an example of a violation of which ethical principle? 1.Autonomy 2.Justice 3.Utilitarianism 4.Confidentiality

1 Rationale: Autonomy refers to the client's right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision.

** ·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? o 1 Listen to breath sounds. o 2 Check peripheral pulses. o 3 Check for muscle flaccidity. o 4 Determine extremity muscle strength.

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.

** 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? o 1 Monitor for dyspnea. o 2 Monitor for alopecia. o 3 Monitor for anorexia. o 4 Monitor for a change in bowel patterns.

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.

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.

1 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.

** A hospitalized client with type 1 diabetes mellitus tells the nurse that they feel like they are having a hypoglycemic reaction. The nurse should complete which action first? o 1 Obtain a blood glucose reading. o 2 Give the client 4 oz (120 mL) of orange juice. o 3 Prepare to administer 50% dextrose intravenously. o 4 Prepare to administer subcutaneous glucagon hydrochloride.

1 Rationale: Management of hypoglycemia depends on the severity of the reaction. To reverse mild hypoglycemia, a 15-g simple carbohydrate is given and works quickly to increase blood glucose levels. However, a blood glucose test (with a glucose meter) should be performed first as soon as manifestations begin. If a meter is not available, it is safest to treat the hypoglycemia. Fifty percent dextrose and glucagon hydrochloride are used to treat severe hypoglycemia, particularly in the unconscious client.

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

1 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.

** A client returns to the nursing unit from the postanesthesia care unit (PACU) after a transurethral resection of the prostate. The nurse should perform which action first? · o 1 Check the client's respirations. o 2 Check the color of the client's urine. o 3 Check the urinary (Foley) catheter for patency. o 4 Read the nursing notes written by the PACU nurse.

1 Rationale: The first action of the nurse is to check the patency of the airway, and the nurse should observe the client and monitor the breathing pattern and respirations. If the airway is not patent and the client is not breathing, immediate measures must be taken for the survival of the client. The nurse then checks cardiovascular function, the condition of the surgical site, the tubes or drains for patency and drainage, and function of the central nervous system. The PACU nurse normally provides a verbal report. Even so, reading the nursing notes would not be the first action.

** The court has found that a registered nurse (RN) harmed a patient by violating his rights. The nurse is ordered to pay the patient a large sum of money. The court has determined that the nurse has committed a: 1.civil act. 2.criminal act. 3.critical wrong. 4.quality breach.

1 Rationale: By definition, civil acts are wrongs that violate the rights of individuals by tort or breach of contract.

** A client is admitted to the emergency department with complaints of severe, radiating chest pain, and a myocardial infarction is suspected. The nurse immediately applies oxygen to the client and plans to take which action next? o 1 Obtain a 12-lead electrocardiogram (ECG). o 2 Call radiology to prescribe a chest radiograph. o 3 Call the laboratory to prescribe stat blood work. o 4 Notify the coronary care unit to inform them that the client will need admission.

1 Rationale: The initial action is to apply oxygen, because the client may be experiencing myocardial ischemia. Based on the options provided, an ECG will be done next because this test can provide evidence of cardiac damage and the location of myocardial ischemia. Vital signs are also measured and should be done just before obtaining the ECG or quickly thereafter. Nitroglycerin, a coronary artery vasodilator, may also be administered. The nurse should then obtain blood work because it can assist in determining the diagnosis and choice of treatment. Although the chest radiograph may show cardiac enlargement, it does not influence the immediate treatment. Notifying the coronary care unit to inform them that the client will need admission should be done once the diagnosis is confirmed and admission is deemed necessary.

** 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? o 1 Assess and treat the wound sites. o 2 Contact the crisis intervention team. o 3 Collect data on psychosocial aspects. o 4 Encourage the client to talk about her or his feelings.

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.

** The nurse is planning the client assignments for the day. Which client should the nurse assign to the unlicensed assistive personnel (UAP)? o 1 A client on strict bed rest o 2 A client scheduled for discharge to home o 3 A client scheduled for a cardiac catheterization o 4 A postoperative client who had an emergency appendectomy

1 Rationale: The nurse is legally responsible for client assignments and must assign tasks based on the guidelines of nurse practice acts and the job descriptions of the employing agency. A client scheduled for discharge to home, a client scheduled for a cardiac catheterization, and a postoperative client who had an emergency appendectomy have both physiological and psychosocial needs that require care by a licensed nurse. The UAP has been trained to care for a client on bed rest. The nurse provides instructions to the UAP, but the tasks required are within the role description of a UAP.

** A staff nurse came in to work the 7 PM to 7 AM shift. She had met her friends for "happy hour" earlier in the evening. Her breath smells of alcohol. If this nurse is allowed to provide care for patients, she may be at risk for: 1.maleficence. 2.mélange. 3.nonmaleficence. 4.nonmanager.

