Managing Care/Collaboration

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1. During orientation, a novice nurse sits and "virtually spends" the first few paychecks, envisioning the money going into a personal bank account. In the dream state, the nurse smiles and knows that the pain of nursing school was worth it. Which phase of reality shock is the nurse experiencing? a. Honeymoon b. Shock or rejection c. Recovery d. Resolution

A During the honeymoon phase, the novice nurse has a positive image of nursing that coincides with the reason for becoming a nurse; this feeling is experienced immediately after the nurse begins work and often while still in orientation.

1. The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to: a. the registered nurse (RN). b. the licensed practical/vocational nurse (LPN/LVN). c. unlicensed assistive personnel (UAP). d. all levels of staff, because the information is about the past and cannot change.

A Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated.

5. Several novice nurses share lunch breaks and have comments such as, "I have insomnia from worrying about what I forgot to do for my patient," and "I have no energy," and "I can't believe I can't do my job correctly." These novice nurses are each experiencing different symptoms of: a. burnout. b. low self-esteem. c. lack of confidence. d. resilience.

A Symptoms of burnout include extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger.

Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established? a. Administer an enema for an elective surgery patient. b. Administer an antiarrhythmic medication IV while interpreting the patient's rhythm on the cardiac monitor. c. Develop a plan of care for a stable patient admitted for observation after a head injury. d. Teach a patient how to instill eye drops for glaucoma.

A The RN who is delegating must consider the following: (1) the delegatee's current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task.

A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee? a. Actually observe the delegatee perform the assigned task. b. Ask the delegatee how many times he/she has performed the task. c. Ask the patient if the care provided was satisfactory. d. Ask other nurses if they feel the delegatee is competent.

A The best way for the nurse to determine the competency of LPNs or UAPs is to observe them perform the task.

A certified oncology nurse notices that a novice nurse is unsure of decision making and lacks technical skills. The novice nurse gains confidence by sharing and learning with the experienced nurse. This relationship continues and builds, allowing the novice nurse to become more confident. This relationship is known as: a. mentoring. b. role modeling. c. a preceptorship. d. socialization.

A The experienced and novice nurses have entered into a mutually agreed upon interactive relationship to ease the transition of the novice nurse into the profession.

9. When the novice nurse asks, "What will happen if this task is not completed," which skill is being demonstrated? a. Priority setting b. Delegation c. Organization d. Clinical skills

A The novice nurse is considering the legal and safety ramifications if the task is not completed.

The novice nurse calls a supervisor and requests that a "float nurse" be assigned to help with all "assessments of new admissions and postoperative patients." The supervisor asks, "How many admissions and surgery patients have you received?" The novice nurse becomes flustered because she has not checked the census but simply bases the need on feeling overwhelmed. This situation best indicates a lack of _____ skills. a. organizational b. communication c. interpersonal d. clinical

A The novice nurse lacks proficiency, which may be exaggerated by feelings of being overwhelmed by the new environment, causing him or her to not get the facts before asking for help.

A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Unlicensed assistive personnel (UAP) d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.

A The patient's condition is not stable; therefore, the skills of an RN are required

19. A novice nurse is in the "rejection phase" of stress and wonders if she made the right decision when deciding nursing was her chosen career. Which strategy would help the novice nurse cope with transition into practice and reduce stress? a. When asked by the charge nurse to accept the new admission even though she had no discharges, the novice nurse stops and considers if this request is acceptable and safe, then accepts the assignment based on two patients having a low acuity level. b. Refusing to eat anywhere but the hospital cafeteria to ensure a balanced diet and time to socialize with other staff and visitors. c. Avoid wasting time by listening to coworkers' problems or ideas on how to staff the unit during the upcoming holiday since the novice nurse's time is valuable and better spent getting her own work completed. d. Make an effort to "win over" hostile or angry coworkers who find fault with the novice nurse's work performance.

A To reduce stress and cope with the rejection phase of transition, the novice nurse should think before answering—take a few minutes before answering and deciding what is best course of action.

16. The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of: a. direction and communication. b. task. c. person. d. circumstances.

A The directions were not clear. The RN did not specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back.

