Leadership Exam 2 chap 8&9
A patient admitted with an elevated ST-segment myocardial infarction (MI) on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. Respiratory therapy administers an albuterol treatment that provides no change in the oxygen saturation. What is the next best action by the RN is best? a. Obtain a 12-lead ECG. b. Notify the health care provider. c. Call the patient's wife to have her sit with him to calm him. d. Ask the UAP to obtain a blood glucose level.
ANS: A Because this patient was admitted with an MI, evolution of the MI should be ruled out as the source of the shortness of breath. Notifying the health care provider should be taken after obtaining all the information necessary. The other options do not address the possible underlying problem.
A nurse is confronted by a visitor and is threatened to be hurt when she gets to her car. What action is best for the nurse to take to protect herself? a. Call security and notify them of the threat. b. Ask security to escort you to your car. c. Explain to the visitor that you carry a gun. d. Assume that this was a joke.
ANS: A Call security immediately whenever you feel threatened even if it has not been verbally stated. Option B is an incident that needs to be reported. Options C and D do not show good judgment.
Employees who are dependent on drugs or alcohol will exhibit signs that should not be ignored by the nurse manager and colleagues. Which of the following signs would alert the nurse manager that the employee may have a dependency problem? a. Changes in behavior or appearance b. Requesting time off to be with a family member c. Scheduled overtime d. Dieting
ANS: A Changes in behavior or appearance should alert the manager that something has changed in this employee and some type of intervention should occur. The other options are not a sign requiring follow-up for substance abuse.
The UAP is given ambulation instructions by a staff nurse for a patient 2 days postoperatively. Which of the following ambulation instructions would require further communication to the UAP to ensure the safety of the patient? a. "Ambulate the patient the length of the hallway and get me if there are any problems." b. "Have you ambulated this type of post-op patient before?" c. "Let me know 1 hour before you are ready to ambulate the patient so I can give him his pain medication." d. "This patient has been ambulating with minimal assistance, but I would like you to walk with him to be sure he is stable."
ANS: A Delegation requires thorough communication including specific instructions regarding task ("ambulate the length of the hallway") and information about possible adverse effects and what to do about them. The other options are incorrect because they only give limited instructions.
The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the planning step of the process? a. Identifying the problem of the lack of ICU beds b. Organizing a meeting to address the problem c. Establishing an alternate site within the hospital for these patients d. Assigning experienced staff to implement care of these patients
ANS: A Establishing objectives should be seen in the planning step following identification of the problem. Option B is the organizing step. Option C is the directing step. Option D is the controlling step.
After reporting a nurse with a substance abuse problem to the State Board of Nursing (SBON), the next step that will most likely occur is a. surrender of license if complaint is found to be valid. b. counseling and then the nurse can return to work. c. the nurse is fired. d. the nurse is prevented from ever working as a nurse again.
ANS: A If the complaint is found valid by the SBON, the nurse will have to surrender her license and will be monitored by the SBON. The other options are not the process for dealing with these issues.
The AACN has addressed the issue of horizontal violence in the workplace and made recommendations for actions by the nurse manager. Which of the following are recommendations for action by the AACN against workplace horizontal violence? a. Develop a culture that does not tolerate violence. b. Report all incidences to upper management. c. Separate the two people by not assigning them to work on the same shifts. d. Ask the two people to sit down and work it out.
ANS: A If the workplace is intolerant of horizontal violence, staff will not participate in that form of conflict. The other options are not actions that should be taken by the manager.
A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. The albuterol treatment provides no relief. What is the next best action by the RN? a. Increase the oxygen concentration and recheck the saturation after 10 minutes. b. Obtain a 12-lead ECG. c. Notify the health care provider. d. Call the patient's wife to have her sit with him to calm him.
ANS: A Increasing the oxygen concentration will provide more oxygen to the tissues, but the saturation should be rechecked to determine effect. Obtaining a 12-lead ECG is appropriate as the next action but not before increasing the oxygen concentration. Notifying the health care provider is an appropriate step after answers A and B are instituted. Calling the patient's wife is not a priority.
A surgeon approaches the charge nurse in an angry manner after his patient fell out of bed, requiring further surgery. Which of the following approaches is most appropriate for the charge nurse to use? a. "Can you step over here out of the hearing of the patients and family members?" b. 'I'm sorry, you should have ordered restraints for the patient." c. "We will accept all liability." d. "My nurses are all new on the night shift. They didn't know how to handle him."