1 Rationale: Maleficence is doing harm to the patient whether it is intentional or unintentional, such as an omission. If the nurse is intoxicated, she may fail to meet the standard of care.

** The nurse is preparing to perform oral suctioning on a client who has coughed, resulting in secretions in the mouth, and is unable to expectorate the secretions adequately. The nurse determines that there is a prescription for the procedure and explains the procedure to the client. Which actions should the nurse take to perform this procedure? Select all that apply. o 1 Washes hands o 2 Applies a face shield o 3 Removes the client's oxygen mask o 4 Tells the client not to cough or breathe during the procedure o 5 Applies a clean disposable glove to the dominant hand and attaches the suction catheter to the connecting tubing o 6 Inserts the catheter into the client's mouth and moves the catheter around the mouth, pharynx, and gum line until secretions are cleared

1, 2, 3, 5, 6 Rationale: The nurse always washes the hands before performing any procedure, applies a face shield because suctioning may cause splashing of body fluids, and then dons a clean glove to each hand or dominant hand for oropharyngeal suctioning. A clean rather than a sterile glove can be used in this procedure because the oral cavity is not sterile. The nurse then completes preparation by attaching the suction catheter to the connecting suction tubing. The nurse removes the oxygen mask just before implementing the procedure so that the client is oxygenated as much as possible (remember that suctioning can deplete oxygen). The catheter is then inserted into the client's mouth until secretions are cleared. If the client is not tolerating the procedure, then the catheter is removed and the oxygen mask is reapplied. The nurse next encourages the client to cough because coughing moves secretions from the lower to upper airways into the mouth. At this point, suctioning is repeated if necessary. The oxygen mask is then reapplied.

** Which ethical principle is violated when the RN tells the hospital accountant that the patient is HIV-positive? Select all that apply 1.Beneficence 2.Veracity 3.Confidentiality 4.Autonomy 5.Fidelity

1, 3

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

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

1, 3, 4

** To establish legal liability on the grounds of malpractice, the injured party must prove which of the following? Select all that apply 1.A duty of care was owed to the injured party. 2.An agreement was made to assume another party's liability. 3.There was a breach of duty. 4.Causation was present. 5.Actual harm or damages were suffered by the plaintiff.

1, 3, 4, 5

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.

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.

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.

2 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.

An active shooter incident occurs in the triage area of a large busy emergency room. What is the priority action for the triage nurse to take? 1.Assist vulnerable patients, who are in the line of fire, to drop to the floor. 2.Locate a safe path and run to a safe place; take others if possible. 3.Find a secure place, such as a barricaded room, to hide self and others. 4.Aggressively fight off the attacker using any means available.

** A client receiving a blood transfusion develops signs of a blood transfusion reaction. The nurse stops the transfusion and maintains the intravenous (IV) line with normal saline. Which action should the nurse take next? o 1 Document the occurrence. o 2 Check the client's vital signs. o 3 Send the blood bag and tubing to the blood bank for examination. o 4 Check the client's urine output, and obtain a urine specimen for analysis.

2 Rationale: If a transfusion reaction is suspected, the transfusion is stopped and then normal saline is infused with new IV tubing pending further primary health care provider prescriptions. This maintains a patent IV access line and aids in maintaining the client's intravascular volume. The nurse should next check the client's vital signs and notify the primary health care provider and the blood bank about the reaction. The nurse should obtain a urine specimen for analysis to check for hemolysis of red blood cells. The nurse then sends the blood bag and tubing to the blood bank for examination and documents the occurrence on the transfusion report and in the client's chart.

** A client is hospitalized with chest pain, and myocardial infarction is suspected. The client tells the nurse that the chest pain has returned, and the nurse administers one 0.4-mg nitroglycerin tablet sublingually as prescribed. What should the nurse do next before administering another sublingual nitroglycerin tablet if the pain is not relieved? o 1 Place the client in a flat position. o 2 Check the client's blood pressure. o 3 Encourage the client to deep-breathe. o 4 Notify the primary health care provider (PHCP).

2 Rationale: In the hospitalized client, nitroglycerin tablets are usually administered 1 every 5 minutes, not exceeding 3 tablets, for chest pain as long as the client maintains a systolic blood pressure of 100 mm Hg or above. The nurse should check the client's blood pressure before administering a second nitroglycerin tablet. The PHCP is notified if the chest pain is not relieved after administering 3 tablets. If there is a sudden drop in blood pressure, the client is placed in a flat position and the PHCP is notified. Deep breathing will not relieve the chest pain that occurs as a result of myocardial infarction.

** The major responsibility for upholding patient care standards belongs to the: 1.chief executive officer of the facility 2.nurse manager. 3.on-call physician. 4.staff nurse providing patient care.

