Leadership Midterm

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

The proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff, is called __.

Skill mix

The patient is treated for hyperkalemia and CCRT is initiated. Which actions will you delegate to the assistive personnel (AP) who are working with you to care for this patient? (Select all that apply.) A. Replace the ECG electrodes. B. Check the dialysis tubing for clot formation. C. Monitor for changes in orientation. D. Inspect the oral mucosa for dryness or cracking. E. Obtain a blood pressure and urine output hourly.

AE Focus: Delegation Since placing ECG electrodes, obtaining vital signs, and measuring urine output are skills that are frequently done in daily care and require little modification between patients, these actions are appropriate to delegate to the AP. Monitoring dialysis equipment and obtaining physical assessment data require nursing judgment and critical thinking and should be done by the RN.

According to the __ organizational approach, organizations are logical and predictable with identifiable and scientifically measurable characteristics that can be predicted, observed, or manipulated. 1.Objective 2.Subjective 3.Postmodern 4.realistic

1 According to the objective perspective, an organization exists as an external reality, independent of its social actors. Organizations are viewed as logical and predictable objects with identifiable and scientifically measurable characteristics (e.g., size) that can be predicted, observed, or manipulated.

These activities are included in the care plan for a 78-year-old patient admitted to the hospital with anemia caused by possible gastrointestinal bleeding. Which activity can the nurse delegate to an experienced unlicensed assistive personnel (UAP)? 1.Obtaining stool specimens for fecal occult blood test (FOBT) 2.Having the patient sign a colonoscopy consent form 3.Giving the prescribed polyethylene glycol electrolyte solution 4.Checking for allergies to contrast dye or shellfish

1 An experienced UAP will have been taught how to obtain a stool specimen for the fecal occult blood test because this is a common screening test for hospitalized patients. Having the patient sign an informed consent form should be done by the health care provider who will be performing the colonoscopy. Administering medications and checking for allergies are within the scope of practice of licensed nursing staff. Focus: Delegation.

An employee satisfaction survey is conducted annually and shows that nurses in a particular unit are committed to their jobs and feel that they make positive contributions. These nurses are: 1.Engaged 2.Disengaged 3.Unproductive 4.At retirement age

1 An ongoing challenge among U.S. employers, including health care systems, is to keep employees engaged. A Gallup poll (2014) indicated that only 31.5% of employees in the United States report they are "engaged at work," meaning they are committed to their job and making positive contributions. Fifty-one percent reported they are "not engaged at work," meaning they are not likely to put effort into organizational goals. Seventeen and a half percent are "actively disengaged," described as unhappy, unproductive, and likely to spread negativity. Shared governance is the gold standard for engaging nurses in solving problems at the point of care.

Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more __ philosophy. 1.Centralized 2.Decentralized 3.Autocratic 4.Democratic

1 Centralization and decentralization are organizational philosophies about power distribution that pertain to the hierarchical level of decision-making authority in the institution. Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization.

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 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.

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 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.

Assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time is known as: A Scheduling. B Staffing effectiveness. C Nursing direct-care hours. D Human resources staffing strategy.

A Scheduling is the process of assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time

The new nursing care model, developed by the American Association of Critical-Care Nurses (2016), focuses on the needs of the patient and the competencies of the nurse. It is known as the: A Synergy Model for Patient Care. B Case Management Model. C Primary Nursing Model. D Clinical Nurse Leader Model.

A The Synergy Model for Patient Care was developed by the American Association of Critical-Care Nurses (2016) and is a patient-centered model focused on the needs of the patient, the competencies of the nurse, and the synergy created when the needs and competencies match. Synergy—or optimum patient outcomes—results when the needs and characteristics of the patient and clinical unit or system are matched with a nurse's competencies. Patient assignment technology may assist in defining—and thereby aligning—patient needs with the nurse's abilities, a concept that is central to the model.

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

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

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 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

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

The workload standard commonly used in nursing when calculating staffing patterns is: 1.patient days. 2.patient acuity system. 3.average length of stay. 4.nursing care hours per patient day.

D The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The workload standard commonly used is nursing care hours per patient day, although the validity of this measure is disputed.

A forecasted workload and a recommended care standard determine the: A staffing pattern. B skill mix of the unit. C nurse-to-patient ratios. D staffing management plan.

D The staffing management plan provides the structured processes to identify patient needs and then to deliver the staff resources as efficiently and effectively as possible. An effective plan first focuses on stabilizing the unit core staffing. A staffing pattern, or core coverage, is determined through a forecasted workload and a recommended care standard (e.g., hours per patient day).

After receiving change of shirt report, in what order would the nurse assess the assigned clients? Prioritize in rank order. 1.Elderly client with pneumonia being discharged to long-term care later today. 2.Client with a white count of 14,000 cells/mm3 and a temperature of 102.8 degrees F. 3.Adolescent client admitted for evaluation following a motor vehicle accident 4.Confused elderly client with a urinary tract infection receiving IV antibiotics. 5.Stable postoperative client who received pain medications about 30 minutes ago.

In order: 1. Client with a white count of 14,000 cells/mm3 and a temperature of 102.8 degrees F. 2. Adolescent client admitted for evaluation following a motor vehicle accident 3. Confused elderly client with a urinary tract infection receiving IV antibiotics. 4. Stable postoperative client who received pain medications about 30 minutes ago. 5. Elderly client with pneumonia being discharged to long-term care later today. Rationale: The client with the elevated white count and temperature is the most unstable at the moment and needs to be a priority. Assessment of the client from the MVA is not complete and so more data is needed to determine that client's status. The elderly client is confused and needs to be assessed to ensure safety. It may take longer than 30 minutes for the pain medication to reach peak action. The client being discharged to long term care is the most stable at this time. THIN Thinking: Help Quick- The nurse needs to be able to prioritize effectively to ensure safe, quality care. When deciding which client to assess first, the nurse needs to consider the client's assessment data, stability and needs.

The Joint Commission's (TJC's) staffing regulation states: 1.staffing ratios are recommended in perinatal and critical care areas. 2.nurse managers may determine the nurse-to-patient ratio as long as the patient's needs are being met. 3.hospitals must also provide the right number of competent staff members to meet the patient's needs. 4.hospitals may limit the number of admissions to ensure there are an adequate number of staff members to meet patient needs.

TJC standards include the human resources function of verifying that nurses are qualified and competent to ensure that the hospital determines the qualifications and competencies for staff positions based on its mission, populations, care, treatment, and services. Hospitals must also provide the right number of competent staff members to meet the patients' needs (TJC, 2016).

· A hospitalized client tells the evening nurse that they have received pain medication at 10:00 AM and again at 2:00 PM and that the medication provided no relief from the pain. The client says to the nurse, "Whenever that daytime nurse takes care of me and gives me pain medication it never works! I am so glad that you are here so that I can get some relief from this pain." The nurse has observed this same occurrence with other clients who were cared for by this same daytime nurse and suspects that the daytime nurse is self-abusing drugs. The nurse should implement which action? · o 1 Report the information to the nursing supervisor. o 2 Talk with the daytime nurse who gave the medication to the client. o 3 Call the impaired nurse organization and report the daytime nurse. o 4 Report the information about the daytime nurse to the police department.

1 If the nurse suspects that another nurse is self-abusing drugs, the nurse needs to report the suspicion to the nursing supervisor. Factual information such as that described by the client and specific information related to the nurse's observations need to be reported. The nurse should not confront the nurse who is suspected of self-abusing drugs because this may lead to a conflict or confrontation. The nurse should follow the organizational chain of communication of the institution to report the incident. The suspicion needs to be reported to the nursing supervisor, who will then report to the board of nursing. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. Drug abuse is the use of drugs illegally. If a nurse is suspected of drug abuse and is taking drugs intended for use by the client, the suspecting nurse needs to report such suspicion. Failure to provide a client with required and needed treatment is harmful to the client and is illegal.

In organizations that practice shared governance, the responsibility for unit outcomes rests with the: 1.Nursing team 2.Nurse Manager 3.Individual nurse 4.Chief nursing officer (CNO).

1 In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager.

Participative leadership was first introduced in the late 1970s. It was adapted by health care organizations to form the basis of shared governance and has evolved to define the roles of nurses and resolve issues related to: 1.patient care. 2.nursing liability 3.nursing salaries. 4.nursing turnover.

1 Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care (Gray, 2013).

The home health nurse is obtaining a history for a patient who has deep vein thrombosis and is taking warfarin 2 mg/day. Which statement by the patient is the best indicator that additional teaching about warfarin may be needed? 1."I have started to eat more healthy foods like green salads and fruit." 2."The doctor said that it is important to avoid becoming constipated." 3."Warfarin makes me feel a little nauseated unless I take it with food." 4."I will need to have some blood testing done once or twice a week."

1 Patients taking warfarin are advised to avoid making sudden dietary changes because changing the oral intake of foods high in vitamin K (e.g., green leafy vegetables and some fruits) will have an impact on the effectiveness of the medication. The other statements suggest that further teaching may be indicated, but more assessment for teaching needs is required first. Focus: Prioritization.

The nurse is making a room assignment for a newly arrived patient whose laboratory test results indicate pancytopenia. Which patient will be the best room- mate for the new patient? 1.Patient with digoxin toxicity 2.Patient with viral pneumonia 3.Patient with shingles 4.Patient with cellulitis

1 Patients with pancytopenia are at higher risk for infection. The patient with digoxin toxicity presents the least risk of infecting the new patient. Viral pneumonia, shingles, and cellulitis are infectious processes. Focus: Prioritization.

The nurse is calling the health care provider to question a medication order for a client. What statement by the nurse is using SBAR? • 1. "Ms. Jones, a 93-year-old client with a fractured femur a very lethargic and difficult to arouse at times. Her blood pressure has been 98/60- 203-72. Do you want to continue using the narcotics for pain or would you like to order something else?" 2. "Mary Smith was admitted this morning with pneumonia. She came here for long0term care. DO you want to continue all of the medications that she was on there?" 3. "Mr. Green is going home today. We have completed all of his discharge teaching and have his prescriptions ready to send with him. Do you want to think about adding something for pain?" 4. "John Potter's lab values cam back from a few minutes ago. His blood glucose after lunch was 220. Do you want to implement a sliding scale insulin?"

1 SBAR communication includes Situation Background Assessment and Recommendation. The statement in response #1 is the only option that includes all of the components of SBAR. THIN Thinking: Nursing Process- When communicating with the health care provider the nurse needs to include the data collected using the nursing process. Presenting the complete picture is important for effective communication.

The nurse is meeting with the interprofessional team doing discharge planning. Which statement by the nurse uses SBAR to organize the communication? 1. "The client will be living alone and has a history of falling. The client is not confident with cane walking so I would recommend adding a walked." 2. "Mrs. Jones has been the ideal client. She has complied with all treatment and I am sure she will follow the treatment plan." 3. "The client continues to be confused and I have some real concerns about the discharge plans. Maybe we should add home health care." 4. "The health care provider has provided all of the discharge prescription and I have completed the discharge teaching. The client seems to understand."

1 SBAR includes describing the situation, background, assessment and recommendation. THIN Thinking: Help Quick- When making decisions about communicating client needs, the nurse needs to prioritize. Communicating safety needs is almost always priority.

The division of work by occupation or function is a form of: 1.Specialization. 2.interdependence. 3.uncertainty. 4.technology.

1 The division (or differentiation) of work by occupation or by function is a form of specialization. Specialization is the extent to which work is divided and assigned to positions and divisions.

Patient surveys convey that they are uncertain about who is the registered nurse (RN). The CEO makes a decision that mandates that white nursing caps will be worn by all RNs and blue nursing caps by all licensed practical nurses to differentiate professional nurses and occupational nurses from nurses' aides and other ancillary staff. Which type of structure does this represent? 1.Centralized 2.Decentralized 3.Nonparticipative 4.Participative

1 This is an example of centralized structure. The CEO makes a top-down decision, and lower-level managers and staff have little decision-making discretion.

A rapid response team within an acute care hospital is comprised of critical care physicians, nurses, and respiratory therapists. The team assists staff throughout the hospital with detecting and managing imminent patient deterioration. This is an example of a __ organizational form. 1. parallel 2. functional 3. modified program 4. matrix

1 To address the challenges of purely functional forms, mechanisms in the parallel form assist in coordinating across functional departments. These mechanisms can include teams, specialists, task forces, liaison roles, and standing committees.

When administering a blood transfusion to a patient, which action can the nurse delegate to the unlicensed assistive personnel (UAP)? 1.Take the patient's vital signs before the transfusion is started. 2.Assure that the blood is infused within no more than 4 hours. 3.Ask the patient at frequent intervals about presence of chills or dyspnea. 4.Assist with double-checking the patient's identification and blood bag number

1 UAP education and role includes obtaining vital signs, which will be reported to the RN prior to the initiation of the transfusion. Monitoring for trans- fusion reactions, adjusting transfusion rate, and assuring that the blood type and number are correct require critical thinking and should be done by the RN. Focus: Delegation.