3. A novice nurse notices a patient is pacing the floor and twisting his hands. When the nurse enters the room, the patient stares at her and mumbles, "Can't anyone understand what I want?" while smiling and reaching out to shake the nurse's hand. The nurse recognizes a risk for violence based on which clinical findings? (select all that apply) a. Glaring at the nurse b. Nervousness, twisting of hands c. Murmuring when talking d. Diagnosis of a terminal illness e. Isolation, desire to be alone

A, B, C Nurses can recognize a risk for workplace violence by using the acronym STAMPEDAR (staring, tone of voice, anxiety, mumbling, pacing, emotions, disease process, assertive/nonassertive behavior, and resources).

1. Which statement made by an RN regarding delegation indicates the need for additional teaching? (select all that apply) a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely. b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion. d. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. e. Responsibility can be delegated to the UAP, but the delegator retains accountability.

A, B, C The statement "UAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely" indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus the assessment skills of an RN are required. The statement "an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD" indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on a patient's blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN.

Which functions can be delegated only to another RN with appropriate experience and training? (select all that apply) a. Assessment of skin integrity on third day of hospitalization b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises c. Nursing judgment related to withholding medication based on vital signs d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel e. Formulation of nursing diagnosis "potential for fall"

A, B, C, E Activities like assessing skin integrity—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like evaluating patient teaching—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like deciding to withhold medication based on vital signs—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like formulating a nursing diagnosis—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.

2. A nursing administrator who is considering the feasibility of an all-RN staff reviews the report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and determines that RNs: (select all that apply) a. are more costly and less efficient than LPNs. b. have little or no effect by being proactive but instead are reactive to patient care errors. c. have a positive effect on patient outcomes when managing patient care. d. are effective overseers of patients' overall health condition. e. lack the training to be effective delegators.

ANS: C, D RNs are effective at coordinating care that results in improved patient outcomes. RNs are valuable monitors of a patient's health status—a practice that results in improved patient outcomes.

Which nurse is more prone to burnout? The nurse who:. a. graduated last in the class. b. is industrious and conscientious. c. refuses to work an extra shift even though he or she needs the money. d. volunteers to serve on only one committee and keeps in touch with schoolmates.

B Burnout is more common among nurses with type A personalities and those who are overachievers.

During height and weight assessments at a school's health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, "Drinking coffee stunts a child's growth." This logical fallacy is referred to as: a. appeal to common practice. b. confusing cause and effect. c. ad hominem abusive. d. red herring.

B Cause and effect are confused when one assumes that a particular event must cause another just because the two events often occur together.

A novice nurse is assigned a patient who has an order to draw blood for culture and sensitivity from a central line before antibiotic therapy is started. The novice reads and rereads the procedure manual. An hour later he stands at the bedside of the patient and stares at the central line, without knowing how to proceed. This phase of reality shock is termed: a. honeymoon. b. shock or rejection. c. recovery. d. resolution.

B During the shock or rejection phase, there is inconsistency with what was learned in school and the work environment, and the novice nurse lacks many of the skills needed to be independent in this new role.

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations? a. Blocking b. Filtration c. Empathy d. False assurance

B Filtration is the unconscious exclusion of extraneous stimuli in communication

During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting: a. assertive communication. b. active listening. c. empathy. d. passive communication.

B In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.

A student nurse wants to meet other nursing students from different countries and to learn of employment possibilities. The student nurse should: a. participate in the clinical facility's employee satisfaction task force. b. join the Student Nurses Association. c. take part in self-mentoring. d. postpone taking the licensure examination so he or she can take a tour of foreign countries.

B Students who participate in preprofessional organizations such as the Student Nurses Association have an opportunity to meet students across the nation and around the world and can network with leaders to gain knowledge about employment possibilities.

An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to: a. check the patient's drug packages to ensure that the correct drugs were given. b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. c. contact the nurse manager and ask that the LPN/LVN's license be suspended. d. call the pharmacy and ask for replacement medications for the patients.

B The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she intervene and identify concerns with the LPN/LVN.

20. The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse: a. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines. b. is at risk for HIPAA violations. c. has properly followed policy and protected the patient by not using her name. d. is demonstrating the logical fallacy of slippery slope.

B The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before.