2 Rationale: Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.

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.

2 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 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? · o 1 Insert a urinary (Foley) catheter. o 2 Administer low-flow oxygen through a nasal cannula. o 3 Obtain an intravenous (IV) infusion pump to administer heparin. o 4 Increase the rate of the IV fluids infusing to prevent hypotension.

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.

** A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply). 1.Justice 2.Autonomy 3.Veracity 4.Confidentiality

2, 3 Rationale: Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case.

** Which of the following are examples of intentional torts that may occur in the health care field? Select all that apply 1.Slip and fall in the hospital cafeteria 2.Patient restrained by the neck utilizing the nurse's arm 3.Ovary removal against the patient's signed consent 4.Restraining a patient without a physician's order 5.Hospital-acquired pressure ulcer

2, 3, 4 Rationale: Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment.

** Which of the following patient-related events may be considered as examples of common negligence allegations in a nursing malpractice suit? Select all that apply 1.Staffing levels in the medical unit 2.Patient fall with injury 3.Heparin error 4.Failure to utilize rapid response team with change in vital signs 5.Failure to ensure telemetry monitor is on the correct patient

2, 3, 4, 5 Rationale: Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians' orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment.

** Professional safeguards that protect the nurse from being wrongfully accused of malpractice include which of the following? Select all that apply 1.Code of Ethics 2.Statute of Limitations 3.Affidavit of Merit 4.Standard of Proof 5.Sources of Law

2, 3, 5 Rationale: Civil law controls those circumstances when an individual, the plaintiff, feels that he or she has been harmed by another. If the other person is a professional, the law provides for professional liability, also known as malpractice. Professionals are provided with many safeguards to avoid them being wrongfully accused of malpractice. The Statue of Limitations is a statutory time limit (most commonly 2 years) by which a plaintiff must file a lawsuit against a professional or lose that opportunity forever. An affidavit of merit is a sworn document by a like kind of professional (a doctor for a doctor defendant and a nurse for a nurse defendant) who reviews the injured patient's chart, and,based upon the reviewer's education and experience, makes a statement that the case has merit and should be permitted to go to trial. Laws are found in case books, as well as online in official reports and legal research services. A reported case is one that can be found in an official reporter. There are state as well as federal reporters. When entered into a reporter, the case is printed and becomes part of the ever-growing body of case law.

** The nurse hears the alarm sound on the telemetry monitor, quickly looks at the monitor, and notes that a client is in ventricular tachycardia. The nurse rushes to the client's room, and on reaching the client's bedside, the nurse should perform which action first? o 1 Open the airway. o 2 Begin chest compressions. o 3 Determine unresponsiveness. o 4 Deliver 2 effective breaths.

3 Rationale: Determining unresponsiveness is the first action to take. When a client is in ventricular tachycardia, there is a significant decrease in cardiac output. However, checking for unresponsiveness determines if the client is affected by the decreased cardiac output. If the client is unresponsive, the nurse proceeds through CAB-compressions, airway, and breathing-of the cardiopulmonary resuscitation (CPR) sequence, remembering that the nurse should collect data before taking an action.

** The most common source of legal liability for nurse managers is a(n): 1.medical malpractice suit. 2.organizational nursing issue. 3.tort. 4.vicarious liability.

3 Rationale: In nursing, harm related to clinical practice commonly arises from negligent acts or omissions (unintentional torts) and a variety of intentional acts (intentional torts), such as invasion of privacy or assault and battery.

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.

3 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.

** A new RN is observed breaking sterile technique by the perioperative nurse. This is an example of a violation of which ethical principle? 1.Autonomy 2.Justice 3.Nonmaleficence 4.Confidentiality

3 Rationale: Nonmaleficence means doing no harm to clients. A break in sterile technique could cause significant harm to a patient by causing an infection.

** A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the: 1.ANA. 2.current federal defense attorney. 3.state nurse practice act. 4.policy and procedure manual of the unit.

3 Rationale: Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision.

** A client with a diagnosis of sickle cell crisis is being admitted to the hospital. The nurse anticipates that which priority intervention will be prescribed? o 1 Laboratory studies o 2 Genetic counseling o 3 Oxygen administration o 4 Electrolyte replacement therapy

3 Rationale: Oxygen, intravenous fluids, pain medication, and red blood cell transfusions are the priority interventions for treating sickle cell crisis. Laboratory studies may also be prescribed, but are not the priority in the care of the client. Genetic counseling is recommended, but not during the acute phase of illness. Electrolyte replacement therapy may be necessary, but this treatment would be based on the results of laboratory studies.

** 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? o 1 Change the intravenous tubing. o 2 Slow the rate of infusion of the TPN. o 3 Notify the primary health care provider. o 4 Call the pharmacy for a new bag of TPN solution.