When delegating client care to an unlicensed assistive personnel (UAP) what does the nurse need to communicate? Select all that apply. • 1. The nurse action that is to be performed. 2. What the nurse expects to have reported. 3. Significant information regarding the client. 4. Information about other clients in adjoining rooms. 5. The names of the medications prescribed for the client.

123 When delegating care the nurse needs to communicate significant information about the specific client needs, what actions are to be performed and what the nurse expects to have reported back. THIN Thinking: Top Three- When delegating care, the nurse needs to follow 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

The unlicensed assistive personnel (UAP) reports to the nurse that the client fell when trying to get back into bed. What nursing actions will the nurse complete to follow up? Select all that apply. • 1. Complete an assessment of the client. 2. Reprimand the UAP for allowing the client to fall 3. Collaborate the UAP to complete an incident report. 4. Discuss the incident with the UAP as a teaching opportunity. 5. Report the incident to the nurse manager.

1345 The UAP is obligated to report falls to the nurse. To follow-up the nurse must assess the client, gather additional data from the UAP about the incident, complete an incident report and most incidents need to be reported to the nurse manager. THIN Thinking: Nursing Process- When the UAP reports an observation such as a fall, the nurse needs to follow-up with an assessment of the client. It is also an opportunity to implement teaching.

The nurse is preparing a presentation for a new group of unlicensed assistive personnel (UAP) to discuss documentation. What should the nurse include in the presentation? Select all that apply. • 1. Legal aspects of documentation. 2. Importance of documenting opinions. 3. Need for documentation to be legible. 4. Role of the UAP with the electronic medical record. 5. Samples of inappropriate documentation.

1345 The UAP may or may not be documenting with the electronic health record. The differs by organizati9on so it is important that the nurse cover this organization's expectations. Documentation needs to be legible and objective, opinions are not appropriate as the chart is a legal document. THIN Thinking: Top Three- Prioritizing data that is included in documentation can help the UAP prepare complete, relevant information. The medical record serves as a legal document.

Organizational benefits of a culture of shared governance include: Select all that apply, 1.improved financial outcomes. 2.Interdependence among staff nurses. 3.increased commitment of staff to the organization. 4.more senior leadership involvement at the point of service. 5.a more efficient model for point-of-service decision making.

135 Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes.

The home care nurse is training a new unlicensed home health worker. The exhibit below indicated the prescriptions for the client. What prescription(s) could be delegated for the unlicensed home health worker? Select all that apply. Mary Jones (age 86) Discharge home following hospitalization for congestive heart failure 1. Observe & Monitor edema in lower extremities 2. Continue with previous medications 3. Assist with bathing once per week 4. Cardiac and respiratory assessments weekly 5. Monitor food and fluid intake

135 The unlicensed home health worker can monitor symptoms such as edema of the lower extremities or food and fluid intake and report observations to the nurse who will make the assessment and/ or clinical decision. The home health worker can also assist with bathing. THIN Thinking: Top Three- When delegating care, the nurse needs to follow the 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

The nurse is planning an in-service for unlicensed assistive personnel regarding being effective team members. What content should the nurse include? Select all that apply. 1. Respect for colleagues. 2. identifying who agrees with you. 3. Being open to others ideas. 4. Communicating clearly. 5. Avoid disagreeing with colleagues.

14 Effective teams require that all members respect each other's opinions and feel free to disagree in a non-judgmental manner. Team members also need to be open to ideas, listen effectively, and communicate clearly. THIN Thinking: Top Three- identifying priorities to plan an in-service is an important strategy for a successful presentation. The goal for the in-service is to develop effective teams to provide quality, safe care.

· The nurse is observing a nursing student perform nasotracheal suctioning on an adult client. The nurse should intervene if the nursing student performs which actions? Select all that apply. · o 1 Sets the wall suction pressure at 140 mm Hg o 2 Encourages the client to cough after suctioning o 3 Inserts the suction catheter during client inhalation o 4 Inserts the catheter beyond the point at which the client elicits the gag reflex o 5 Applies intermittent suction on the catheter during removal for up to 10 to 15 seconds

14 When suctioning an adult client, the wall suction should be set at 80 to 120 mm Hg (portable suction is set at 7 to 15 mm Hg). Elevated suction pressure settings can increase the risk of trauma to the mucosa and can induce greater hypoxia. The catheter should be inserted until the gag reflex is elicited. The catheter should not be inserted beyond this point. Suction is applied intermittently during withdrawal afterward. Options 2, 3, and 5 are correct steps in performing this procedure. Nasotracheal suctioning is a procedure that is used to remove accumulated secretions from the respiratory tract when the client is unable to effectively cough them out. It is a sterile procedure and requires specific actions to prevent trauma to the mucosa of the respiratory tract and to prevent hypoxia.

The charge nurse id planning the assignments for the day on an acute care unit. What factors should be considered when making the assignments? Select all that apply. • 1. Client acuity levels. 2. Room configuration on the unit. 3. Staff requests. 4. Client needs. 5. Staff preparation.

145 The level of acuity, or degree of illness, is a factor in making assignments, as are the extensiveness of client needs and the level of expertise of the staff members. The staff member's personal requests and the physical layout of the unit are not priorities. THIN Thinking: Top Three- When delegating care, the nurse needs to follow the 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

The charge nurse us reviewing another nurse's documentation for a postoperative client who just returned to the unit following abdominal surgery with a general anesthetic. The nurse caring for the client documented that active bowel sounds were heard in all 4 quadrants. What is the most appropriate action by the charge nurse. • 1. Compliment the nurse on documenting a complete post-operative assessment. 2. Question the nurse about hearing bowel sounds when assessing this client. 3. Go into client's room and assess the client with a focus on an abdominal assessment. 4. Do nothing and wait to see what the nurse documents the next time the client is assessed.

2 A client who had abdominal surgery under a general anesthesia will not have active bowel sounds immediately postoperatively. Therefore, the charge nurse is responsible for questioning the nurse in a non-threatening manner. THIN Thinking: Nursing Process- The nurse needs to understand what assessment data is "normal: at various stages of recovery following a general anesthetic. The assessment may be accurate but the charge nurse should question it because it does not fir the "normal" expectation.

An organizational chart with one line of management and one line of staff reflects which of the following types of organizational structures? 1.Authoritarian structure 2.Flat structure 3.Power structure 4.Vertical structure

2 A flat or horizontal structure has few administrative layers between management and employees. Employees have more decision-making power in this type of hierarchy.

The nurse is Facebook friends with other members of the nursing team. The nurse notes that one of the unlicensed assistive personnel (UAP) posts a comment of Facebook about a client 'it was great to see my neighbor was discharged from the hospital today." Why should this be a concern that needs to be addressed? 1. potential legal issues. 2. potential HIPAA issue 3. potential ethical issues. 4. potential malpractice issue.

2 Although the UAP did not identify the client by name, others could determine the client by name, others could determine who the client was the UAP was referring to in the post. Referring to a client via social media can be an infringement of privacy and potential HIPAA concern. THIN Thinking: Top Three- Safe practice means that the nurse protects the confidentiality of the client to meet the HIPAA standards. Compromising HIPAA can impact the nurse's job and professional standards.

· The charge nurse is observing a new nursing graduate perform an ear irrigation to remove impacted cerumen from the client's ear. The charge nurse should intervene during the procedure if the new nursing graduate performs which action? 1 Washes hands before performing the procedure 2 Positions the client with the affected side up after the irrigation 3 Warms the irrigating solution to a temperature that is close to body temperature 4 Directs a slow, steady stream of irrigation solution toward the upper wall of the ear canal

2 During the irrigation, the client is positioned sitting with an ear basin under the ear. Irrigation solutions that are not close to the client's body temperature can be uncomfortable and may cause injury, nausea, and vertigo. A slow, steady stream of solution should be directed toward the upper wall of the ear canal and not toward the tympanic membrane. Too much force, and a flow directed toward the tympanic membrane could cause tympanic membrane rupture. After the irrigation, the client should lie on the affected side for a time to finish the drainage of the irrigating solution and to allow gravity to assist in the removal of the earwax and solution. An ear irrigation is the instillation of water or a saline solution into the ear and is usually done to remove excess cerumen from the ear. Ear irrigations are not done if a perforated tympanic membrane is suspected. It is important for the nurse to know the procedure for performing an ear irrigation to prevent complications of the procedure, such as rupture of the tympanic membrane.

A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team, the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse's aide, conduct the interviewing process with key questions that were developed by the team. This is an example of: 1.centralized power. 2.shared governance. 3.span of control. 4.vertical authority.

2 For shared governance to be effective, decision making must be shared by empowered staff at the point where patients receive care.

A patient who has sickle cell disease is admitted with vaso-occlusive crisis and reports severe abdominal and flank pain. Which of the analgesic medications on the pain treatment protocol will be best for the nurse to administer initially? 1.Ibuprofen 800 mg PO 2.Morphine sulfate 4 mg IV 3.Hydromorphone liquid 5 mg PO 4.Fentanyl 25 mcg/hr transdermal patch

2 Guidelines for the management of vaso- occlusive crisis suggest the rapid use of parenteral opioids for patients who have moderate to severe pain. The other medications may also be appropriate for the patient as the crisis resolves but are not the best choice for rapid treatment of severe pain. Focus: Prioritization.

· The nurse is preparing to administer a medication to a client and notes that the dose prescribed is higher than the recommended dosage. The nurse calls the primary health care provider (PHCP) to clarify the prescription, and the PHCP instructs the nurse to administer the dose as prescribed. Which action should the nurse take? · o 1 Call the pharmacy. o 2 Contact the nursing supervisor. o 3 Administer the dose as prescribed. o 4 Contact the medical director on call.

2 If the PHCP writes a prescription that requires clarification, it is the nurse's responsibility to contact the PHCP for clarification. If there is no resolution regarding the prescription because the prescription remains as it was written after talking with the PHCP or because the PHCP cannot be located, the nurse should then contact the nurse manager or supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until clarification is obtained. Calling the pharmacy is a resource action that will confirm that the dose of medication prescribed is inappropriate, but this action will not resolve the problem facing the nurse. Option 4 is a premature action. The client's PHCP will document specific prescriptions regarding the client's care in the medical record, and the nurse needs to follow the prescriptions unless the nurse deems that a prescription may harm the client. If the prescription can cause harm to the client, the nurse needs to contact the PHCP to change the prescription. If the PHCP does not change the prescription or if the nurse is unable to locate the PHCP, the nurse should follow the chain of command in the health care organization. In this situation, the nurse should contact the nursing supervisor. Under no circumstances should the nurse implement a prescription that could cause harm to the client.

A 32-year-old patient with sickle cell anemia is admit- ted to the hospital during a sickle cell crisis. Blood pressure is 104/62mm Hg, oxygen saturation is 92%, and the patient reports pain at a level 8 (on a scale of 0 to 10). Which action prescribed by the health care provider will the nurse implement first? 1.Administer morphine sulfate 4 to 8 mg IV. 2.Give oxygen at 4 L/min per nasal cannula. 3.Start an infusion of normal saline at 200 mL/hr. 4.Apply warm packs to painful joint

2 National guidelines for sickle cell crisis indicate that oxygen should be administered if the oxygen saturation is less than 95%. Hypoxia and deoxygenation of the blood cells are the most common cause of sickling, so administration of oxygen is the priority intervention here. Pain control (including administration of morphine and application of warm packs to joints) and hydration are also important interventions for this patient and should be accomplished rapidly. Focus: Prioritization

The ways in which work is divided and coordinated among members and the resulting network of relationships, roles, and work groups is the: 1.Organization. 2.Organizational social structure. 3.Structure. 4.formal relationship.

2 Organizational social structure is defined as the ways in which work is divided and coordinated among members and the resulting network of relationships, roles, and work groups (e.g., units, departments).

Shared governance is a model of organizational structure in which staff nurses are: 1.employed to establish mutual goals with clients. 2.empowered through autonomy and accountability. 3.engaged in problem-solving strategies and techniques. 4.equipped with evaluative thinking methodologies.

2 Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

The local hospital has a new specialty unit for women and children. The nursing staff has created a family advisory council to assist in reviewing educational materials used at discharge. This shared governance structure is an example of: 1.interprofessional education. 2.whole-system integration. 3.engagement. 4.Collaboration

2 Some see the benefits of decentralization and the shared governance model extending beyond nurses and all care providers to all employees. "As for the future of Shared Governance, Susan Allen PhD, RN (assistant vice president, Cincinnati Children's Hospital) says it would be ideal to see whole-system integration involving all hospital staff. Clearly, the next steps in this vision are to include patients and the community more deliberatively into the shared governance model. Allen says Cincinnati Children's Hospital has a family advisory council and a teen council that get involved in projects, including reviewing potential educational materials and designing a new learning center (Gray, 2013).