6. A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to: a. supplement the staffing pattern when an RN is not available. b. aid the RN by performing appropriately delegated care tasks. c. replace the RN when the health care facility provides long-term care. d. provide patient teaching, allowing more direct care to be provided by the RN.

B The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice

The nurse is demonstrating active listening when: a. while assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." b. eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. he or she states, "I know how you feel, I recently lost my father and I am still hurting." d. cultural values are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."

B The behavior demonstrates active listening. A number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.

A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often take shortcuts. b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." c. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." d. "This drug always occludes the line because it is so viscous."

B The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation.

15. An experienced nurse working in oncology is shocked to realize that he feels little empathy when a patient explains, "I developed cancer from having to work in the dry cleaning industry since I was only 8 years old to help support my younger siblings during the depression. Now they have all moved away and refuse to help me financially, and it takes everything I have to pay for my chemotherapy medicine." The nurse is experiencing: a. burnout. b. compassion fatigue. c. reality shock. d. horizontal hostility.

B The nurse is experiencing a gradual decline in compassion over time as a result of being exposed to events that have distressed his or her patients, such as working at a young age to support a family while inadvertently being exposed to carcinogens.

A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy? a. "Research is identifying many risk factors for cancer besides smoking." b. "I understand how you could feel angry about the diagnosis." c. "He is still a good husband." d. "Why do you think he got cancer?"

B The nurse is placing herself in the wife's position and sharing her emotions

In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging

B Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.

Which of the following situations would be appropriate for the supervisory level of initial direction and/or periodic inspection? a. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis. b. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain "next steps." d. No supervision is necessary since both are registered nurses.

B When a working relationship is established and competencies of the delegate established, the delegator may check in during intermittently during the shift.

A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea

B With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated.

Faculty comes to class to present information about joining the Student Nurses Association (SNA). A student is heard saying, "Why join this organization? It is just a bunch of students like us. I'll wait and join the real nursing organization after graduation." This student is not aware of which benefits of SNA? (select all that apply) a. Members are eligible to sit for the licensure examination at a reduced rate. b. Leadership skills can be refined by working with other schools of nursing. c. The National SNA provides discounted rates for study abroad opportunities. d. A global view of nursing can be obtained through networking internationally. e. Lobbying efforts are a major benefit of belonging to SNA.

B, D Leadership opportunities are available as officers and through conferences. SNA members work with other nursing students across the nation and internationally.

1. In orientation, a new graduate is surprised to learn of workplace violence in health care agencies and asks, "What kind of violence is common in hospitals?" The educator describes workplace violence as: (select all that apply) a. care of patients admitted who are victims of domestic violence. b. experienced nurses withholding pertinent information from coworkers to portray them as incompetent. c. coworkers participating in an employee assistance program (EAP) to learn more about anger management for adult children living at home. d. care of persons being held for treatment prior to be incarcerated for committing homicide. e. statements such as "The new nurse has book sense but can't perform an admission physical without the help of everyone on the unit."

B, E Withholding information from novices or coworkers to purposely cause them to appear inadequate or unskilled is considered workplace violence because of the anxiety and stress it produces. This should not be tolerated and should be reported. Such statements, which belittle employees, lead to job dissatisfaction, lack of teamwork, and burnout and are considered lateral or workplace violence. This should not be tolerated and should be reported.

1. A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating: a. open communication. b. filtration. c. blocking. d. false assurance.

C Blocking occurs when the nurse responds with noncommittal or generalized answers.

3. According to Kramer, nurses in the shock phase should ask themselves: a. "How can I fit in with other staff?" b. "Why can't I perform as everyone expects?" c. "What changes can I make to make me feel good about the choice to become a nurse?" d. "How can I get the rest of the staff to change?"

C During the shock or rejection phase, novice nurses must ask themselves what they must do to become the type of nurse envisioned and to make a contribution.

An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a. "You are just too late for that. Where were you when he needed you?" b. "Did you ever consider purchasing a cell phone for your dad to prevent this from happening?" c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." d. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."

C Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person.

A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation? a. Baby Boomers b. Traditionalist c. Generation X d. Millenniums

C Generation X individuals grew up in when there was a high rate of divorces; they tend to be more cynical and value work-life balance and teamwork. Holidays are often associated with family gatherings which may have been absent in this generation's family; belief that ALL politicians are untrustworthy may be viewed as cynical. The need to take time to form suggestions to save time and come together to reach team decision are reflective of this generation.