ANS: A It is always the best practice to remove the angry person from the audience. Usually, when removed, the person settles down and becomes more reasonable. The other options are not appropriate to the situation and could antagonize the angry physician.
To avoid transcription errors, the current trend in hospitals is to use the Computerized Physician Order Entry (CPOE). Further instructions should be given to the nurses when which statement is made? a. "I don't need to review the new orders for accuracy." b. "The orders will go directly to the appropriate departments." c. "The risk for transcription errors is less." d. "I am still responsible for communicating the changes to the appropriate care givers."
ANS: A Orders entered into the CPOE still require the nurse to review and therefore would need further instructions. The other options are correct statements and therefore do not require further instructions.
When determining the basis for conflict, interpersonal sources as the basis would include which of the following? a. Personality differences b. Shift preferences c. Staffing inconsistency d. Assignments
ANS: A Personality differences are a source for interpersonal conflict. The other options are incorrect because they are an intrapersonal source of conflict.
he nurse manager receives a telephone call from an RN saying she will be late because of traffic due to an accident. The charge nurse needs to make arrangements for the care of that nurse's team of patients until her arrival. What is the best action to take to ensure the management of those patients until the RN arrives? a. Distribute the patients evenly to each of the other nurses. b. The charge nurse will take the assignment until the RN's arrival. c. Ask the nurse manager to assume care temporarily. d. Ask the night nurse to stay until the RN's arrival.
ANS: A The best action is to evenly distribute the patients so that no single nurse is overwhelmed and the charge nurse can continue to function in her role. The other actions would not provide for the best care to patients.
There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admissions
ANS: A The first-line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle-level managers set short- and long-term goals. Option C is incorrect because it is a responsibility of upper-level management to forecast trends in nursing. Option D is incorrect because it would be the responsibility of the charge nurse.
A student nurse is working with a preceptor who appears abrupt and disinterested in precepting students. What action by the student is most appropriate? a. Notify the instructor. b. Talk with the nurse to see what is wrong. c. Identify this as lateral violence. d. Nothing, he was having a bad day.
ANS: A The instructor can approach the nurse and determine the next course of action. The other options are incorrect because the problem needs to be dealt with by the instructor, not by the student.
The nurse is admitting a patient who speaks very little English. What is the most appropriate method to use to ensure the patient understands the instructions? a. Obtain a hospital interpreter. b. Ask a family member to interpret. c. Ask other staff for help. d. Incorporate sign language.
ANS: A The most appropriate means for interacting with a patient whose language is not English is to obtain an interpreter. The other options are not appropriate alternatives.
1. Which patient should be considered the highest priority by the nurse manager? a. A patient who attempts suicide b. A patient who attempts to escape from the hospital c. A patient who refuses to eat d. A patient who refuses her medications
ANS: A The priority for the nurse manager is the attempted suicide of a patient. The options are not a priority.
A float nurse is assigned four patients on the day shift. Which of the following reports by the float nurse would require immediate intervention by the charge nurse? a. "Dr. Smith, your patient, Mr. Jones is complaining of a headache." b. "Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache." c. "Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?" d. "Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?"
ANS: A This answer gives no information to the physician about the patient or his condition and thus would require further teaching. The other options give a different level of information, which is better and more informative than answer A and therefore does not require further teaching.
Which of the following patients should be seen by the nurse first based on the information provided during the shift report? a. A patient admitted with hypertension complaining of back pain. b. A patient admitted with mental status changes. c. A patient complaining of incisional pain postoperatively. d. A patient asking for assistance in getting back to bed.
ANS: A This patient may be experiencing angina. The other options are incorrect because this patient does not require an urgent assessment.
Patients are complaining that they are not receiving pain medications on the night shift. The night nurse has charted that they were given. What is the most appropriate action by the charge nurse? a. Notify the nurse manager. b. Confront the nurse about the problem. c. Ask other nurses what they think. d. Report the suspicion to the State Board of Nursing.
ANS: A T his question illustrates the concern for illegal charting of pain medications and substance abuse in nurses. It is essential for the nurse identifying this issue to report it to her nurse supervisor (chain of command). The other options are not appropriate responses to the implied illegalities in this question
What are some tools available for the nurse manager to use for conflict resolution? (Select all that apply.) a. Prevention b. Negotiation c. Cooperation d. Resentment e. Rejection
ANS: A, B, C Options A, B, and C are an approach to resolving conflict. The other options are not appropriate ways to resolve conflict.