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.

** A child with a diagnosis of pertussis (whooping cough) is being admitted to the pediatric unit. As soon as the child arrives on the unit, which action should the nurse perform first? o 1 Weigh the child. o 2 Take the child's temperature. o 3 Place the child on a pulse oximeter. o 4 Administer the prescribed antibiotic.

3 Rationale: To adequately determine if the child is getting enough oxygen, the child is placed on a pulse oximeter. The pulse oximeter will then provide ongoing information on the child's oxygen level. The child is also immediately placed on a cardiorespiratory monitor to provide early identification of periods of apnea and bradycardia. The nurse should then collect data on the client, including taking the child's temperature and weight and asking the parents about the child. An antibiotic may be prescribed, but the child's airway status needs to be checked first.

** The nurse is collecting data on a client with a diagnosis of bulimia nervosa who has problems with nutrition. The nurse should obtain information from the client about which finding first? o 1 Lack of control o 2 Previous and current coping skills o 3 Feelings about self and body weight o 4 Eating patterns, food preferences, and concerns about eating

4 Rationale: The nurse should first identify the client's eating patterns, food preferences, and concerns about eating when collecting data on a client with bulimia nervosa to determine a baseline for further planning and because this information relates to the client's physiological needs. The nurse should also obtain information about lack of control, previous and current coping skills, and the client's feelings about self and body weight, but this information is secondary to eating patterns and food preferences.

** The nurse is caring for a client with an injury to the brainstem. The nurse should monitor which parameter as the priority? o 1 Urine output o 2 Electrolyte results o 3 Peripheral vascular status o 4 Respiratory rate and rhythm

4 Rationale: The respiratory center is located in the brainstem. Therefore, monitoring the respiratory status is a priority in a client with a brainstem injury. The nurse may also monitor urine output, electrolyte results, and peripheral vascular status, but these are not the priority.

Which combination of employees would be best to include in a committee to address the issue of violence against emergency department (ED) personnel? •1. ED health care providers and charge nurses •2. Experienced RNs and experienced paramedics •3. RNs, LPNs/LVNs, and assistive personnel •4. At least one person from all ED groups

** The nurse is caring for a client in Buck's extension traction. The nurse should identify which client problem as the priority? o 1 Expressed feelings of social isolation o 2 Observed inability to distract oneself o 3 Verbalized anger about the need for immobility o 4 Observed skin redness around the edges of the boot appliance

4 Rationale: Buck's extension traction is a type of skin traction in which weights are attached to the skin with the use of a boot or elastic bandage. A priority problem for the client in this type of traction is the potential for breaks in skin. The potential for alteration in neurovascular status is also a concern. Options 1, 2, and 3 may be problems for the client in Buck's extension traction, but redness around the edges of the boot appliance presents the greatest risk for skin breakdown.

** The nurse on a medical unit is caring for a 19-year-old with complications from a congenital heart defect. The client's mother is consistently at the bedside asking questions and attempting to direct the treatment plan. Which of the following shows how the nurse should communicate with the mother? 1.Discuss personal information that the client shared with the nurse in confidence. 2.Provide the mother with any information required for continuity of care. 3.Explain that client confidentiality prevents the nurse from disclosing information. 4.Ask the client if he gives permission for the nurse to share information with the mother.

4 Rationale: It is the nurse's legal and ethical duty to protect the adult "child's" autonomy and not simply accept a parent's intervention, without lawful authority, just because it may seem easier at the moment. The nurse must obtain permission from the client before sharing information with the mother.

** An antepartum client at 32 weeks' gestation positioned herself supine on the examination table to await the obstetrician. The nurse enters the examination room, and the client says, "I'm feeling a little lightheaded and sick to my stomach." The nurse recognizes that the client may be experiencing vena cava syndrome (hypotensive syndrome) and should take which immediate action? o 1 Give the client an emesis basin. o 2 Place a cool cloth on the client's forehead. o 3 Call the obstetrician to see the client immediately. o 4 Place a folded towel or sheet under the client's right hip.

4 Rationale: Lying supine (on the back) applies additional gravity pressure on the abdominal blood vessels (iliac vessels, inferior vena cava, and ascending aorta), increasing compression and impeding blood flow and cardiac output. This results in hypotension, dizziness, nausea, pallor, clammy (cool, damp) skin, and sweating. Raising 1 hip higher than the other reduces the pressure on the vena cava, restoring the circulation and relieving the symptoms. Although an emesis basin and a cool cloth placed on the forehead may be helpful, these are not the immediate actions. It is not necessary to call the obstetrician immediately unless the client's complaints are unrelieved after repositioning.