Standardization of __ provides a uniform structure for information delivery and flow in order to facilitate exchange among those involved in common work processes. 1.physician orders 2.Communication 3.work processes 4.work outputs

2 Standardization of communication methods coordinates work by providing a uniform infrastructure of information to facilitate exchange among those involved in common work processes.

The patient is a 69-year-old woman who has a history of diabetes mellitus, peripheral vascular disease, and myocardial infarctions. She was admitted to the hospital with a stroke and is being transferred to a subacute facility and then to a rehabilitation facility. At every transfer she must review her entire history, provide telephone numbers of family members, list all 30 of her medications, and list all home care and medical supply companies. Which of these processes could improve the fragmentation in work flow? 1.Departmentalization 2.Standardization 3.Specialization 4.Subdivision

2 Subdividing work may create breaks or fragmentation in work flow, which can be addressed in organizations by integrating work processes across roles and subunits using coordination devices (Hatch & Cunliffe, 2013). At the work group level, coordination may involve specific roles, standardization (programming), groups, or feedback devices. For example, handoff communication and techniques such as situation, background, assessment, and recommendation (SBAR) are used to coordinate between units or providers in the delivery of care.

The nurse is long-term care is making assignments to a team that includes one LPN/LVN and 2 unlicensed assistive personal (UAPs). What task is most appropriate for the LPN/LVN only? 1. monitoring vital signs. 2. Dressing changes. 3. Ambulating clients.. 4. Routine ADLs

2 The LVN/LPN has the skills to perform routine nursing actions such as dressing changes. The UAP does not have the knowledge level to be able to collect data regarding wound healing while changing a dressing. THIN Thinking: Top Three- When delegating care, the nurse needs to follow the 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

The nurse is orienting a new graduate nurse to the unit. Reviewing the policies and procedures is included in the orientation. What statement by the nurse reinforces the importance of complying with the organization's policies and procedures? 1. "Always refer to the policies and procedures as a reminder for how to do whatever task you are assigned." 2. "If there is a legal question about a practice issue the policies and procedures serve as the standard of care." 3. "the policies and procedures are a recipe for success to make sure we all do things the same way." 4. "Administration develops the policies and procedures for us so that we are providing cost effective care."

2 The first question that will be asked if there is a legal issue was whether the practice was consistent with the prevailing standard of care. The organization's policies and procedures are based on best practices and serve as the standard of care for practice. THIN Thinking: Help Quick- The nurse needs to always be aware of legal issues that may arise from practice. Once the nurse considers the legal implications then other issues raise in priority.

A neighbor calls the emergency room nurse who is off- duty and at home to report "My son just fell out of a tree and his eyes are rolled back in his head. Please help me." What is the most appropriate action by the nurse? • 1. Immediately go to the neighbor's house to assess the boy. 2. Call 911 before going over to assess the boy. 3. Tell the mother that you are off duty and can't do anything. 4. Tell the mother to call her primary health care provider.

2 The first thing the nurse should do is call 911 for emergency help. Once the nurse arrives on the scene, he/ she is obligated to stay until first responders arrive per the Good Samaritan Law. THIN Thinking: Top Three- The nurse needs to identify the top priority when the neighbor calls. The first step is to get emergency help for the kid.

The nurse manager is orienting a new nurse to the charge nurse role. What needs to be included in the orientation regarding delegation? • 1. When delegating to an LPN/LVN the nurse is also delegating accountability. 2. The delegating nurse retains accountability for care delegated to non-RN staff. 3. The LPN/LVN can re-delegate an assignment to unlicensed assistive personnel (UAP). 4. The unlicensed assistive personnel (UAP) has the authority to refuse a delegating.

2 The nurse delegating to an LPN/LVN or unlicensed personnel remains accountable for the care provided. The individual doing the delegating is personally responsible for making prudent decisions based on the 5 rights of delegation. THIN Thinking: Help Quick- When delegating care, the nurse needs to follow the 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

The nurse on the quality improvement committee has asked the staff nurses on the unit to participate in evaluating the new protocol. What statement by the nurse describes the role of the staff nurses. 1. "We will conducing a research project so each nurse will need to read the research proposal 2. "Staff nurses on the unit will be implementing the new protocol and documenting your findings." 3. "Each staff nurse will be responsible for identifying problems that would be barriers to implementation." The staff nurse will participating in collecting data for the research project not identifying barriers. 4. "Once you have implemented the new protocol you will need to report to the committee." The staff nurse will document findings and responses.

2 The quality improvement process focuses on continual evaluation of new products, processes and procedures. The role of staff nurses is typically to implement the new product, process or procedure and document their findings THIN Thinking: Nursing Process- The nurse needs to understand the quality improvement process and the staff's role in implementation of these projects. Being on the quality improvement committee is an opportunity for the nurse to advocate for the profession and evidence-based practice.

Which of these patients who have just arrived at the emergency department should the nurse assess first? 1.Patient who reports several dark, tarry stools and a history of peptic ulcer disease 2.Patient with hemophilia A who is experiencing thigh swelling after a fall 3.Patient who has pernicious anemia and reports paresthesia of the hands and feet 4.Patient with thalassemia major who needs a scheduled blood transfusion

2 Thigh swelling after an injury in a patient with hemophilia likely indicates acute bleeding, which can compromise blood flow and nerve function in the leg and should be treated immediately with the administration of factor replacement. The other patients also need assessment, treatment, or both, but the data do not indicate any immediate threat to life or function. Focus: Prioritization.

The nurse manager should use which of the following behaviors when implementing a shared governance structure? 1.Autocratic decision making of the manager 2.Coaching the staff to be successful 3.Harboring the vision within the team 4.Reimbursing the staff for overtime

2 To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

After a car accident, a patient with a medical alert bracelet indicating hemophilia A is admitted to the emergency department. Which action prescribed by the health care provider will the nurse implement first? 1 Transport to the radiology department for cervical spine radiography. 2 Transfuse factor VII concentrate. 3 Type and cross-match for 4 units of packed red blood cells (PRBCs) 4 infuse normal saline at 250 mL/hr

2 When a hemophiliac patient is at high risk for bleeding, the priority intervention is to maximize the availability of clotting factors. The other prescribed actions also should be implemented rapidly but do not have as high a priority as administering clotting factors. Focus: Prioritization.

The charge nurse is following up with a staff nurse following a medication error. Which of the statements by the staff nurse could be the root cause for the error? 1. "I checked the client's wristband and asked him to tell me his birthday before I administered the medications." 2. "When I entered the room the client was on his way to the bathroom so I gave him his medications right away." 3. "I doubled checked the medication dosage and route before I took the medication out of the package." 4. "The client was NPO for a lab test so I held the medication until the test was completed."

2 following up after a medication error or a near miss is an opportunity to discover the root cause so that the error can be avoided in the future. When administering medications, the nurse needs to use two methods of identifying the client. Response number 2 suggest the nurse just gave the client the medications because he was in a hurry to get to the bathroom. THIN Thinking: Help Quick- Safe medication administration is a priority for quality nursing care. The nurse needs to follow the 5 rights for medication administration every time.

the nurse case manager is planning care for a client who had a total knee replacement 10 days ago and is being discharged from a rehabilitation center. What other disciplines should the nurse case manager seek input from to develop the plan of care? Select all that apply. 1. Chaplain. 2. Physical therapist. 3. Home health nurse. 4. Respiratory therapist. 5. Pharmacist.

23 The case manager will seek input for the interprofessional team collaborating to provide care to a client in rehabilitation. The rehabilitation team usually consists of the case manager and physical therapist following a knee replacement. A referral to home health is common after a stay in rehabilitation so the home health nurse would also be part of the discharge planning team. THIN Thinking: Top Three- The nurse needs to be able to prioritize who needs to participate in discharge planning meetings. Getting the right people at the meeting can facilitate an effective discharge plan.

· The charge nurse is observing a new nursing graduate insert an indwelling urinary (Foley) catheter. The charge nurse should intervene if the new nursing graduate begins to perform which actions? Select all that apply. · o 1 Lubricates the catheter before inserting it o 2 Positions the client in a side-lying position o 3 Inflates the balloon to test patency before inserting the catheter o 4 Cleans the area around the urinary meatus before inserting the catheter o 5 Inflates the balloon as soon as urine begins to flow through the catheter tubing

235 Before insertion of the catheter, the client (if female) should be positioned on the back with the posterior sides of the feet touching one another with the knees bent. This allows for optimal visualization and access to the urethral meatus. The balloon is not inflated before insertion of the catheter because this can increase the fragility of the balloon and increase the likelihood of balloon breakage or fragmenting. After urine begins to flow, the catheter is inserted 2.5 cm (1 inch) more. Doing so ensures that the balloon is in the bladder, not in the urethra. Options 1 and 4 identify correct procedure. An indwelling urinary (Foley) catheter is a rubber tube with a balloon tip that is filled with a sterile liquid after it is inserted in the bladder. It is connected to a bag that collects urine draining from the bladder. Sterile technique is used to insert this catheter. This type of catheter is used when continuous drainage of the bladder is needed, such as during a surgical procedure.

· The nurse is observing a student donning a pair of sterile gloves and preparing a sterile field. The nurse should intervene if the student performs which actions? Select all that apply. · 1 Puts the right glove on and then the left glove 2 Dons the sterile gloves without washing the hands 3 Uses the inner wrapper of the gloves as a sterile field 4 Maintains the gloved hands below the level of the waist 5 Touches the gloves on the overbed table, removes them, and dons another sterile pair

24 Hands must always be washed (even though sterile gloves are used) to keep germs from spreading. The hands should be maintained above the level of the waist to keep them and the areas that need to remain sterile exposed to as few contaminated areas as possible. The inside wrapper provides an excellent area for usage because it is sterile. Gloves that touch anything unsterile must be considered contaminated, and a new package of gloves must be obtained and used. The order of placing gloves on is up to the individual as long as sterile technique is not broken. Sterile technique, also known as aseptic technique, is the use of special procedures to prevent contamination of the nurse, object, or area by microorganisms. A sterile field is an area that the nurse prepares that is considered free of microorganisms. Sterile technique and a sterile field are used to perform various procedures, such as changing a wound dressing. Hand washing is always done before any procedure even if the nurse plans to don gloves.

The charge nurse is explaining to the new nurse the role of the licensed vocation/ practical nurse (LVN/LPN) on the acute care unit. What is included in the LVN/LPN's scope of practice? Select all that apply. 1. Developing a plan of care for assigned clients. 2. Administering routine medications to stable clients. 3. Conducting client teaching 4. Collecting subjective and objective data. 5. Analyzing assessment data for decision making.

24 The LPN/LVN works under the direct supervision of the RN in the acute setting. The key to delegating to the LPN/LVN us the stability of the client because unstable clients tend to change more quickly requiring assessment and decision making. The RN develops the plan of care and the LPN/LVN implements the plan with activities included in their scope of practice such as collecting data and administering medications. Assessment and teaching are not in the scope of practice of the LPN/LVN. THIN Thinking: Nursing Process- When delegating care, the nurse needs to follow the 5 rights which included understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

· The nurse is supervising an unlicensed assistive personnel (UAP) performing mouth care on an unconscious client. The nurse should intervene if the nurse noted the UAP performing which actions? Select all that apply. · 1 Turning the client's head to one side 2 Placing the client in a flat supine position 3 Using small volumes of fluid to rinse the mouth 4 Using a gloved finger to open the client's mouth 5 Placing an emesis basin under the client's mouth

24 The client who is unconscious is at a great risk for aspiration. The client should have the head of the bed elevated because a flat supine position presents the risk of aspiration. The UAP should either place the client in a side-lying position or turn the client's head to the side. An emesis basin is placed underneath the mouth to collect the small volumes of fluids used to rinse the mouth. A bite stick or a padded tongue blade is used to open the mouth, not a gloved finger, to prevent injury to the caregiver. Unconsciousness is a state of complete or partial unawareness or lack of response to stimuli. It can be caused by a variety of conditions, such as shock, hypoxia, or stroke (brain attack). The client who is unconscious requires complete care, including mouth care. Depending on the state of unawareness, the client may exhibit some responses to stimuli, such as bearing down with the teeth if an object is placed in the mouth; therefore, you should never insert a finger into a client's mouth, regardless of the state of consciousness. It is extremely important to remember that the flat position places the client at risk for aspiration.

In organizations that practice shared governance, the nurse manager's role is to, select all that apply: 1.hire new employees. 2.mentor the nursing staff. 3.train new nurses in patient care. 4.support the decisions of the nursing team. 5.enable the staff to become effective leaders.

245 The nurse manager is primarily responsible for mentoring, facilitating, enabling, and supporting the staff personnel. Sustainable change can occur at the unit and organizational level if the nurse manager works within the framework of transformational leadership, shared governance, and action processes.