Which of the following are true when communication is effective? (Select all that apply.) a. The sender is credible. b. There is clarity. c. Simple, exact language is used. d. Slang is used. e. The receiver rolls her eyes when asked to complete a task.
ANS: A, B, C Options A, B, and C are principles of effective communication. The other options are examples of inappropriate communication and even resistance to what is being communicated.
In what ways is the environment controlled by the hospital safety committee to prevent workplace violence? (Select all that apply.) a. Emergency alarms b. Cameras and videos c. Assigned patrol for each unit d. Security provided for visitors in parking lots, etc. e. Respond only when called
ANS: A, B, D Environmental controls include accessible alarms, monitoring systems, and access to security in areas of vulnerability. The other options are incorrect because they are not methods to prevent violence.
A staff nurse must leave work for an emergency. The nurse tells the charge nurse that her patients are fine and received all their AM medications. As the day progresses, it becomes apparent to the responsible RN that some things were not completed, especially some necessary AM medications. Which communication principle was not followed in this situation? (Select all that apply.) a. Interaction b. Clarity c. Simple exact language d. Feedback e. Credibility f. Direct communication
ANS: A, B, D, F In this scenario, the staff nurse leaving the unit does not interact directly with the RN who will now become responsible for the care of the patients and thus no questions could be asked and feedback could not obtained. The other options do not apply to this situation.
The role of the charge nurse is a relatively new role in nursing. What responsibilities would the nurse expect to see from the charge nurse? (Select all that apply.) a. Making daily patient care assignments b. Troubleshooting problems occurring during shift c. Providing coverage for breaks d. Taking turns floating to another unit e. Assisting staff as needed
ANS: A, B, E Options A, B, and E are responsibilities of the charge nurse. Options C and D do not apply to the charge nurse.
Formal communication in health care is used to properly inform staff of (Select all that apply.) a. changes in CPR certification dates. b. Christmas party celebration. c. patient survey results. d. girl Scout cookie order pick-up. e. termination of an employee.
ANS: A, C Options B, D, and E are correct because formal communication would be used to distribute information regarding institutional policy changes. The other options are examples of informal communication.
In an escalating situation, the nurse should observe certain rules to protect herself from violence. Which of the following are good rules to keep in mind if one is ever in a violent situation? (Select all that apply.) a. Remove yourself from the situation. b. Speak loudly with authority. c. Call for help. d. Do not allow the person to stand between you and the door. e. Stand in a corner against a wall.
ANS: A, C, D Protecting yourself by removal from the situation is one of the best actions that can be taken. Protecting yourself by calling for help is one of the best actions that can be taken. Not allowing the person to come between you and safety is a good rule of thumb. Options B and E do not provide protection
What methods can the nurse manager use to address horizontal violence in the workplace? (Select all that apply.) a. Provide training to staff. b. Pick a side so that the assaults do not include you. c. Name the problem "horizontal violence." d. Observe and analyze the culture of the workplace. e. Have the victim file a grievance
ANS: A, C, D Providing training for conflict resolution, calling it by name, and observing what is being said for yourself and then analyzing the culture for ways to prevent this behavior are methods the manager can use to address the issue. Options B and E are incorrect because they are not methods for conflict resolution that a nurse manager should use.
It is vital to communicate changes in patient condition to the physician. When using the SBAR process, the nurse knows that what should be included when communicating patient condition? (Select all that apply.) a. Problem b. Current medications c. Assessment d. Diagnosis e. Documentation f. Lab data
ANS: A, C, D, F Options A, C, D, and F should be provided to any health care provider when reporting changes in patient conditions and obtaining new orders. Options B and E may not be required in all circumstances.
Walking rounds are currently being implemented to avoid errors or omissions in shift reports. Which observations made during walking rounds would be seen as an advantage to the shift report? (Select all that apply.) a. Foley bag is not emptied on a patient on strict I&O. b . Patient needs assistance to bathroom. c. IV infusion bag is nearly dry. d. Patient with a PCA requests instructions to avoid increased pain. e. Patient's family member is caught smoking in the bathroom. f. IV line is not infusing what is currently ordered.