** 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? o 1 Constipation o 2 Urine output o 3 Temperature o 4 Blood pressure

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 client is scheduled for a diagnostic procedure requiring the injection of a radiopaque dye. The nurse should check which priority information before the procedure? o 1 Intake and output o 2 Height and weight o 3 Baseline vital signs o 4 Allergy to iodine or shellfish

4 Rationale: Procedures that involve the injection of a radiopaque dye require an informed consent. The risk for allergic reaction exists if the client has an allergy to iodine or shellfish. The risk of allergic reaction and possible anaphylaxis must be determined before the procedure. Although options 1, 2, and 3 identify information obtained before the procedure, these items are not the priority

** A client has been newly diagnosed with diabetes mellitus. The nurse should perform which action as the first step in teaching the client about the disorder? o 1 Decide on the teaching approach. o 2 Plan for the evaluation of the session. o 3 Gather all available resource materials. o 4 Identify the client's knowledge and needs.

4 Rationale: Determining what to teach a client begins with a determination of the client's own knowledge and learning needs. Once these have been determined, the nurse can effectively plan a teaching approach, the actual content, and resource materials that may be needed. The evaluation is done after teaching is completed.

** On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse's actions, the admitting hospital may be found to be: 1.a judicial risk. 2.an ostensible authority. 3.indemnified. 4.vicariously liable.

4 Rationale: If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable.

** Nurse managers are able to respond better to ethical dilemmas when they have access to the organization's: 1.mission and vision. 2.patient safety plan. 3.medical staff bylaws. 4.ethics committee.

4 Rationale: It is critical that nurses and administrators have access to and inclusion on the health care organization's ethics committee. Nursing professionals are ideal members because of their responsibilities and experiences associated with patient care.

** Which ethical principle is violated when there are insufficient community resources to meet the needs of low-income families? 1.Nonmaleficence 2.Autonomy 3.Beneficence 4.Justice

4 Rationale: Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served.

** 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? · o 1 Respirations o 2 Urine output o 3 Lung sounds o 4 Blood pressure

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.

A 50-car pileup occurs on a major freeway in California's Central Valley as a result of heavy fog. There are major injuries, and victims are expected to be transported to local emergency departments. Which type of disaster is this classified as? a.Mass casualty event b.Conventional disaster c.Biological disaster d.Radiological disaster

A Rationale: A mass casualty event is a catastrophic public health or terrorism-related event that results in the community's health care system being overwhelmed by the needs of victims

All-hazards disaster is best defined as: a.all types of natural and human terrorist events. b.an event involving floods, tornadoes, hurricanes, and earthquakes. c.an unforeseen and often unplanned event causing great damage. d.any type of biological, chemical, radiological, or nuclear event.

A Rationale: An all-hazards disaster includes all types of natural acts such as earthquakes, forest fires, floods, and hurricanes, or terrorist events such as biological, chemical, radiological, and nuclear attacks. A disaster is an unforeseen and often sudden event that causes great damage, destruction, and human suffering.

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. A.Authoritarian B.Democratic C.Laissez-faire D.Servant

A Rationale: 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

** 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

A Rationale: 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 employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighborsays 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.

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.

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: A.Effective leadership B.Management involvement C.Mentoring D.Rewards and recognition

A Rationale: 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.

** 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 D.Assessing the community to determine which population groups to target for education.

A Rationale: 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.

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.

In a hospital's emergency operations plan, what would be the expected roles of the security department (select all that apply)? a.Overseeing facility security b.Lockdown of the facility as necessary c.Managing people entering and leaving the hospital d.Restraining uncooperative visitors e.Being the primary source of communication to nursing staff

A, B, C Rationale: The primary responsibility of the safety and security department, in conjunction with nursing leadership, is to develop or refine the hospital's emergency operations plan for incidents based on the hazard vulnerability analysis. The safety and security department needs to have assigned oversight for facility security, quick lockdown or controlled access, and management of people flowing into and out of the hospital.

Which of the following questions should be considered in the hospital gap analysis survey of clinical operations readiness in the event of a disaster (select all that apply)? a.Does the facility have procedures in place to maximize staff safety in a disaster? b.Does the facility have procedures in place for use of PPE? c.Can the facility track patients until discharge or death while maintaining confidentiality? d.Does the facility have a lockdown plan in case of emergency? e.Does the facility have a mechanism of tracking costs associated with the event?

A, B, C Rationale: assessing the clinical operations readiness in the gap analysis survey can be answered by asking some of the following questions: Does the facility have procedures in place to maximize staff safety in a disaster? Does the facility have procedures in place for use of PPE? Can the facility track patients until discharge or death while maintaining confidentiality?