The charge nurse is making the daily assignments on the medical-surgical unit. Which patient is best assigned to a float RN who has come from the postanesthesia care unit (PACU)? 1.A 30-year-old patient with thalassemia major who has an order for subcutaneous infusion of deferoxamine 2.A 43-year-old patient with multiple myeloma who requires discharge teaching 3.A 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy 4.A 65-year-old patient with pernicious anemia who has just been admitted to the unit

3 A nurse who works in the postanesthesia care unit will be familiar with the monitoring needed for a patient who has just returned from a procedure such as a colonoscopy, which requires moderate sedation or monitored anesthesia care (conscious sedation). Care of the other patients requires staff with more experience with various types of hematologic disorders and would be better to assign to nursing personnel who regularly work on the medical-surgical unit. Focus: Assignment.

A 67-year-old patient who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. Which statement made by the patient when the nurse is obtaining the admission history is of most concern? 1."I've noticed that I bruise more easily since the chemotherapy started." 2."My bowel movements are soft and dark brown." 3."I take ibuprofen every day because of my history of osteoarthritis." 4."My appetite has decreased since the chemotherapy started."

3 Because nonsteroidal anti-inflammatory drugs (NSAIDs) will decrease platelet aggregation, patients with thrombocytopenia should not use ibuprofen routinely. Patient teaching about this should be included in the care plan. Bruising is consistent with the patient's admission problem of thrombocytopenia. Soft, dark brown stools indicate that there is no frank or occult blood in the bowel movements. Although the patient's decreased appetite requires further assessment by the nurse, this is a common complication of chemo- therapy. Focus: Prioritization.

A patient is admitted to the intensive care unit with disseminated intravascular coagulation (DIC) associated with a gram-negative infection. Which assessment information has the most immediate implications for the patient's care? 1.There is no palpable radial or pedal pulse. 2.The patient reports chest pain. 3.The patient's oxygen saturation is 87%. 4.There is mottling of the hands and feet.

3 Because the decrease in oxygen saturation will have the greatest immediate effect on all body systems, improvement in oxygenation should be the priority goal of care. The other data also indicate the need for rapid intervention, but improvement of oxygenation is the most urgent need. Focus: Prioritization

A patient with sickle cell disease is admitted with splenic sequestration. The blood pressure is 86/40 mm Hg, and heart rate is 124 beats/min. Which of these actions will the nurse take first? 1.Complete a head-to-toe assessment. 2.Draw blood for type and cross-match. 3.Infuse normal saline at 250 mL/hr. 4.Ask the patient about vaccination history.

3 Because the patient is severely hypotensive, correction of hypovolemia caused by the splenic sequestration is the most urgent action. The other actions are appropriate because a complete assessment will be needed to plan care, a transfusion is likely to be needed, and vaccination history is pertinent for patients with sickle cell disease. However, infusion of saline is the priority need. Focus: Prioritization; Test Taking Tip: Although thorough assessment of a newly admitted patient is always needed, when the primary assessment (focused on airway, breathing, circulation, and disability) indicates a need for rapid treatment, the treatment should be initiated before proceeding with the rest of the assessment.

The nurse is recommending a change in practice based on evidence-based practice. Which statement by the nurse reflects an understanding of evidence-based practice? 1. "I think we should change the practice because the way I learned to do in school was different. Both my teachers and the book said to do it this way." 2. "For the last couple years, I have done it this way and the outcomes have been good. So I would like to change the practice." 3. "I was at a conference recently and hear about this new technique and I have two recent research publications that support it." 4. "We keep doing the same thing and getting the same outcomes that no one is happy with so let's try something different and see what happens."

3 Evidence-based Practice is based on data that is accumulated through practice protocols or research. Depending on authority to determine practice or traditional ways of providing care may not be the best to facilitate quality outcomes. THIN Thinking: Top Three- Exploring the sources of rationale for decision making helps to determine whether or not it is evidence based. Priorities for quality outcomes are based on evidence- based practice.

The nurse is providing orientation for a new RN who is preparing to administer packed red blood cells (PRBCs) to a patient who had blood loss during surgery. Which action by the new RN requires that the nurse intervene immediately? 1 Waiting 20 minutes after obtaining the PRBCs before starting the infusion 2 Starting an IV line for the transfusion using a 22-gauge catheter 3 Priming the transfusion set using 5% dextrose in lactated Ringer's solution 4 Telling the patient that the PRBCs may cause a serious transfusion reaction

3 Normal saline, an isotonic solution, should be used when priming the IV line to avoid causing hemolysis of red blood cells (RBCs). Ideally, blood products should be infused as soon as possible after they are obtained; however, a 20-minute delay would not be unsafe. Large-bore IV catheters are preferable for blood administration; if a smaller catheter must be used, normal saline may be used to dilute the RBCs. Although the new RN should avoid increasing patient anxiety by indicating that a serious transfusion reaction may occur, this action is not as high a concern as using an inappropriate fluid for priming the IV tubing. Focus: Prioritization.

The new graduate nurse is being orientated by a nurse preceptor. The new graduate asks "why do you belong to a professional nursing organization?" What is the most appropriate response by the nurse preceptor? 1. "I was in the student nurse organization then felt like I should become a member of a professional organization when I graduated. 2. "I get additional points at my annual performance evaluation because I can prove I am a member of one of the nursing organizations." 3. "It is a good way to stay involved with the big picture of nursing by advocating for the profession and establishing guidelines for practice." 4."I really enjoy the socialization with other nurses across the county and the dues have been tax deductible as a professional expense."

3 Nursing professional organizations advocate for the discipline on local and national levels. Organizations also are instrumental in setting standards of practice, codes of ethics and taking stands on practice issues. THIN Thinking: Nursing process - Using the nursing process the nurse will be able to look at the bigger picture of any situation to made decisions. Understanding the purpose of professional organizations should be the motivator for participation.

The nurse witnesses another nurse bully a colleague. What is the best action for the witness to take? 1. Confront the nurse who is bullying the colleague. 2. Came to the rescue of the victim of the bullying. 3. Report the observation to the charge nurse. 4. ignore it but watch to see if it happens again.

3 Reporting the behavior observed to the charge nurse or nurse manager is the most appropriate behavior. Intervening or rescuing the other nurse could exacerbate the situation. Everyone is responsible for workplace safety so ignoring the situation is not an option. THIN Thinking: Top Three- Prioritizing strategies when observing bullying is critical for breaking the cycle of lateral violence. Recognizing that the priority is to report the observation is an opportunity for the nurse to report data so that appropriate decisions can be made.

The nursing chief executive officer (CEO) works in a major rehabilitation and subacute facility network. Her span of control refers to the number of: 1.miles in which the network resides. 2.ancillary staff accountable to her. 3.nurses and non-nurses reporting to her. 4.inpatients that the facilities service.

3 Span of control refers to the number of nurses and non-nurses reporting to a manager.

Staffing management is one of the most critical activities for nurse leaders at every level of the health care organization today because it affects: 1.delegation and supervision. 2.unit leadership productivity. 3.organizational outcomes. 4.professional development and quality control.

3 Staffing management is one of the most critical yet highly complex and time-consuming activities for nurse leaders at every level of the health care organization today. How well or poorly nursing leaders execute staff management impacts the safety and quality of patient care, financial results, and organizational outcomes, such as job satisfaction and retention of registered nurses (RNs).

The nurse is delegating care for a team clients. Which client would be most appropriately delegated to an unlicensed assistive personnel (UAP)? 1. Client with difficulty swallowing. 2. Client with continuous tube feedings. 3. Client requiring a clean catch urine specimen. 4.Client just transferred from ICU..

3 The UAP is prepared to provide care for stable clients and can assist with routine nursing actions such as specimen collection. THIN Thinking: Top Three- When delegating care, the nurse needs to follow the 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

An approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations in the 1990s. These changes in skill mix led to: 1.decreases in RN workload. 2.increased nursing satisfaction. 3.decreased patient satisfaction. 4.decreased patient safety concerns.

3 The approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations and often lacked evaluation of the skill mix change and other changes on the quality of care and nurse job satisfaction and retention . This was most apparent in California where a leaner RN skill mix was tried by Kaiser Permanente Northern California in the early 1990s. Skill mix was reduced from 55% RNs to 30% RNs in 1995 . The changes in skill mix led to widespread real and perceived increases in RN workload, patient safety concerns, and nurse and consumer complaints

The network or pattern of social relationships and friendship circles within an organization is known as the: 1.clique. 2.Formal structure. 3.informal structure. 4.hierarchy.

3 The informal structure is simply the network or pattern of social relationships and friendship circles that are outside the formal structure. It is an interconnected web of relationships that operate in and around the formally designated lines of communication.

Which of the following factors influences the structure of an organization? 1.Age of the building 2.Brand of computer system 3.Number of employees 4.Square footage of the facility

3 The number of employees influences the structure of an organization. Organizational structure is a consequence of both the division of and the coordination of labor, which results in a formal set of interrelated and interdependent roles and work groups.

The nurse case manager for a hospice client reviews the goals of the interprofessional team at the meeting with the family. What is the priority goal? • 1. Treatment of disease symptoms 2. Keeping the client at home. 3. Providing comfort care. 4. Providing cost effective care.

3 The nurse case manager place a pivotal role in coordinating hospice care. At the meeting it is important to reinforce that the priority goal for a hospice client is to provide care. THIN Thinking: Top Three- The nurse to recognize the priority goals for hospice care so that planning can be done appropriately.

The nurse reports to work for the schedules shift. The nurse manager tells the nurse to report to the emergency department today as a float nurse due to staffing shortages. The nurse has never worked in the emergency department. What is the best action by the nurse? • 1. refuse to float to the emergency department. 2. Call the supervisor to report the reassignment. 3. Clarify the reassignment with the nurse manager. 4. Check the policies and procedures regarding float assignments.

3 The nurse is an employee of the organization and therefore, can be floated to another unit if needed. Refusing to go to the emergency department can be seen as insubordination. Clarifying the reassignment with the nurse manager can be an opportunity to discuss whether the nurse meets the 5 rights of delegation. THIN Thinking: Help Quick- the nurse is responsible for the duties delegated by the nurse manager. Therefore, the priority action would be to clarify with the nurse manager before moving to any other steps.

A staff nurse has been working in the neonatal critical care unit for 10 years. She believes that a professional nurse is a lifelong learner. Many staff members come to her for clinical problem solving and advice. This nurse has: 1.decisional authority. 2.formal power. 3.informal power. 4.quantum authority.

3 This nurse has informal power. She is a staff nurse with a great amount of expertise, with many relationships and alliances in the organization.

The nurse is reviewing the complete blood count for a patient who has been admitted for knee arthroscopy. Which value is most important to report to the health care provider before surgery? 1.Hematocrit of 33% (0.33) 2.Hemoglobin level of 10.9 g/dL (109 g/L) 3.Platelet count of 426,000/mm3 (426 109/L) 4.White blood cell count of 16,000/mm3 (16 109/L)

4 Centers for Disease Control and Prevention guidelines for the prevention of surgical site infections indicate that surgery should be postponed when there is evidence of a preexisting infection such as an elevation in white blood cell count. The other values are slightly abnormal but would not be likely to cause postoperative problems for knee arthroscopy. Focus: Prioritization.

Within nursing practice, the use of advanced practice roles is an example of: 1.cross-training. 2.departmentalization. 3.fragmentation. 4.specialization.

4 In health care, specialist roles have emerged to address the increasing complexities of care and technology. Within nursing, specialist roles have also evolved to address particular areas of nursing practice and include advanced practice roles such as clinical nurse educators, nurse practitioners, and nurse anesthetists.

In organizations that practice shared governance, staff, managers, and leaders are responsible for: 1.technology. 2.Budgeting 3.Education 4.Innovation

4 In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager. The manager is primarily responsible for mentoring, facilitating, enabling, and supporting.

· The nurse reviews the laboratory results of a client receiving chemotherapy and notes that the white blood cell count is extremely low. The nurse asks a nursing student assigned to care for the client to place the client on neutropenic precautions. The nurse determines the need to review the procedures for neutropenic precautions if the student nurse took which action? · 1 Removes the water pitcher from the client's room. 2 Removes fresh cut flowers from the client's room. 3 Places a box of face masks at the entrance to the client's room. 4 Leaves fresh pears and apples brought to the client by a family member in the client's room.

4 In the immunocompromised client, a low-bacteria diet is necessary. This includes avoiding fresh fruits and vegetables. Thorough cooking of all food is also required. Anyone who enters the client's room should perform strict and thorough hand washing and wear a mask. Cut flowers or any standing water is removed from the room because it tends to harbor bacteria. Neutropenia is an abnormal decrease in the number of neutrophils in the blood that places the client at risk for infection. Therefore, neutropenic precautions are instituted. This type of precaution focuses on protecting the client from infection, and any potential source of infection is avoided in the client's environment or in the care of the client.