ANS: A, C, F Options A, C, and F are correct because inaccuracies of shift reports can be eliminated by using walking rounds. Options B, D, and E would cause interruptions in the report and lead to walking rounds.
Which of the following is a risk factor for hospital workplace violence? a. Unlimited security coverage b. Public availability 24 hours a day c. Insecure medication access d. Semiprivate rooms
ANS: B Unlimited public access, mixed with other risk factor, makes the hospital an unsafe workplace. The other option are not risk factors for violence.
Workplace violence can be initiated by an employee in the workplace as well as by patients or family members. Which of the following would be cause for concern when observed in an employee? a. Divorce b. Personality changes c. Death in the family d. Miscarriage
ANS: B A change in personality may indicate substance abuse or mental health problems. The other options are not risk factors for employee violence.
Which patient should be considered the highest priority by the new RN? a. A patient who is requesting his pain medication b. A patient who is reported by the UAP to be choking c. A patient who is requiring suctioning per tracheostomy d. A patient who is requiring discharge instructions who is waiting at the desk with her family
ANS: B A patient who is reported by the UAP to be choking is the most unstable and should be seen first. A patient who is requiring suctioning per tracheostomy is not a priority. The patient needs to be suctioned but nothing given here indicates that this patient is more at risk than the patient who is choking, which must be assessed first. The other patients are not a priority.
Most organizations provide assistance to employees with problems that can affect their work performance. They provide assistance with issues ranging from financial issues to personal relationship issues. Which of the following best describes these programs? a. Faith-based initiatives b. Free confidential employee assistance programs (EAPs) c. Fee-for-service private counseling d. The nurse manager fills this role in most institutions.
ANS: B EAPs assist employees in many areas of their lives. Options A and C are not services offered by the institution. Option D is not a responsibility of the nurse manager.
A nurse takes a telephone order from a physician. Which procedure is best for the nurse to use to avoid errors? a. Ask another nurse to listen to the conversation on another telephone. b. Repeat the order, write the order verbatim, and read the order back to the physician. c. Ask the physician to come to the unit to write the order. d. Hold implementation of the order until the order is written by the physician
ANS: B Following this procedure will reduce errors in communication between the health care provider and the nurse. The other options are not practical methods to use to avoid errors.
What methods can administration use for the prevention of workplace violence? a. Separate staff entrance b. Staff ID badges c. Separate parking for staff d. Visual presence of security at all times
ANS: B ID badges must be worn by all staff and temporary contract employees. The other options are not a form of administrative control.
First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager? a. Making daily staffing assignments b. Managing the unit's budget c. Maintaining currency in profession d. Making daily patient rounds
ANS: B Managing the unit budget is the sole responsibility of the nurse manager and first-level manager. The other options are not specific to first-level managers.
Which response by the patient following discharge teaching would require further teaching? a. "I should weigh myself daily since I started on Lasix (furosemide) for my heart failure." b. "I need to check my blood glucose after eating." c. "I should take my Lanoxin (digoxin) with my morning medications." d. "I need my blood checked frequently now that I am on Coumadin (warfarin)."
ANS: B Option B is not correct and therefore requires further teaching. The other options are correct statements and therefore does not require further teaching.
What is a recommendation from the Occupational Health and Safety Administration for prevention of violence in the workplace? a. Assign different shifts. b. Provide training and education. c. Point out the issues to the people involved. d. Arrange for the people involved to meet and discuss the issues.
ANS: B Providing training and education is one of the major recommendations by all organizations for intervening to prevent workplace violence. The other options are not recommendations of the organization.
When analyzing the sources for conflict, the nurse manager may identify which of the following as one of the most likely sources? a. Different attitudes b. Different facts or perception of the event c. Different incomes d. Different ages
ANS: B The differences in the facts or perception of the facts of the event may be a source of the conflict. The other options are not usually the source of conflict.
Middle-level managers are responsible for planning for changes of the unit. What activity would the nurse expect to see only from a middle-level manager? a. Maintaining currency in profession b. Planning for changes within the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery
ANS: B The middle-level manager is solely responsible for planning changes and presenting them to upper-level managers. The other activities are not an exclusive responsibility of the middle-level manager.