Hospital leadership should consider which of the following ethical dilemmas prior to experiencing an actual disaster (select all that apply)? a.Which clinical leader will make the decision about distribution of scarce resources b.Criteria to determine which patients receive aggressive treatment and which will receive palliative care c.Which nursing staff will be the first to report to the hospital in the event of a disaster d.How prophylactic pharmaceuticals will be distributed to protect staff and their families e.Who will be primarily responsible for external communication

A, B, D Rationale: An emerging issue that challenges care during a disaster is allocation of scarce resources when the system is overwhelmed. Implementing periodic tabletop discussions regarding how to allocate resources in a time of scarcity will prove to be a powerful tool in setting the stage for what to do if such an event occurs. Collaborative professional staff and hospital leadership discussions about scarce resource allocation will present ethical dilemmas that need to be thoughtfully considered in a planning time that is devoid of emotion. Questions to be discussed at the tabletop include which hospital and/or clinical leader will make the final decision about ventilator allocation and other scarce resource distribution; the criteria used to determine which patients receive aggressive treatment and which will receive palliative care, both imminently and long term, as other life-threatening complications ensue; and how prophylactic pharmaceutical dissemination plans are going to be activated to protect staff and their families.

The hospital plays an important role in the community in the case of a disaster. What are some of the expected roles of the hospital (select all that apply)? a.Stockpiling emergency equipment b.Purchasing personal protective equipment (PPE) c.Providing additional security for the community d.Educating staff on all-hazards preparedness e.Providing emergency shelter to community members

A, B, D Rationale: The hospital will play an important role in the community in the case of a disaster. The materials, equipment, and training required for hospitals to prepare adequately for their role in responding to disasters are very expensive. Capital expenditures will be required to create decontamination facilities; purchase PPE; train and educate staff on effective all-hazards preparedness; stockpile emergency equipment, supplies, and pharmaceuticals; ensure adequate isolation rooms; and outfit a hospital command center. Hospitals need financial assistance to do this well, and the AHPTF members can be advocates for federal and state funding.

Nursing leadership competencies in disaster planning and crisis management encompass which of the following domains (select all that apply)? a.Assessment of the disaster scene b.Technical skills c.Budget and resource allocation d.Risk communication e.Critical thinking

A, B, D, E Rationale: Nursing leadership competencies in disaster planning and crisis management are invaluable, and fortunately they have been developed by a collaborative group led by the Department of Veterans Affairs, Office of Nursing Services. These disaster competencies are categorized into four domains: assessment of the disaster scene, technical skills, risk communication, and critical thinking (Coyle et al., 2007).

What are the major roles of nursing leadership in disaster planning (select all that apply)? a.Providing clearly defined roles for staff nurses in a disaster situation b.Providing policies that speak to expected hours of work in a disaster c.Encouraging staff to stay at home in the event of a disaster to decrease confusion d.Ensuring that the community is synchronizing internal department plans in the event of a disaster e.Sharing written identified roles with every department to ensure disaster preparedness

A, B, E Rationale: Nursing leadership needs to lead efforts to ensure that all facility departments have an understanding of their role in a disaster situation. The role of the staff nurse in a disaster must be clearly defined and contain performance standards, including policies that speak to expected hours or refusal to work (Danna et al., 2009). Nurse leaders are the coordinators in synchronizing department plans so that everything fits together to meet the staff's, patients', hospital's, and community's essential needs. Once the comprehensive all-hazards preparedness plans are complete, every department should understand their identified written role.

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

A, B, and D Rationale: 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.

A disaster is a sudden event that can cause great destruction and human suffering and often requires external assistance. Which of the following statements are accurate depictions of various types of disasters or disaster-related definitions (select all that apply)? a. A cyber disaster is a catastrophic event that results from the use of information technology systems. b.A catastrophic event caused by the use of weapons is a radiological disaster. c.A biological disaster occurs when there is a deliberate or unintentional release of biological materials that may affect the health of those exposed. d.A chemical disaster occurs when there is deliberate or unintentional release of biological materials that may adversely affect the health of those exposed. e.A hazard vulnerability analysis is an exercise that identifies an organization's potential emergencies.

A, C, E rationale: A cyber disaster is catastrophic event that results from the use of information technology systems to control or disrupt critical infrastructure systems. A biological disaster occurs when there is a deliberate or unintentional release of biological materials that may affect the health of those exposed. A hazard vulnerability analysis is an exercise that identifies an organization's potential emergencies, the likelihood of the event occurring, and the impact it would have on the organization.

** 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

A, C, E, and F Rationale: 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.

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

A, C, and D Rationale: 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

Which of the following questions should be considered in the hospital gap analysis survey of safety and security readiness in the event of a disaster (select all that apply)? a.Does the facility have a lockdown plan in case of emergency? b.Does the facility have procedures in place for use of PPE? c.Does the facility have a mechanism of tracking costs associated with the event? d.Do you have a plan for allowing staff entry into the facility during an emergency? e.Does the facility have emergency-powered phones in case of a disaster?