A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should: a. query the state nursing association to determine their stance on the role of LPNs. b. ask the LPNs on the unit to list what tasks they routinely performed. c. contact the state board of nursing to determine legal scope of practice for LPNs. d. refer to California's nurse practice act because the scope of LPNs/LVNs is consistent across the United States.

C If the nurse practice act lacks clarity, the state board of nursing can provide guidance.

10. An RN is counseled by the nurse manager regarding inappropriate delegation when the: a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms. b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen and the RN states, "I will show you this time and you can show me the next time." c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube. d. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home.

C Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation

15. An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation? a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin. b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound. c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway. d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3.

C Risk of falling is great in later stages of Huntington's disease due to chorea movements

A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through: a. empathy. b. positiveness. c. supportiveness. d. accommodation.

C Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position.

20. Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria? a. The RN administers all medications to all patients. b. The LPN performs sterile dressings and IV tubing changes on all central lines. c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. d. The RN administers an enema to a stable patient who has an order "administer fleet enema PRN when no bowel movement in 2 days."

C The UAP, when properly trained, can place patients on telemetry. This meets quality and cost containment goals because the LPN and RN have higher salaries.

When comparing mentoring and role modeling, the role of mentoring is represented by which of the following situations? a. The experienced nurse is unaware that the novice nurse is observing him or her gathering supplies needed to start intravenous antibiotics. b. The novice nurse mimics conversations with his or her own patients that were unobtrusively overheard between the experienced nurse and his or her patients. c. The novice nurse receives feedback from the experienced nurse related to the use of a new occlusive dressing product and is told, "I couldn't have done it better myself." d. An experienced nurse is nominated for outstanding employee of the month by the novice nurse.

C The experienced nurse knowingly enters into a relationship to advocate for and to enhance the self-esteem of the novice nurse.

13. A novice nurse is unsure how to correctly administer an injection using the Z-track method. What is the best approach for learning this procedure? a. Read the procedure manual and follow the steps exactly. b. Make an appointment at the skills laboratory of the former nursing school to practice. c. Ask to observe the skill as it is being performed; then perform it under direct supervision. d. Try to remember how the task was previously performed during a simulation.

C The novice nurse can become familiar with the technique, then can perform the skill under the supervision of an experienced nurse, ensuring competency.

7. A novice nurse notices the medication nurse hurriedly gathering medications to be administered for the entire day, removing them from the packages, and placing them in a paper cup with the patient's name and room number on the cup. When one of the patients points at a pill and asks, "What is this?" and "What does this do?" the medication nurse is uncertain, because it has long since been removed from the packaging. The novice nurse speaks to the nurse manager about her observations and describes her concerns. The novice nurse has assumed the role of: a. loner. b. "rutter." c. change agent. d. "native."

C The novice nurse is working to improve the safety and patient environment and is a patient advocate.

A novice nurse is placed in charge just after orientation ends. Which statement by the novice nurse would ensure a smooth delegation experience when delegating to an experienced staff member? a. "You have the patients in rooms 1 to 7. These patients require little skill so you will be fine." b. "Your assignments are posted in writing by the nurses' station. Be certain all your tasks are completed so the next shift is not behind." c. "You have patients in rooms 5 through 10 and I will administer all IV medications. I will let you know if I have to adjust. If you see you need help let me know." d. "Everyone is capable of providing the best care, so please sign up for the patients you would like to be assigned to."

C The nurse is clearly stating the assignments, allowing for a need to adjust both to needs of the unit and the delegate's needs.

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

C The patient must be able to name the day of the week rather than use answer yes or no.

2. An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that: a. the role of the LPN/LVN is the same from state to state. b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. c. he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN.

C The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN.

An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? a. There is no supervision, because at times the LPN/LVN is not with the RN. b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. c. Continual supervision is being provided until the RN determines competency. d. Initial supervision is being provided because this is the LPN/LVN's first day on the unit.

C This level of supervision is required when the working relationship is new, the task is complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of competence.

15. A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "What exercise practices do you participate in?"

D "What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances.