The nurse manager works regularly with a nurse who has recently gone through a custody battle with her ex-husband. The nurse manager has become concerned about some of the changes in appearance of the nurse. One evening the nurse comes to work and seems "giddy" and is acting inappropriately. The nurse manager understands that she must take which of the following actions? a. Counsel the nurse on these observations. b. Report this behavior to human resources and the state board of nursing. c. Give her the evening off. d. Work closely with her to prevent unsafe care to the patients.
ANS: B The nurse manager can talk with the nurse and find out what is going on, but if substance abuse is suspected, it must be reported. The other options do not address mandatory reporting of these actions.
A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. Which action by the RN is best? a. Increase the oxygen concentration. b. Ask respiratory therapy to administer an albuterol treatment. c. Notify the health care provider. d. Determine if anxiety could be causing the shortness of breath.
ANS: B The respiratory therapist should administer a bronchodilator as the first action to assess the patient's response before determining the next action. Increasing the oxygen concentration should be delayed until assessing any change after the bronchodilator administration. Notifying the health care provider should be delayed until assessing any change after the bronchodilator administration. Determining if anxiety could be causing the shortness of breath is probably not responsible for the change in condition
What step in the employment process may have been omitted when the staff appears to be nervous and overly cautious around a new nurse manager? a. Involvement of human resources in the interview process b. Involvement of the upper-level manager in the interview process c. Involvement of the staff in the interview process d. Involvement of the middle-level manager in the interview process
ANS: B The upper-level manager may have been omitted from the process. Human resources must be involved in the employment process. Staff members would not intimidate the new employee. The middle-level manager is key in the process.
Which patient should be considered the highest priority by the charge nurse? a. A patient who is complaining that no one answers his call light b. A patient who is threatening to leave AMA with tubes and drains in place from a surgical procedure c. A confused patient who is attempting to get out of bed d. A patient who is asking for help to the bathroom
ANS: B This patient should be helped to decide against leaving the hospital until he is more stable. The other options are not a priority.
Upper-level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper-level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7
ANS: B Upper-level managers are responsible for forming strategic plans. The other activities are responsibilities shared by all levels.
Personal and financial issues, as well as drugs or alcohol, can impair employees and can precipitate violence. The nurse manager and all staff must be aware of the signs of drug or alcohol use. Which of the following indicators should concern the nurse manager in an employee when addressing violence in the workplace? (Select all that apply.) a. Recent divorce b. Troubled adolescent c. Tremors of the hands d. House foreclosure e. Religious counseling
ANS: B, C, D Options B, C, and D are symptom of someone under the influence of drugs and/or alcohol. Options A and E are not necessarily associated with drugs or alcohol impairment.
In the change of shift report, what should be included? (Select all that apply.) a. Family contact telephone numbers b. Current assessment c. Plan of care d. Change in condition e. Discharge plan f. Personal comments
ANS: B, C, D, E Options B, C, D, and E are correct because only pertinent information required for delivery of care should be transmitted during the change of shift report. Family contact telephone numbers may, at times, be pertinent but not as a routine. Personal comments are almost never appropriate
Informal ("grapevine") communication in health care is used to properly inform staff of (Select all that apply.) a. changes in practice. b. Christmas party celebration. c. patient survey results. d. girl Scout cookie order pick-up. e. termination of an employee.
ANS: B, D, E Options B, D, and E are examples of informal communication and are more closely aligned with gossip. These are not formal communication methods in an institutional environment. Options A and C are examples of formal communication.
The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff.
ANS: C As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other activities may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills
A UAP becomes sick at work and asks to leave. Which response by the charge nurse is most appropriate? a. "You can't leave until all the baths are completed." b. "Write down what needs to be completed." c. "Tell me what responsibilities still need to be completed." d. "Be sure to call by 5 AM if you are still sick tomorrow."
ANS: C Direct communication is the best method to avoid errors and allow for questions regarding remaining tasks. Options A and D are not appropriate for determining continuity of care. Options B is not the most effective means of communication and does not allow for questions and feedback.
A male nurse is working with female nurses on a unit. One of the female nurses is overheard talking about how cute the male nurse is. The nurse overhearing this comment should be expected to do which of the following? a. Notify the nurse manager. b. Tell the male nurse that the female nurse was making inappropriate comments. c. Nothing, this is not harassment. d. Warn the nurse that the conversation was overheard.
ANS: C Option C alone does not constitute harassment. The other options are incorrect because they are not appropriate.