A, D, E Rationale: Assessing the readiness of safety and security in the gap analysis survey can be answered by asking some of the following questions: Does the facility have a lockdown plan in case of emergency? Do you have a plan for allowing staff entry into the facility during an emergency? Does the facility have emergency-powered phones in case of a disaster?

** 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.

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.

The nursing leadership role once the all-hazards preparedness plan is completed is to: A.confirm that resources are allocated appropriately. B.ensure that every department understands their role is a disaster situation. C.establish goals for all-hazards preparedness. D.provide rewards for the committee's accomplishments

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

** All-hazard preparedness plan drills should occur at least: a.annually. b.biannually. c.monthly. d.quarterly.

B Rationale: All-hazard preparedness plan drills should occur at least twice a year.

A health care system's ability to rapidly expand beyond normal capacity to meet an increased demand for qualified personnel, beds, and medical care services in the event of a large-scale emergency or disaster is known as: A.acuity. B.surge capacity C.mass casualty D.natural disaster

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.

** 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. D.Assisting patient with personal hygiene and other activities of daily living as needed.

B Rationale: 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.

The system-wide AHPTF should conduct a gap analysis. What should be evaluated? a.Differences between standards and policies and procedures b.Differences between pieces of the program that are and are not in place c.Similarities between standards and policies and procedures d.Similarities between pieces of the program that are and are not in place

B Rationale: A gap analysis compares current standards and programs that are in place with the ones that are needed.

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: A.adaptation. B.empowerment. C.flexibility. D.relationship management.

B Rationale: 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.

Which of the following warnings is used to alert the American people about credible terrorist threats? a.Imminent threat b.Elevated threat c.Unlikely threat d.Likely threat

B Rationale: In April 2011, the federal government implemented a new alert system, the National Terrorism Advisory System (NTAS), which replaced the color-coded system implemented by Homeland Security. The new two-level system will warn the American public about elevated threats, which warns of a credible terrorist threat, or imminent threat, warning the public that a credible and specific terrorist threat is imminent

What is unique to the role of the nurse that fosters strong leadership in the overwhelming workload of the "keeping the momentum going" phase in the development of an all-hazards preparedness plan? Nurses are experts at: a.creating key components of disaster protocols. b.developing workable action plans for difficult issues. c.establishing guidelines for policy and procedures. d.improving care by developing patient care plans.

B Rationale: Nurses are experts at creating workable action plans for seemingly impossible obstacles and helping others to see the steps to take, because they do this every day while caring for patients

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

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 experience a worsening condition.

A health care system's ability to rapidly expand beyond normal capacity to meet an increased demand for qualified personnel, beds, and medical care services in the event of a large-scale emergency or disaster is known as: a.acuity. b.surge capacity. c.mass casualty. d.natural disaster.

B Rationale: Surge capacity refers to a health care system's ability to rapidly expand or flex up beyond normal capacity to meet an increased demand for qualified personnel, beds, and medical care services in the event of a large-scale emergency or disaster (Agency for Healthcare Research and Quality [AHRQ], 2005b; TJC, 2008). In addition to the overall all-hazards preparedness plans, the hospital will need to define procedures regarding what will be done in any biological, chemical, nuclear/radiological, or conventional disaster, and the surge capacity needs related to any of the events.

The nursing leadership role in the "working the issues list" phase of an all-hazards preparedness plan is to: a.confirm that team members are working on their assignments. b.ensure that every facility department has a disaster plan. c.guarantee that all work will be completed by the deadline. d.provide rewards for the committee's accomplishments.

B Rationale: The role of nursing leadership is to lead efforts to ensure that every facility department has a plan for what to do in a disaster situation.

** 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.

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.

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.

** 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.

B rationale: 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.

What are the two agencies that require all health care facilities to have detailed all-hazard preparedness plans (select two that are correct)? a.Patient Protection and Affordable Care Act b.Health Insurance Portability and Accountability Act c.TJC d.National Response Plan

B, C Rationale: Health care executives across the country understand the need to dedicate resources to support effective all-hazards preparedness. The Health Insurance Portability and Accountability Act (HIPAA) and TJC require all health care facilities to have detailed all-hazard preparedness plans. Nursing leaders are an integral part of the planning process and should have knowledge of the national response plan and state and local disaster response plans.

In an AHPTF, which of the following entities could be utilized as external ad hoc members (select all that apply)? a.Facility engineering b.Public health department representatives c.Community physicians d.Vendor representatives e.Chaplain services

B, C, D Rationale: As the AHPTF evolves in its work, ad hoc members can be added as needed. Internal ad hoc members might include radiology, facility engineering, telecommunications, volunteer support, chaplain services, physician chairs, social work, case management, dietary, respiratory, and laboratory services. External ad hoc members might include representatives from the local public health department; government liaisons; police; fire and rescue; public school systems; representatives from the faith community; community physicians; and even vendor representatives, who can be contracted to provide such things as oxygen, ice, food, cots, and linens in the event of a disaster.