Which statement related to delegation is correct? a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate training. c. Supervision is not required when routine tasks are delegated to a competent individual. d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.

D Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice

Which statement accurately describes communication? a. The components of communication are mutually exclusive. b. Communication is linear. c. Communication involves only the sender and the receiver; everything else is superficial. d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.

D Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes.

Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegatee has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.

D Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation.

10. In distinguishing between evaluation methods used in school versus those used in the work environment, it is noted that the work environment evaluation includes: a. determining whether steps are logical. b. formulating increments in correct order. c. efficiently organizing stages of the procedure. d. appraising outcomes according to policy.

D Outcomes are based on meeting existing criteria rather than on knowing how the outcome was achieved.

A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? a. Assertive b. Aggressive c. Passive d. Passive-aggressive

D Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering.

5. A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of a(n): a. interpretation. b. context. c. precipitating event. d. preconceived idea.

D Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver's acceptance and understanding of the message.

A novice nurse is stressed due to always being behind with her assignments. She is overheard saying, "No one here worries about checking nasogastric tube placement before they give medications and hang feedings. Skipping that step would save me an extra 30 minutes to be used for charting. If they can do it, so can I." This nurse is experiencing which stage of reality shock? a. loner. b. "rutter." c. change agent. d. "native."

D The novice nurse is mimicking the actions of the experienced nurse taking shortcuts that were not taught in school and not following policy and procedure.

A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the state board of nursing to determine scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include: a. the RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. b. the RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. c. since the LPN is licensed, they practice professional nursing. d. to determine what tasks can be safely delegated, the RN must first assess the patient.

D The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient's condition is critical.

During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that: a. the health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. UAPs cannot be held responsible for their own actions or inactions. d. the nurse practice act and state regulations related to delegation override the organization's policies.

D The state's nurse practice act is the deciding factor regarding what can legally be delegated.

Which component of an e-mail shown below would be both effective and concise? a. Subject: A short concise subject line: Meeting. b. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582.

D This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication.

A recruiter is explaining benefits to a group of nursing externs who are highly sought for employment. The recruiter states, "We are the only hospital in town that offers a residency program." The recruiter further explains that a residency program: a. provides housing for the graduate nurse to decrease expenses until income is established. b. partners a medical resident with a nurse resident to learn interprofessional care. c. allows new graduates to work on a higher degree in nursing while being paid full-time. d. offers extended time for both theory and clinical activities that promote problem solving and clinical decision making.

D. Residency programs offer a longer precepted orientation period (often 12 months) to bridge the gap between the classroom and practice.

5. A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance

ANS: D Right circumstance involves the delegation of tasks that do not require independent nursing judgments.

An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect

A An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue.

10. A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is known as: a. straw man. b. red herring. c. slippery slope. d. confusing cause and effect.

B A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue.

An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for: a. delegating the task to another UAP if he or she does not have the time or skill to complete the task. b. keeping the RN informed of any abnormal blood pressure readings. c. calling the physician when the patient's vital signs are not within established parameters. d. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive.

B After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN

A nurse gives Dilantin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "Everyone just pushes the medicine slowly. No one checks for compatibility. There isn't even a compatibility chart on the unit." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Appeal to emotion d. Appeal to tradition

B An appeal to common practice occurs when the argument is made that something is okay because most people do it.

The new director of nurses has instituted "walking rounds" on all nursing units, rather than the usual taped shift reports. A veteran nurse exclaims, "She doesn't know how we do things here!" The nurse is demonstrating: a. appeal to emotion. b. appeal to tradition. c. red herring. d. straw man.

B An appeal to tradition is the argument that doing things a particular way is best because they've always been done that way.

The novice nurse arrives on the nursing unit, is introduced to the staff, is assigned a preceptor, and is asked to participate in the next staff meeting. This introduction into nursing is appropriately termed: a. biculturalism. b. socialization. c. transition. d. "going native."

Socialization involves the acceptance and integration of the novice nurse into the profession of nursing, as well as the identification of the novice nurse with the profession of nursing

1. The healthiest form of communication is the ________ style.

assertive Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing.

1. It is important for novice nurses to know that "self-esteem = self-confidence + self-______."

respect


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