Implementation of the electronic medical record as changed the way documentation is done. What is the primary goal for implementing the electronic medical record? • 1. Eliminate spelling and grammatical errors. 2. Enhance the nurse ability to read prescriptions. 3. Streamline documentation eliminating narratives. 4. Share information across disciplines and settings.

4 The primary goal for implementing the electronic medical record is to facilitate communication and information sharing across disciplines and settings. By sharing information the quality and continuity of care is enhanced. THIN Thinking: Top Three- Understanding the priority reasons for implementing technology is important to facilitate buy-in to the process. Communicating across disciplines and settings may prevent errors

what personal quality that is admired in the person with referent power?

problem solving

· The nurse is reviewing the preprocedure care for a client who is scheduled for a cardiac catheterization with a nursing student. The nurse determines that the student needs further instruction while preparing the client if the nursing student made which statement? · o 1 "The procedure takes about 5 hours." o 2 "The client may experience flushing feelings during the procedure." o 3 "The blood vessels and flow of blood will be examined with this procedure." o 4 "There is minimal discomfort with catheter insertion because a local anesthetic is used."

1 A cardiac catheterization is a diagnostic test that examines the coronary arteries and the flow of blood through them. The procedure is done in a darkened cardiac catheterization room in the radiology department. A local anesthetic is used so there is minimal discomfort with catheter insertion. The preprocedure preparation and the procedure may take approximately 1 to 3 hours, during which the client may feel various sensations, such as a feeling of warmth or flushing, with catheter passage and dye injection. Cardiac catheterization is a test performed to examine the status of the coronary arteries or the presence of congenital heart disease, stenosis, or valvular disease. Risks associated with the procedure include dysrhythmias (irregular heartbeats), infection, and thrombosis, and the nurse needs to monitor the client closely after the procedure

Which assessment finding for this patient is most important to report to the health care provider? A. Heart rate 46 and prolonged QRS duration B. Crackles at lung bases and peripheral edema C.Confusion and 1+ deep tendon reflexes D.Nausea and abdominal distention

A Focus: Prioritization The bradycardia and QRS prolongation are caused by the markedly elevated serum potassium level; rapid action is needed to prevent cardiac arrest. The other findings are also associated with acute kidney injury and poor renal function but are not life threatening.

A patient with a presumptive diagnosis of chronic pancreatitis should also be assessed and questioned about which set of symptoms? A. Polyphagia, polydipsia, and polyuria B. Palpitations, dizziness, and cool extremities C. Eructation, flatulence, and bloating D. Nocturia, proteinuria, and uremic fetor

A Focus: Prioritization While a complete history and review of symptoms must always be performed, loss of pancreatic endocrine function causes development of diabetes mellitus in patients with chronic pancreatic insufficiency. Polyphagia, polydipsia, and polyuria are commonly associated with diabetes mellitus. Palpitations, dizziness, and cool extremities are associated with decreased cardiac output, such as in left-sided heart failure. Eructation, flatulence, and bloating are symptoms of gastroesophageal reflux disease. Nocturia, proteinuria, and uremic fetor are symptoms of kidney failure.

The health care provider prescribes IV fluids and broad spectrum antibiotics for the patient after confirming the diagnosis of peritonitis. Which actions associated with the IV therapy should be delegated to the assistive personnel (AP)? Select all that apply. A. Recording daily intake and output B. Placing a nasogastric (NG) tube to decompress the stomach C. Checking the placement of the nasal cannula for oxygen during every patient contact D. Administering analgesics for pain E. Assessing lung sounds each shift F. Assisting the patient out of bed into the chair

A, C, F Focus: Delegation Recording I&O, checking the oxygen cannula placement, and assisting patients to get out of bed are all within the scope of practice for the AP. Placing an NG tube, administering medications, and assessing lung sounds are more appropriate to the RN's scope of practice. An LPN/LVN could also administer oral analgesics.

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.

B

Mr. D says, "I am old and fat, and I am going to die soon anyway. So what's the point of trying?" What is the most therapeutic response? A. "Don't talk like that. I have really enjoyed taking care of you." B. "You have a lot to cope with. What's kept you going thus far?" C. "Sounds like you are giving up. Would you like to speak to a counselor?" D. "After your physical health improves, I am sure that you will feel better."

B Focus: Prioritization Acknowledge his difficulties, and then assess his strengths. It is likely that he can identify at least one thing that has helped him in the past. An honest expression of pleasure in caring for a patient is always welcome, but "don't talk like that" is a direct command to withhold true feelings. Offering referral to a counselor may be an option, but immediately going off to find one is not therapeutic. Option D is an empty platitude.

A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? A. Obtain a court order for the surgical procedure. B. Ask the EMS team to sign the informed consent. C. Transport the victim to the operating room for surgery. D. Call the police to identify the client and locate the family.

C. Transport the victim to the operating room for surgery

The nurse is caring for a patient who has been transferred to the PACU from the operating room after receiving general anesthesia. What is the correct order of nursing actions that the nurse will take? A. Obtain blood pressure and heart rate. B. Monitor incisions for bleeding or swelling. C. Check O2 saturation with a pulse oximeter. D. Assess the level of consciousness.

CABD Focus: Prioritization The highest priority after general anesthesia is airway maintenance, the nurse's first action should be to assess the patient's oxygenation. Assessment for adequate circulation is the next priority; changes in heart rate and blood pressure are early indicators of inadequate cardiac output. Since bleeding is always a potential complication after surgery, the nurse will check the surgical incision or dressing. The patient's level of consciousness is constantly monitored but can be impaired in patients who have had recent sedation or opioids. This should be taken into consideration in the assessment in the event the patient is unable to control the airway.

To prepare the patient for emergency surgery, which tasks would the RN perform? Select all that apply. A. Explain the procedure and the risks of surgery B. Collect patient's belongings and label bag. C. Establish a second peripheral IV. D. Notify the operating room and give a report. E. Obtain vital signs and pulse oximetry reading F. Insert an indwelling urinary catheter G. Ensure that medical records are complete. H. Transport the patient to the operating room.

CDFGH Focus: Prioritization The health care provider should explain the procedure. The nurse should be present to witness the consent. The AP can collect belongings and assist with transport. Establishing a peripheral IV, giving a report, inserting an indwelling urinary catheter and completing the medical records and are responsibilities of the RN. The RN would accompany the patient to the operating room, because the patient is unstable; the AP can assist as needed.

The nurse reports to work for the schedules shift. The nurse manager tells the nurse to report to the emergency department today as a float nurse due to staffing shortages. The nurse has never worked in the emergency department. What is the best action by the nurse? A. Refuse to float to the emergency department. B. Call the supervisor to report the reassignment. C. Clarify the reassignment with the nurse manager. D. Check the policies and procedures regarding float assignments.

Clarify the reassignment with the nurse manager The nurse is an employee of the organization and therefore, can be floated to another unit if needed. Refusing to go to the emergency department can be seen as insubordination. Clarifying the reassignment with the nurse manager can be an opportunity to discuss whether the nurse meets the 5 rights of delegation. THIN Thinking: Help Quick- the nurse is responsible for the duties delegated by the nurse manager. Therefore, the priority action would be to clarify with the nurse manager before moving to any other steps.

The psychiatric nurse is presented with a group clients in the emergency department. Which clint requires immediate attention? 1.A young adult client who failed medical school and says, "My pain will be over soon." 2.An adult client who is unable to talk in front of other people due to symptoms of anxiety. 3.A middle-aged client who hears voices saying to harm others. 4.A middle-aged client who is anxious after witnessing a murder.

Correct: 1) A young adult client who failed medical school and says, "My pain will be over soon." This client is indicating thoughts of suicide and is at immediate risk for self-harm. The nurse must determine if the client has the means to inflict self-harm. The nurse should place the client on one-to-one observation and stay with client to help control self-destructive impulses. Incorrect: 2) This client does not require immediate attention. The indications of anxiety include increased pulse, increased blood pressure, and increased respirations. The client may also exhibit perspiring and flushing and describe heat sensations. 3) This client should be the second client seen in this situation. The client is at risk for harming others. 4) This client does not require immediate attention. The client may be experiencing post-traumatic stress syndrome.

In a surgical unit, which delegation assignment, made by the RN, requires immediate follow-up by the charge nurse? A. A practical nurse assigned to administer oral medication to the clients. B. A practical nurse is assigned to transport the patient the post-operative patient to the physical therapy. C. A graduate nurse to check the BP of a client every 2 hours and report to the RN. D. An unlicensed assistive personnel to assess a patient for prolonged constipation and having impacted stool.

D. An unlicensed assistive personnel to assess a client for prolonged constipation and having impacted stool. Assessment is not in a scope of practice for PN and UAP. Assessing for fecal impaction needs critical thinking and immediate intervention in post-op clients.

The nurse is delegating care for team clients. Which client would be most important to be supervised for the task delegated to an unlicensed assistive personnel (UAP)? A. Bathing a client who has lung cancer and is on continuous tube feedings. B. Transferring an elderly client to a bedside commode. C. Helping a client with chronic back pain to do range of motion exercises. D. Feeding a client with multiple sclerosis who has swallowing difficulty.

D. Feeding a client with multiple sclerosis who has swallowing difficulty. MS history includes progression of illness and additional health problems due to weakness progression and spastic paralysis. Optic neuritis (loss of vision) and swallowing difficulties needs to be assessed. A patient with swallowing difficulty needs close monitoring during feeding. Prioritization: Client safety.

Which nursing actions can the preoperative nurse delegate to the assistive personnel (AP)? (Select all that apply.) A. Obtaining, reporting, and recording patients' vital signs in their charts. B. Removing dentures, jewelry, and giving them to family members. C. Verifying that patient informed consent forms are signed. D. Ensuring that patient preoperative checklists are completed. E. Transporting patients by stretcher to the operating room (OR). F. Informing the OR staff about patient allergies and current vital signs.

Focus: Delegation The assistive personnel role includes actions that do not require clinical judgment, such as obtaining, reporting, and documenting vital signs, removal of dentures and jewelry to give to family members, and transport of stable patients. Verifying informed consent, completing the preoperative checklist, and communicating patient status to other professionals should be done by the RN, who has the legal scope of practice and education required for these nursing actions.

which power refers to relationships across subunit departments?

Horizontal - subunit or horizontal power pertains to relationships across departments

Ms. S tells you, "I pass a little urine when I sneeze, and with the surgery and my weight, it's hard for me to get up to the bathroom." Which two types of incontinence are affecting Ms. S?

Stress incontinence (small amounts of urine with coughing/sneezing) Functional incontinence (weight and surgery impede getting to toilet)

The health care provider prescribes these orders. Which will you implement first? A. Decrease IV fluids from 100 mL to 50 mL/hr. B. Insulin (regular or rapid acting) (20-50 units) with dextrose (20-50mg) in normal saline infused over 15 to 30 minutes. C. Give sodium polystyrene sulfonate (Kayexalate)15 g. D. Notify the dialysis department to prepare for continuous renal replacement therapy (CCRT).

B Focus: Prioritization An IV insulin dose of 10 units plus 25 g of dextrose lowers the serum potassium level by 1 mEq/L (mmol/L) within 10-20 minutes and the effect lasts about 4-6 hours. This therapy may be associated with significant hypoglycemia. Kayexalate works over a few hours to bind potassium in the gut and lower the total body potassium level. The patient's laboratory and assessment information indicates that decreasing fluid intake and hemodialysis or CCRT are also appropriate, but the nurse's first action should be to correct potentially fatal dysrhythmias caused by the hyperkalemia as quickly as possible.

Ms. P, a 25-year-old woman, comes to the emergency department for lower abdominal pain and light vaginal bleeding with fatigue, nausea, and breast tenderness. She reports a history of endometriosis. Which question will help you to identify a possible life-threatening condition for this patient? A. "Have you been running a high fever?" B. "When was your last menstrual period?" C. "Have you ever experienced this pain before?" D. "Are you currently being treated for endometriosis?"

B Focus: Prioritization Because of her age and symptoms, possibility of pregnancy should be established. Assessment of pain, past history, and other symptoms are relevant but less specific in identifying an ectopic pregnancy or possible miscarriage.

Which event, mentioned by the mother during history taking is probably responsible for causing the asthmatic exacerbation? A. Starting the fifth grade B. Rhinitis C. Replaced the furnace D. Playing archery

B Focus: Prioritization Colds and infections can exacerbate asthma. The patient has a low- grade fever of 99°F (37.2°C ), and a recent onset of rhinitis which most likely triggered the asthma. Starting the fifth grade in the same school should not precipitate an emotional event, replacing the furnace is advantageous to keeping the inside air cleaner and playing archery is not considered to be strenuous exercise that can induce asthma.