Which exchange between the RN and the UAP requires intervention by the charge nurse? a. "Take the patient's blood pressure every 15 minutes and inform me of the results." b. "Check the patient's blood glucose before breakfast and lunch and inform me of the results." c. "Ambulate the patient in 2210 as far as he can walk." d. "Shave the patient in 2210. His beard is long."
ANS: C Option C is inadequate because it does not provide enough information to the UAP and requires intervention. The other options are appropriate communication and therefore do not require intervention.
Family members who have access to hospitals may present risks to the staff when which of the following is most likely present? a. Family members are not doing well. b. Family members are in the intensive care unit. c. Family members are under the influence of drugs or alcohol. d. Family members are unable to visit regularly.
ANS: C People under the influence of drugs or alcohol are more likely to be volatile and unpredictable. The other options are incorrect because these people are not as likely to present a problem.
Universal strategies to use in the presence of escalation of a potential violent situation include which of the following? a. Demand that the potentially person back off. b. Remain close to the patient to protect her. c. Remain calm with a caring attitude. d. Speak loudly with authority.
ANS: C Sometimes not reacting to the situation can calm the person down. Always present a caring attitude, not a threatening one. The other options are incorrect because they may cause the situation to escalate.
A patient is inappropriate when speaking to a UAP. What is the most appropriate action by the nurse? a. Change the assignment. b. Ask the UAP what they did to precipitate this. c. Explain to the patient how what they say is being interpreted. d. Complain to the physician
ANS: C Sometimes patients are not aware of how their comments are interpreted by staff. Informing them may correct the situation. The other options do not address the underlying problem of inappropriate communication.
A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza continues to experience shortness of breath and has no ECG changes. What is the next best action by the RN is best? a. Call the patient's wife to have her sit with him to calm him. b. Ask the UAP to obtain a blood glucose level. c. Call the Rapid Response Team. d. Ask the charge nurse to check on the other patients.
ANS: C The Rapid Response Team (RRT) should be called to assess the patient's condition. The other options do not address the cause of the change in condition.
Which activity should be considered the highest priority by the RN? a. Assessment of a stable patient ready for discharge b. Administration of daily medications c. Administration of STAT medications d. Discharge teaching for a patient with heart failure
ANS: C The STAT medications order is a priority because STAT means immediately. The other options do not take priority over a STAT order.
Arrange in order of priority the nurse's actions when a patient admitted with an elevated ST-segment myocardial infarction on droplet precautions and oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. 1. Call the rapid response team (RRT). 2. Obtain a chest radiograph. 3. Obtain a 12-lead ECG. 4. Initiate a bronchodilator nebulizer treatment. 5. Increase the oxygen concentration 2 L. 6. Repeat the oxygen saturation in 10 minutes a. 5, 3, 2, 4, 6, 1 b. 1, 4, 2, 5, 6, 3 c. 4, 5, 6, 3, 1, 2 d. 5, 4, 3, 6, 2, 1
ANS: C The first step should be to try a bronchodilator first, then increase the oxygen concentration, repeat the oxygen saturation for changes, then obtain a 12-lead ECG to rule out evolving myocardial infarction, call the RRT for their consult, and then obtain a chest radiograph to see if that explains the change in condition. The other options do not present the steps in the correct order.
Human resources is required to provide education on violence prevention and management, which is tracked by the state board of health and The Joint Commission. Which of the following would the nurse expect to find in an education program required by state and federal health care regulatory agencies about violence prevention in the workplace? a. Location of all monitoring equipment b. Schedule of security officers rounds c. Early recognition and response plan d. Identification of people most at risk for causing harm
ANS: C The plan for employee early recognition and response to violent behavior is included in the orientation of new employees and annual skills day. The other options are not beneficial to the overall prevention plan.
There are three steps to conflict management: determining the basis, analyzing the source, and conflict resolution. Which of the following may be the most likely source for conflict between a patient and the health care provider in the workplace? a. Food served b. Medication effects c. Ethical dilemmas d. Smoking withdrawal
ANS: C Treatment decisions that cause ethical dilemmas are likely sources of conflict between patient, family, and health care providers. The other options represent annoyance but usually does not lead to violence.