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

B, C, D, and E Rationale: 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.

Testing the all-hazards preparedness plan requires drilling to identify and work through problems. Which of the following are examples of internal drills that can be used to test specific departments and/or hospital responses (select all that apply)? a.Surge capacity drills b.Lockdown of hospital entrances c.Prioritization of police response to biological events d.Simulating decontamination processes e.Setting up the command center

B, D, E Rationale: Having comprehensive all-hazards preparedness plans requires frequent (at least biannual) drills to work through problems. Internal drills test specific department and/or hospital responses (e.g., setting up and operating the command center; recognizing a biological event both in the emergency department and on the units; lockdown of the hospital entrances; simulating decontamination processes; operating using downtime procedures during a communications or cyber disaster event; handling various surge capacity situations).

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

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).

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? A.Autocratic B.Consultative C.Joint D.Delegated

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.

In an AHPTF, who would have primary responsibility for serving as spokesperson for emergency physician needs with regard to disaster preparedness? a.Chief nursing officer b.Marketing director c.Department medical chair d.Chief information technology officer

C Rationale: The emergency department medical chair would represent all aspects of emergency medicine and physician needs related to all-hazards preparedness.

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.

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.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 b.A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. c.A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. d.The client cannot make changes in the advance directive once the client is admitted into the hospital.

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: A.Primary work team B.Leadership team C.Ad hoc team D.Dysfunctional team

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.

In a disaster, it is most important that the: a.clients are sent home quickly. b.medications and supplies are secure. c.nurses and their families feel safe. d.security department increases its workforce.

C Rationale: It is most important that the staff members feel safe. In a disaster, the paradigm of keeping the patient safe first needs to change its focus so that staff members and their families feel as safe as possible. This way, staff members are best able to meet their patients' needs.

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

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

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

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

** 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

C Rationale: 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.

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

C -Call the doctor afterwards

Which combination of leadership is recommended for chairing an all-hazards preparedness task force (AHPTF)? a.Chief executive officer and internal medicine physician b.Chief financial officer and emergency care nurse liaison c.Representative chief nurse officer and emergency care physician d.Representative chief information technology officer and critical care physician

C Rationale: A representative chief nurse officer such as a nursing director, along with an emergency care physician, creates a dynamic team that is uniquely prepared to tackle any issues that arise because of an all-hazards disaster. Including a senior executive administrator of the health care team provides the leadership needed to communicate the importance of all-hazards preparedness as a system priority.

** 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

C Rationale: 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.

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: A.Care provider B.Business principles C.Care coordination D.Change management

C Rationale: 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.

** 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

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

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: A.Living wills. B.Assisted suicide. C.Passive euthanasia. D.Advance directives.

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

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.

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

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.

The Joint Commission's (TJC's) emergency management accreditation standards call for hospitals to sustain disaster operations for at least ______ hours. a.24 b.48 c.72 d.96

D Rationale: TJC's emergency management accreditation standards call for hospitals to sustain disaster operations for at least 96 hours should an external disaster occur that impacts the local area or region (TJC, 2012). Lessons learned from Hurricane Katrina illustrate just how long it can take before assistance is available.

** An all-hazards command center should: a.facilitate planning meetings. b.provide a place for the commander to sleep. c.be operated by an emergency department triage nurse. d.be located near the security department.

D Rationale: The command center usually is located near the security department and is commanded by the administrator on call, along with the chief nurse officer, emergency department-air care medical director, and safety and security director.

** 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

D Rationale: 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.

When working with the community, recognizable nomenclature is important for: a.response. b.education. c.reporting. d.communication.

D Rationale: When working with the community, recognizable nomenclature becomes especially important for communication in crisis situations. A response plan is provided in staff education about what to do in a disaster and what types of communication to expect.

A conventional disaster is a catastrophic event caused by: a.a high-magnitude earthquake. b.an exposure to toxic materials. c.an outbreak of a pathogen. d.the use of military weapons.

D Rationale: A conventional disaster is a catastrophic event caused by the use of weapons such as guns, bombs, missiles, and grenades.

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? 1."Let me get permission from the client first." 2."Sure, which client is it?" 3."I can't do it unless you supervise me." 4."I can't do it. Is there something else I can help you with."

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.

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? A.Refuse to float in the ICU B.Call the hospital lawyer C.Call the nursing supervisor D.Report to the ICU and identify tasks that can be safely performed.

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

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.

** 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.

D Rationale: 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

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