The patient's pain is severe and vital signs are: T: 98.4° F; P: 120 breaths/min; R: 24 breaths/min; and BP: 100/60 mmHg. She is anxious and sobbing uncontrollably, saying "My baby, my baby." What is the priority nursing concern? A. Acute pain related to peritonitis and rupture B. Fluid imbalance related to rupture of fallopian tube C. Anxiety related to unknown outcomes of condition D. Potential loss of reproductive function

B Focus: Prioritization Hypovolemic shock is the primary concern at this point. The other concerns must also be addressed once the cardiodynamic status is stabilized.

sbar is used in health care institutions to improve hc communication. which patient population benefits most from clinicians who use sbar

long term patients bc of continuity of care

The Collaborative Care Model of CM is best used for: 1.patients with co-occurring physical and mental health needs. 2.individuals and small systems. 3.hospital-based case management programs focusing on episodic care. 4.The transition of high-risk clients from acute care to community or long-term care settings.

1 In the Collaborative Care Model, dedicated team members address the needs of patients through a comprehensive and strategic care delivery process. Included in the team are a primary care provider, a case manager who is trained in behavioral health, and psychiatric consultants and/or behavioral health specialists (Unützer et al., 2013). This comprehensive approach to care serves as a proactive means to screen and track mental health conditions within the primary care setting.

A population health approach: 1.aims to improve the health of the entire population. 2.is funded by local, state, and national governments. 3.strives to care for people who already exhibit optimal health. 4.treats community-acquired diseases in area clinics.

1 Population health is an approach to health that aims to improve the health of the entire population and reduce health inequities among population groups.

Nursing outreach programs are the core element of: 1.population health management. 2.disease management. 3.case management. 4.care management.

1 The newest generation of PHM programs involves proactive outreach. Nursing outreach programs are the core element. Personal communications (usually via telephone) between an expert nurse and the health plan participant build a personal relationship, help identify knowledge deficits and counseling needs, facilitate close monitoring and progress toward goals, enhance treatment adherence, and promote clinical and cost stabilization.

· The nurse notes that an unlicensed assistive personnel (UAP) dons clean gloves but has not washed their hands before taking an oral temperature on a client. The nurse implements a teaching session for UAPs and should incorporate which principle? · o 1 Learning involves a change of behavior. o 2 Learning is a cognitive, passive process. o 3 UAPs need constant supervision when caring for clients. o 4 Negative rewards reduce undesirable behavior and should be used when an error is seen.

1 The nurse assumes leadership for improving client care by implementing a teaching session that has the potential for changing behavior. Persons who change their behavior have internalized information and apply it to their actions. Options 3 and 4 use negative strategies to change behavior, and this is not usually successful. Option 2 views the learner as not being actively involved in the teaching and learning process. Hand washing is always done before and after every client contact even if the nurse intends to don gloves for client care. If the nurse observes an incorrect action by another health care team member, it is the nurse's responsibility to teach correct procedure to ensure client safety and a safe environment. Learning involves acquiring knowledge about a skill and changing behavior as a result of the training.

A disease management program usually focuses on patients with: 1.chronic conditions. 2.mental health issues. 3.outpatient procedures. 4.surgical diagnoses.

1 While CM programs serve a smaller percentage of the overall population, enrollees are complex from a medical-behavioral, health-social vulnerability perspective. DM programs serve a larger percentage of patients whose main problem is one or more chronic condition(s). These individuals generally have similar primary needs regarding health condition education and accommodation strategies.

Which change strategy is most likely to be used by nurse managers who believe that people are rational and will act in ways that will be in their own best interest? 1.Empirical-Rational Strategies. 2.Power-Coercive Strategies. 3.Normative-Reeducative Strategies 4.Historical-Futuristic Strategies.

1) Empirical-Rational Strategies. Empirical-rational strategies are based on the idea that people are rational and will act in ways that they intellectually understand will be in their own best interest. Incorrect: 2) This is not the most likely strategy. Power-coercive strategies are based on the use of power to cause change. Most often in the direction of having less powerful people conform to plans and directive of the more powerful. It may also go in the opposite direction, such as when employees strike and thereby exert their own power to coerce change. 3) This is not the most likely strategy. Normative-reeducative strategies include the empirical-rational idea that people are intelligent and rational but include the importance of attitudes and values. In addition to giving information, attention is paid to attitudes, values, skills and relationships. There is considerable focus on individuals as the basic unit of the social organization. 4) This is not the most likely strategy. Historical and futuristic ideas may be particularly useful underpinnings for empirical-rational strategies.

The nurse cares for a client with a managed care plan of insurance. Which is correct about managed care? 1.The client may only use certain approved providers. 2.The client has unlimited coverage for all services prescribed. 3.The client may have services without prior authorization. 4.The client may select any provider the client desires to provide care.

1) The client may only use certain approved providers. Use of health care providers and services is limited to those within the group who agree to certain fee schedules. Monitoring medical usage is critical in managed care. Incorrect: 2) Cost containment is crucial to managed care. Covered services are restricted to those approved by the managed care provider. 3) Services and providers must be pre-authorized in order to be covered. There may be a medical review to determine necessity. 4) Use of health care providers is limited to those within the network who agree to the allowed payment schedule.

The nurse manager wants implement a three-day work week on the nursing schedule. The nurse manager states, "Anyone who doesn't go along with the change will not receive vacation time this year." The staff identifies that the nurse manager is demonstrating which type of power? 1.Coercive power 2.Reward power 3.Expert power 4.Referent Power

1). Coercive Power Coercive power derives from fear and the ability to punish. This type of leader uses power to influence staff in order to achieve goals. Incorrect: 2) Reward power: The basis of reward power is the ability to provide favors or promise money or other benefits. For example, a manager would reward staff with promotions. 3) Expert power: Expert power derives from the knowledge and skills that one has developed. A nurse instructing a client about how to manage diabetes has expert power. 4) Referent Power: The basis of referent power is the desire of a follower to be like the leader. For example, students would emulate the behavior of nursing instructors and staff nurses.

In the emergency room, after receiving a change of shift report, in which order should the RN assess clients? Prioritize the highest priority action. A. Elderly client with pneumonia being discharged to long-term care later today. B. Adolescent client admitted for evaluation following a motor vehicle accident. C. Confused elderly client with a urinary tract infection receiving IV antibiotics. D. Stable postoperative client who received pain medications about 30 minutes ago. E. A client who is diagnosed with Addison disease a week and discontinued taking his corticosteroids.

1- E. A client who is diagnosed with Addison disease a week and discontinued taking his corticosteroids. Client exhibiting the signs of Addison's Crisis is the priority. 2- B. Adolescent client admitted for evaluation following a motor vehicle accident. 3- C. A confused elderly client with a urinary tract infection receiving IV antibiotics. 4- D. A stable postoperative client who received pain medications about 30 minutes ago. 5- A. An elderly client with pneumonia being discharged to long-term care later today.

An organizational chart is used to depict: Select all that apply 1.a visual display of the organization's positions. 2.the intentional relationships among positions. 3.open positions within human resources. 4.flow of authority. 5.advisory committees.

124 Hierarchy reflects the formal structure of the organization, which can be identified on an organizational chart. An organizational chart is a visual display of the organization's positions and the intentional relationships among positions. The organizational chart reflects the various positions and the formal relationships between and among the positions and, by extension, the people who are a part of the organization.

The primary purpose of unit practice committees in a health care organization is to improve: Select all that apply 1.practice. 2.processes. 3.outcomes. 4.reimbursement. 5.Turnover

123 The purpose of the unit practice council is described as being "part of the shared governance structure to promote shared decision making at the unit/clinic/program of care level. To make and implement recommendations to improve practice, processes, and outcomes

Once the client is taken to the preoperative area, the unit nurse documents the interactions with the client and the spouse. For each medical record entry below specify whether the entry is appropriate or inappropriate. Nurse's Documentation Entry 1."Client and the client's spouse fighting all morning." 2."Client's spouse approached the nurse in the hallway and asked to sign consent forms for the client." 3."Client's spouse asked the nurse to minimize the physical risks of surgery, including death, to the client." 4."Client is acting very emotional about surgery, which may be an attempt to gain attention from the spouse."

1."Client and the client's spouse fighting all morning." -inappropriate 2."Client's spouse approached the nurse in the hallway and asked to sign consent forms for the client." -appropriate 3."Client's spouse asked the nurse to minimize the physical risks of surgery, including death, to the client." -appropriate 4."Client is acting very emotional about surgery, which may be an attempt to gain attention from the spouse." -inappropriate Documentation must be based on facts and accurate statements provided in context to the situation. It is appropriate for the nurse to include the entries regarding the spouse's actions and statements but inappropriate to include those that are based on conjecture, supposition, and judgement.

What is the purpose of the Nurse Practice Act for any given state? Select all that apply. 1. Define nursing for that state. 2. regulate nursing practice within the state. 3. Set standards of care for the state. 4. Differentiate practice by education. 5. Set standards for nurse education programs.

124 The Nurse Practice Act defines nursing within that state, identifies the differentiated roles of practice such as LVN/LPN, RN and Advanced practice, and regulates criteria for licensure in that state. THIN Thinking: Help Quick- Knowledge of the Nurse Practice Act provides a framework and reference for safe nursing care.

According to organization theories, there are three perspectives regarding the nature of reality and knowledge within an organization. Which of the following are those perspectives? Select all that apply: 1.Objectivism 2.Subjectivism 3.Postmodernism 4.Realism 5.Idealism

123 The field of organization theory contains a variety of approaches to and assumptions about the phenomenon of organization. Objectivism, subjectivism, and postmodernism reflect three broad perspectives regarding the nature of reality and the nature of knowledge with respect to the concept of organization.

The CM dyad team model—composed of a nurse case manager and social worker—has been widely adopted in hospitals. Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on: 1.minimization of inpatient transitions. 2.promotion of patient and family satisfaction through efforts of advocacy. 3.maximization of health care benefits. 4.reduction of cost by decreasing the length of stay. 5.enhanced discharge planning.

1245 Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on (1) minimization of inpatient transitions, (2) reduction of cost by decreasing the length of stay, (3) promotion of patient and family satisfaction through efforts of advocacy, and (4) enhanced discharge planning (Carr, 2009).

Which of the following governmental agencies tracks population and health trends? Select all that apply 1.U.S. Census Bureau 2.The Joint Commission 3.CDC 4.Bureau of Labor Statistics (BLS) 5.Health Resources and Services Administration (HRSA)

1345 Population and health trends are tracked by governmental agencies such as the U.S. Census Bureau, CDC, BLS, and HRSA, as well as private foundations and organizations.

Which of the following components are common to all case management models? Select all that apply 1.Client identification and outreach 2.Population management 3.Monitoring service delivery 4.Individual assessment and diagnosis 5.Evaluation 6.Environmental management

1345 There are eight main service components common to all case management models. They are client identification and outreach; individual assessment and diagnosis; service planning and resource identification; linking clients to needed services; service implementation and coordination; monitoring service delivery; advocacy; and evaluation.

Population health management (PHM) is viewed as a major health care strategy to improve health outcomes. This is because effective population health management programs: Select all that apply 1.have proactive interventions. 2.promote client satisfaction through advocacy. 3.coordinate care for chronic conditions. 4.have consistency of care for at-risk populations. 5.customize care support. 6.encourage adherence to treatment.

13456 PHM is now being viewed as a major health care strategy to improve health outcomes across multiple populations while lowering costs and improving patient satisfaction. PHM has demonstrated effectiveness across disease states, including integrated behavioral health, chronic illness (e.g., diabetes, congestive heart failure), and assorted payers (e.g., Medicare, Medicaid, third-party populations) (Fortney et al., 2015; Lyles, 2016; Rushton, 2015; Sidorov & Romney, 2016). Attractive features include effective population management, coordination of care for chronic conditions, consistency of care for at-risk populations, customization of care support, encouragement of adherence to treatment, and proactive interventions.

Which of the following collaborative processes assesses, plans, facilitates, coordinates, advocates, and evaluates options and services required to meet an individual's comprehensive health needs? 1.Care management 2.Case management 3.Disease management 4.Population health management

2 Case management (CM) is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes" (Case Management Society of America, 2016a).

· The nurse is teaching an unlicensed assistive personnel (UAP) how to measure a carotid pulse. The nurse should tell the UAP to measure the pulse on only one side of the client's neck for which primary reason? · o 1 Because the pulse rate will be easier to count o 2 To prevent dizziness and a drop in the heart rate o 3 So that the client will not feel a sense of choking o 4 Because it will provide a more accurate determination of the quality of the pulse

2 Applying pressure to both carotid arteries at the same time is contraindicated. Excess pressure to the baroreceptors in the carotid vessels could cause the heart rate and blood pressure to reflexively drop and cause syncope. In addition, the manual pressure could interfere with the flow of blood to the brain. The remaining options are unrelated to the reason for measuring the pulse on only one side of the client's neck. The carotid artery is located in the neck region and is one of the major arteries supplying blood to the head. It is one of the pulse points in the body that can be palpated to check a client's pulse.