SBAR is a convenient tool to use when notifying physicians of a change in patient condition. In which of the following situations could it also be appropriately used? a. Communication with radiology scheduling b. Communication with case manager c. Transferring patient d. Change of shift report e. Rapid response team (RRT)
ANS: C, D, E Options C, D, and E are circumstances in which the SBAR tool of communication can be used effectively. Options A and B are not necessarily appropriate circumstance for the use of SBAR.
The end of shift report is the appropriate time to communicate (Select all that apply.) a. the frequency of which the call light was used. b. patient's relationship to a staff member. c. new patient orders. d. impending procedures. e. evaluation of medication response.
ANS: C, D, E Options C, D, and E are correct because only information directly related to the care of the patient should be transmitted during the shift change report. Options A and B are not usually pertinent to care of the patient.
In the workplace, violence may escalate as a result of many factors. Which of the following should the nurse be alert for in the escalation to violence? a. Crying b. Isolation c. Asking for help d. Pacing and using profanity
ANS: D Pacing and use of profanity may be signs of escalation of anger to violence. The other options do not represent a sign of escalation to violence.
A nurse is working the night shift with another RN who keeps disappearing without explanation. The nurse is caught napping in a patient's room. What is the best action by the discovery nurse to take? a. Confront the nurse and ask what is wrong. b. Report the behavior to the vice president of nursing. c. Ask to not be scheduled on the same nights again. d. Report the behavior to the nurse manager.
ANS: D The nurse must report this behavior to the nurse manager for further investigation. The other options do not address the legal issues of this behavior.
Which of the following patients should the charge nurse admit to a room with a patient who is confused and incontinent of stool? a. A postoperative patient b. A patient with diabetes c. A patient who is going to surgery later today d. A patient from the cardiac catheterization lab who is going home in the morning
ANS: D A patient from the cardiac cauterization lab who is going home in the morning is at the least risk for acquiring an infection from the exposure. The other patients are at high risk for acquiring an infection from the exposure.
The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision-making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step-down unit
ANS: D Decision making is a result of the other steps. The other options are different steps in the management process.
A staff nurse complains to the nurse manager about an employee of another department constantly asking her out on a date even though she has told him she is not interested. Which action by the nurse manager is most appropriate? a. Confront the employee and ask him to stay away from the staff nurse. b. Observe future interaction to confirm the reported harassment. c. Contact the supervisor to decide on the next step. d. Review the personnel manual to decide on the next step.
ANS: D If unfamiliar with the approved actions in a sexual harassment situation, the nurse manager should refer to the official references for action. The other actions are not appropriate in this case.
The end of shift report is vital for the coordination of patient care. Which of these statements would require an intervention if overheard by the charge nurse during report? a. "Mr. Smith is quite afraid of the outcome of his procedure today. I had to give him an anti-anxiety medication." b. "Mr. Smith is quite afraid of the outcome of his procedure today. I called his wife to come in early." c. "Mr. Smith is quite afraid of the outcome of his procedure today. I called the chaplain to see him and his wife today." d. "Mr. Smith is quite afraid of the outcome of his procedure today. I was in the room most of the day."
ANS: D It illustrates the nurse making an inappropriate judgment regarding this patient's anxiety and therefore would require intervention. The other options are appropriate communication regarding a patient and his anxiety and therefore does not require intervention.
The nurse working the night shift has concerns about the safety of the unit. What would cause security concerns for this nurse? a. A visitor is sleeping in the recliner in the room with their family member. b. A parent stays overnight with their teenage child. c. No unit secretary is assigned for the night shift. d. She is working with only one other employee.
ANS: D Nurses working short staffed are at greater risk for violence from visitors or strangers in the hospital because they can easily be isolated from the other employee. The other options are not a cause for concern as long as sufficient staff is working
Which patient should the charge nurse direct the RN to see immediately after the shift report? a. Patient with a blood sugar of 240 mg/dL b. Patient complaining of burning on urination c. Patient in a Posey vest who is trying to get out of bed d. Patient with a temperature of 38°C who is scheduled for surgery later that day
ANS: D This patient is unstable and requires urgent assessment. The other assessments can be delayed
Horizontal conflict in the workplace is observed with which of the following situations? a. Discussion with the manager before escalation occurs b. Refusing to work on day off c. Sharing views on patient care d. Withholding information that will undermine the ability to perform his job
ANS: D Withholding of information that can affect one's ability to perform professionally is a form of horizontal violence. The other options are not seen as part of horizontal conflict