The core element common to all provider interventions in case management (CM), disease management (DM), and population health management (PHM) is: 1.disease preventative care. 2.care coordination. 3.client-centered. 4.population-focused.

2 Care coordination is the core element common to all provider interventions in CM, DM, and PHM.

· The nurse is reviewing the preprocedure care for a client scheduled to have an echocardiogram after a myocardial infarction. The nurse determines that the student nurse understands the preprocedure instructions if the student nurse made which statement? · o 1 "The client needs to sign an informed consent." o 2 "The procedure is painless and takes 30 to 60 minutes to complete." o 3 "The client cannot eat or drink anything for 4 hours before the procedure." o 4 "An allergy to iodine or shellfish is a contraindication to having the procedure."

2 Echocardiography uses ultrasound to evaluate the heart's structure and motion. It is a noninvasive, risk-free, pain-free test that involves no special preparation. It is commonly done at the bedside or on an outpatient basis. The client must lie quietly for 30 to 60 minutes while the procedure is being performed. Options 1, 3, and 4 are not preprocedure preparations. Diagnostic uses of an echocardiogram include the detection of atrial or other tumors, measurement of the heart chambers, and evaluation of valve and chamber function. An important point to remember is that an informed consent is only needed if the test is invasive. Another important point is that the nurse must ensure that the client understands the test to be done and its purpose and teaches the client about the test.

· A client comes to the hospital emergency department with complaints of severe right lower abdominal pain characteristic of appendicitis. The client does not have any health insurance. The nurse understands that legally the hospital has which obligation? · o 1 Refer the client to the nearest public hospital. o 2 Provide uncompensated care in emergency situations. o 3 Have a health care provider see the client before admission. o 4 Respect the family's requests to admit their family member to the hospital.

2 Federal law and many state laws require that hospitals must provide emergency care. The client can be transferred only after the client has been medically screened and stabilized. The client must give consent for the transfer, and there must be a facility that will accept the client. Options 1, 3, and 4 do not fully address the legal requirements for emergency care. An important point to remember is that the client is the priority. If an emergency condition exists, the health care agency must provide care, regardless of the client's insurance status. Appendicitis is an acute inflammation of the appendix that, if left untreated, can lead to perforation and peritonitis, which is life threatening.

Nurses' involvement in shared governance is an important component of: 1.practice models. 2.Magnet recognition. 3.Increased reimbursement 4.Physician satisfaction

2 Nurses' involvement in governance is an important component of the American Nurses Credentialing Center's Magnet Recognition Program

· The charge nurse is observing a new nursing graduate insert a nasal trumpet airway to provide a route for suctioning the client. The nurse should intervene if the new nursing graduate performs which action? · o 1 Checks the nose for septal deviation o 2 Uses a nasal trumpet that is slightly larger than the nares o 3 Inserts the nasal trumpet gently following the contour of the nasopharyngeal passageway o 4 Lubricates the nasal trumpet with a water-soluble lubricant jelly containing a local anesthetic

2 The nurse should select a nasal trumpet airway that is slightly smaller than the nares and slightly larger than the suction catheter to be used to suction the client. Options 1, 3, and 4 are correct actions for inserting a nasal trumpet airway. A nasal trumpet is a tube that is inserted into 1 of the client's nostrils to provide assistance in maintaining the client's airway and to provide a route for suctioning secretions from the client.

The nurse provides care for clients in a gynecological clinic. Which client does the nurse see first? 1.A middle-aged client reporting a dry vaginal wall and painful intercourse. 2.An adult client who had a hysterosalpingogram and is experiencing tachycardia and has a generalized rash. 3.An adult client preparing for a cervical biopsy who reports feeling highly anxious. 4.A young adult client scheduled for a Pap smear who reports heavy bleeding with menstruation.

2) An adult client who had a hysterosalpingogram and is experiencing tachycardia and has a generalized rash. A hysterosalpingogram is an x-ray of the cervix, uterus, and fallopian tubes performed after the injection of a contrast medium. Tachycardia and rash indicates the client is having an allergic reaction and needs immediate attention. Prior to any diagnostic test in which contrast medium is used the nurse should assess for allergy to shellfish or iodine. Incorrect: 1) This client does not require immediate attention. Due to hormonal changes, these findings are not unusual for this age client. The nurse should provide instruction about water-soluble lubricants. 3) This client does not require immediate attention, but the anxiety should be addressed prior to the client undergoing the procedure. The client should be the second client seen. The health care provider usually performs a biopsy as a follow up to suspicious Pap smear findings. 4) This client does not require immediate attention. The pap smear is an exam used to detect precancerous and cancerous cells from the cervix. More information should be obtained rom the client to clarify the description of heavy bleeding.

The RN assess clients for the day shift. The nursing team includes one RN, two LPN/LVNs, and four unlicensed assistive personnel (UAP). The nurse determines assignments are appropriate if which client is assigned to the UAP? 1. The client diagnosed with Crohn disease requiring a sterile dressing change 2.The client diagnosed with chronic kidney failure requiring intake and output. 3.The client diagnosed with full thickness burns requiring IV morphine prior to a dressing change. 4.The client diagnosed with cancer of the lung reporting a headache.

2) The client diagnosed with chronic kidney failure requiring intake and output. UAPs assist with direct client care activities (bathing, transferring, ambulating, feeding, toileting, obtaining vital signs, height and weight, intake and output, housekeeping, transporting stable clients, and stocking supplies). Assign standard, unchanging procedures. Delegation is the reassignment of responsibility for the performance of a job from one person to another, the responsibility for the task is transferred, but the accountability for the process or outcome of the task remains with the delegator. Incorrect: 1) Sterile dressing change should be assigned to the LPN/LVN. 3) The RN should care for this client; intravenous medication is within the scope and practice of the RN. 4) This client requires a nursing assessment; the RN should care for this client as assessment falls withing the scope of practice for the RN.

The home health nurse is concerned about the large number of clients who are receiving home visits even though they no longer need skilled nursing or therapy services. The nurse discusses these concerns with the management of the agency, but no changes are made. Which would protect the nurse from termination if the nurse reports the agency to regulatory authorities? 1.Title VII of the Civil Rights Act of 1964 2.Whistleblower Laws 3.Occupational Health and Safety Act 4.Family and Medical Leave Act

2) Whistleblower Laws Whistle blower laws are intended to prevent employers from taking retaliatory action against nurses such as suspension, demotion, harassment or discharge for reporting improper patient care or business practices. The whistleblower law vary from state to state and according to the subject matter. Incorrect: 1) This law makes it illegal to discriminate against someone on the basis of race, color, religion, national origin, or sex. 3) Employers covered by the Occupational Health and Safety Act must comply with the regulations and the safety and health standards promulgated by the Occupational Health and Safety Administration. Employers also have a general duty under the act to provide their employees with work and a workplace free from recognized, serious hazards. 4) The Family and Medical Leave Act (FMLA) requires employers of 50 or more employees to give up to 12 weeks of unpaid, job protected leave to eligible employees for the birth or adoption of a child or for the serious illness of the employee or a a spouse, child or parent.

Decentralization occurs when: 1.equipment is being purchased from approved vendors. 2.hiring decisions are made at the executive level. 3.power is distributed to those closest to the work of caregiving. 4.supplies are distributed from one central supply area in the hospital.

3 Decision-making authority rests at lower levels in the organizational framework, closer to the point of care, rather than being passed up through the chain of command to an executive.

Which of the following statements accurately describe disease management? Select all that apply 1.Disease management is care coordination that is organized to achieve specific client outcomes, given fiscal and other resource constraints. 2.Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. 3.Disease management relies on a structured system of interventions that focus on a specific condition. 4.Disease management program content and interventions are evidence and guideline based. 5.Disease management is the medical management of chronic disease.

234 Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. DM programs usually focus on a single condition, rely on a structured system of interventions that focus on a single condition; and program content and interventions are evidence and guideline based.

· The nurse tells an unlicensed assistive personnel (UAP) that a client recovering from a myocardial infarction requires a complete bed bath. During the bath, the nurse should intervene if the nurse observed the UAP performing which action? · o 1 Washing the client's chest o 2 Giving the client a back rub o 3 Asking the client to wash her or his legs o 4 Washing the client's perineal area

3 A complete bed bath is for clients who are totally dependent and require total hygiene care. Total care may be necessary for a client recovering from a myocardial infarction to conserve the client's energy and reduce oxygen requirements. The nurse should intervene if the nurse observed the UAP asking the client to wash her or his legs. Options 1, 2, and 4 are components of providing a complete bed bath. Bathing a client is an important role of the nurse and is necessary for hygienic purposes and to prevent infection, maintain skin integrity, stimulate circulation, and provide comfort. Several types of baths may be given, including a bed bath, tub bath, shower, complete bath, or partial bath.

A concept involving a system that guides and tracks patients over time through a comprehensive array of health services to span all levels of intensity of care is known as: 1.transition of care. 2.continuum of care. 3.rounds. 4.disease management strategies.

3 Continuum of care is a concept involving a system that guides and tracks patients over time through a comprehensive array of health services to span all levels and intensity of care (Young et al., 2014). The services incorporated in each patient's unique continuum vary based on the individualized health and/or behavioral health needs of each person.

· The nurse administers a fatal dose of morphine sulfate to a client. During the subsequent investigation of error, it is determined that the nurse did not check the client's respiratory rate before administering the medication. Failure to adequately assess the client is addressed under which function of the nurse practice act? · o 1 Defining the specific educational requirements for licensure in the state o 2 Describing the scope of practice of licensed and unlicensed care providers o 3 Identifying the process for disciplinary action if standards of care are not met o 4 Recommending specific terms of incarceration for nurses who violate the law

3 In this situation, acceptable standards of care were not met (the nurse failed to adequately check the client before administering a medication). Option 3 refers specifically to the situation described in the question, whereas options 1, 2, and 4 do not. A nurse practice act is a statute enacted by the legislation of a state. Nurse practice acts may vary from state to state, but generally include educational requirements of the nurse, distinguishing between nursing practice and medical practice, and defining the scope of practice for the nurse. Additional issues that may be covered in the act include grounds for disciplinary action and the rights of the nurse if disciplinary action is taken. All nurses are responsible for knowing the provisions of the act in the state in which they work.

Ten clients from a motor vehicle accident are transferred to the hospital. The nurse triages in the emergency department (ED). Which client does the nurse see first? 1.A client with ecchymosis and lacerations to the facial area. 2.A client who reports chest tightness and pressure. 3.A client with a BP of 90/60 mmHg and apical pulse of 120 beats/minute. 4.A client who reports dizziness and nervousness.

3) A client with a BP of 90/60 mmHg and apical pulse of 120 beats/minute This client is experiencing an actual problem. The vital signs indicate shock. This is the most unstable client. Incorrect: 1) The description of this client does not indicate the client is in immediate danger. This client does not require immediate attention. 2) This would be the second client seen. Airway and breathing are high priority assessments, and the client is at risk for potential problems. This client is not the most unstable. 4) This client is the most stable of the four clients. Using Maslow's hierarchy of needs theory to prioritize client problems, physiological needs take priority.

The nurse understand which is primary focus of the NCLEX-RN? (select all that apply) 1.Performance appraisal. 2.Evaluation of nursing schools. 3.Assessment of minimum competency. 4.Determination of ability of entry level nurse to perform safely. 5.Measurement of quality client care.

3) Assessment of minimum competency. 4) Determination of ability of entry level nurse to perform safely. The NCLEX-RN examination measures minimal competency to perform safe client care as a new nursing graduate at the generalist level. It is a national United States examination, adopted by all 50 states and the territories (except for Puerto Rico) and Canada. Incorrect: 1) The NCLEX-RN is not a performance appraisal except in the general sense that performance of a new graduate on the NCLEX-RN examination is assessed as to whether minimal competency standards are met. A performance appraisal is specifically the formal objective evaluation, usually annual, of the work performance of an employee. 2) While some assessments about the functioning of a nursing school may be at least informally made based on its overall "pass" and "fail" rates on the NCLEX-RN examination, this is not the purpose of the examination. Also, evaluation of a nursing school consists of many factors other than the NCLEX-RN examination results. 5) Passing of the NCLEX-RN examination indicates that a new graduate nurse is expected to be at least minimally competent in providing safe client care at the generalist level. It is not related to quality of care except for that.

The nurse moves to a different state and reviews the Nurse Practice Act (NPA) for the state. The nurse understands which governing body enforces the rules of the NPA? 1.American Nursing Association (ANA) 2.National Council of State Boards of Nursing (NCSBN) 3.State Board of Nursing (BON) 4.State Nursing Association

3) State Board of Nursing (SBON) Each state has a Board of Nursing (BON) that interprets and enforces the rules of the NPA. AN NPA is enacted by state legislation and its purpose is to govern and guide nursing practice withing that sate. An NPA is actually a law and must be adhered to as law. Incorrect: 1) The American Nurses Association (ANA) is a nonprofit professional organization developed to advance and protect the profession of nursing. The ANA is responsible for establishing standards of nursing practice, promoting the rights of nurses in the workplace, and advancing the economic and general welfare of nurses. 2) The National Council of State Boards of nursing (NCSBN) is an independent, not-for-profit organization through which nursing regulatory bodies act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including the development of nursing licensure examinations. 4) State nursing associations can provide timely and helpful information on nursing issues and policies in the stat where the nurse works. They also provide access to local educational conferences, networking opportunities, and job searches.

A patient has a history of diabetes mellitus, myocardial infarctions, and hypertension. His HgbA1c level dropped from 7.8% to 6.2% 2 months after he began a walking exercise program. The nurse case manager had provided diabetic education and suggested ways to enhance his cardiac reserve. This is an example of: 1.nursing empowerment. 2.nursing knowledge. 3.patient expertise. 4.patient participation in care.

4 The scenario depicts an example of a case manager's intervention resulting in a positive clinical outcome. This is the result of the patient's participation in his own care.

Which organizational theory emphasized the informal aspects of organization social structure and was influenced by the Hawthorne experiments? 1.Bureaucratic theory 2.Scientific management school 3.Classical management theory 4.Human relations school

4 Theorists in the human relations school emphasized the informal, rather than formal, aspects of organization social structure. Hawthorne experiments were influential in this school of thought.

The nursing staff on a critical care unit thought that professional growth could be enhanced. Which of the following interventions would support empowerment of the nursing staff? Select all that apply: 1.Eliminating computers and reverting back to paperwork 2.Increasing pay wages for ancillary and professional staff 3.Providing various methods for ongoing education and continuing education units 4.Working to make equipment and medications readily available

34 Social structures important to the growth of empowerment are having access to information, receiving support, having access to resources necessary to the job, and having the opportunity to learn and grow.

· A client requires a partial bed bath. The nurse gives instructions to an unlicensed assistive personnel (UAP) about the partial bed bath and should tell the UAP to perform which action? · o 1 Just wash the client's hands and face. o 2 Provide mouth care and perineal care only. o 3 Let the client decide what she or he wants washed. o 4 Be sure to bathe the client's body parts that would cause discomfort or odor if left unbathed.

4 A partial bed bath involves bathing the body parts that would cause discomfort or odor if left unbathed. This may include the axillary areas, perineal areas, and any skinfold areas. Options 1, 2, and 3 do not completely address a partial bed bath. Bathing a client is an important role of the nurse and is necessary for hygienic purposes and to prevent infection, maintain skin integrity, stimulate circulation, and provide comfort. Several types of baths may be given, including a bed bath, tub bath, shower, complete bath, or partial bath.

· The nurse has instructed an unlicensed assistive personnel (UAP) in the procedure for collecting a 24-hour urine specimen from a client. The nurse determines that the UAP understands the directions if the UAP makes which statement? · o 1 "I need to keep the specimen at room temperature." o 2 "I need to save the first urine specimen collected at the start time." o 3 "I need to discard the last voided specimen at the end of the collection time." o 4 "I need to ask the client to void, discard the specimen, and note the start time."

4 Because a 24-hour urine specimen is a timed quantitative determination, the test must be started with an empty bladder. Therefore, the first urine is discarded. Fifteen minutes before the end of the collection time, the client should be asked to void, and this specimen is added to the collection. The urine collection should be refrigerated or placed on ice to prevent changes in urine composition. Urine specimens may be collected to diagnose various conditions. These specimens may be prescribed to be collected as a random specimen, a sterile specimen, or a 24-hour urine collection. An important point to remember is that the procedure for its collection needs to be followed to ensure accurate results.

According to the Centers for Disease Control (CDC), chronic diseases account for __% of deaths in the United States. 1.20 2.40 3.50 4.70

4 Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. Chronic diseases account for 70% of all deaths in the United States, which is 1.7 million each year. These diseases also cause major limitations in daily living for almost 1 out of 10 Americans, a total of about 25 million people.

· The primary health care provider has prescribed a cleansing enema for an adult client. The nurse provides directions to a nursing student who is trained to administer enemas and should tell the student that the maximum volume of fluid that can be administered is which volume? · o 1 100 mL o 2 300 mL o 3 500 mL o 4 1000 mL

4 Cleansing enemas promote complete evacuation of feces from the colon. They act by stimulating peristalsis through the infusion of a large volume of solution or through local irritation of the colon's mucosa. For an adult client, 750 to 1000 mL is used. Therefore, the maximum volume of solution for an adult is 1000 mL. An enema is the introduction of solution into the rectum for cleansing the bowel. Cleansing of the bowel may be prescribed to treat constipation or may be prescribed as a preprocedure treatment, such as before a diagnostic test or surgical procedure involving the colon.

The structure of authority in an organization is known as the: 1.authority. 2.centralization. 3.bureaucracy. 4.hierarchy.

4 In bureaucratic and classical management theory, hierarchy is the structure of authority in an organization. Authority is equated with the enforcement of regulations.

The nursing student is preparing a client who will have spinal anesthesia for surgery. The nurse in charge asks the nursing student to identify which highest priority preoperative data to report to the nurse on the next shift who will care for the client postoperatively? · o 1 Pulse rate of 78 beats/min o 2 Voided 300 mL preoperatively o 3 Blood pressure of 126/78 mm Hg o 4 Presence of weakness in the left lower extremity

4 It is important to document and report any preoperative weakness or impaired movement of a lower extremity in the client who is to have spinal anesthesia because it causes temporary paralysis of the lower extremities. When the client's function returns, the preoperative weakness or impairment will not be misinterpreted as a complication of anesthesia. Options 1, 2, and 3 may be documented and reported, but they are not the highest priority. Spinal anesthesia is done by an injection into the subarachnoid cerebrospinal fluid space. It produces a state of lack of sensation in the lower part of the body. An important nursing responsibility in the postoperative period is to monitor for the return of sensation in the lower body. If sensation does not return or is altered in any way, the surgeon is notified.

· The nurse is observing a nursing student auscultating the breath sounds of a client. The nurse should intervene if the nursing student performs which action? · o 1 Used the diaphragm of the stethoscope o 2 Placed the stethoscope directly on the client's skin o 3 Asked the client to breathe slowly and deeply through the mouth o 4 Asked the client to lie flat on the right side and then on the left side

4 The client ideally should sit up and breathe slowly and deeply through the mouth. The diaphragm of the stethoscope, which is warmed before use, is placed directly on the client's skin, not over a gown or clothing. A breath sound is the sound of air passing in and out of the lungs as heard with a stethoscope. Normal breath sounds include vesicular, bronchovesicular, and bronchial sounds. Auscultating breath sounds is a part of data collection.

· The nurse determines that a client with a stroke is experiencing difficulty with fine motor coordination when performing activities of daily living. The nurse should suggest that the client be referred to which member of the health care team? · o 1 Physical therapist o 2 Speech pathologist o 3 Recreational therapist o 4 Occupational therapist

4 The occupational therapist provides assistance with developing methods that assist in managing difficulty with fine motor coordination when performing activities of daily living. Although a physical therapist may also address fine motor activities, the focus is primarily on gross motor skills and the development of muscle strength. Speech pathologists and recreational therapists do not address this aspect of care. A stroke is an abnormal condition of the brain that is characterized by occlusion by a clot, hemorrhage, or vasospasm that results in ischemia of the brain tissues. Paralysis, weakness, sensory changes, speech defects, or even death can occur. The client who experiences a stroke will require rehabilitative services that will assist the client in relearning activities to promote independence.

Which of the following statements best describes an organizational chart? 1.All job positions are displayed clearly in a two-dimensional drawing. 2.All outside organizations with relationships to the hospital are depicted. 3.Informal and formal structures within the organization are outlined. 4.It shows organizational positions and relationships in a visual representation.

4 The organizational chart is a diagrammatic representation that displays "the flow of authority, chain of command, titles, and functions.

The nurse is observing an unlicensed assistive personnel (UAP) talking to a client who is hearing impaired. The nurse should intervene if the UAP performs which action during communication with the client? · o 1 Speaks in a normal tone o 2 Speaks clearly to the client o 3 Faces the client when speaking o 4 Speaks directly into the impaired ear

4 When communicating with a hearing-impaired client, the nurse should speak in a normal tone to the client and should not shout. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express the statement differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse should avoid talking directly into the impaired ear. Special communication techniques are needed when caring for a hearing-impaired client. Some of these include facing the client when speaking; enunciating words slowly, clearly, and in a normal voice; avoiding placing the hands over the mouth when speaking so that the client can lip-read; and avoiding speaking into the impaired ear. It is important for the nurse to know these techniques because the nurse needs to use them to communicate with the hearing-impaired client to prevent social isolation. In addition, teaching and supervising others are roles of the nurse, and the nurse needs to intervene if she or he observes incorrect communication techniques performed by another health care team member.

· The nurse is observing an unlicensed assistive personnel (UAP) measuring the blood pressure (BP) of a client. The nurse should intervene if which action was observed that would interfere with accurate measurement of the BP? · o 1 Positions the client's arm at heart level o 2 Exposes the extremity fully by removing constricting clothing o 3 Explains the procedure to the client and asks the client to rest for 5 minutes o 4 Palpates the carotid artery and then places the cuff of the sphygmomanometer 1 inch (2.5 cm) above the brachial artery

4 When taking a BP, the brachial artery is palpated (not the carotid artery) and the cuff of the sphygmomanometer is positioned 1 inch (2.5 cm) above this site of pulsation. Options 1, 2, and 3 are correct actions when taking a BP. BP is the amount of pressure exerted on the walls of the arteries and veins and the heart chambers by the circulating volume of blood. This pressure is measured by taking the client's BP. To ensure accuracy of the measurement, a specific procedure is followed.

The nurse evaluates clients in the gastrointestinal clinic. Which client does the nurse see first? 1.A middle-aged client diagnosed with irritable bowel syndrome reports cramping and loose stools. 2.A young adult client reports not having a bowel movement in 2 days. 3.A school-aged client diagnosed with gastroenteritis who had five diarrheal stools in the last 3 days. 4.A newborn client experiencing projectile vomiting and irritability.

4) A newborn client experiencing projectile vomiting and irritability. The client's symptoms indicates pyloric stenosis. The infant is at risk for fluid and electrolyte imbalance and requires immediate intervention. Incorrect: 1) The client is experiencing symptoms of irritable bowel syndrome. The nurse should encourage the client to eat meals at regular intervals, chew food slowly and avoid drinking fluids with meals. 2) The client may be constipated. The nurse should determine the client's normal bowel pattern and encourage fluids and foods high in roughage. 3) This is the second client the nurse should see. The client does not require immediate attention but a child with frequent diarrhea stools has the potential for dehydration. Real problems take priority over potential problems.

The nurse notices a client diagnosed with major depression crying in the day room. The nurse puts a hand over the client's shoulder and states, "Let's talk about it." Which ethical principle describes the nurse's action? 1.Autonomy 2.Veracity 3.Nonmaleficence 4.Beneficence

4) Beneficence Beneficence is an action that promotes good will. This ethical principle requires the nurse to help clients meet all their needs. Incorrect: 1) Autonomy is the right to choose and freedom to make decisions for oneself. It is accomplished by providing information and supporting client's choices. 2) Veracity is telling the truth completely. Intentionally deceiving a client is a violation of this principle. 3) Nonmaleficence is the principle of "do not harm". It requires nurses to protect clients from danger and to protect clients who cannot protect themselves.

The nurse collapses minutes after putting on latex gloves, and the cardiac team successfully resuscitates the nurse. The nurse manager discusses that certain workers may be at greater risk for latex allergies than others. After reviewing he medical histories of the nurses on the unit, the nurse manager determines which nurse can safely use latex products. 1.The nurse with a history of allergies to pollen and grass. 2.The nurse with a history of allergies to banana and kiwi. 3.The nurse with a history of multiple surgeries. 4.The nurse with a history of GI upset.

4) The nurse with a history of GI upset. A history of GI upset is not an indication that a nurse is at risk for latex allergies. Incorrect: 1) Any history of allergies indicates a greater risk for latex allergies. The incidence of latex allergies has increased since the advent of universal precautions and increased us of personal protective equipment. Latex is found in gloves, goggles, blood pressure cuffs, stethoscopes, oral and nasal airways, and IV tubing. 2) A history of food allergies indicates an individual is a greater risk for latex allergies 3) Individuals who have had numerous surgeries and therefore numerous opportunities for repeated exposure to latex are at greater risk for latex allergies.

The patient tells you that her room is too hot and she is sweating too much. To promote comfort, which instruction would you give the AP? A. Reduce the room temperature. B. Change the bed linen every day. C.Assist the patient to take a warm shower. D.Provide room temperature water.

A Focus: Delegation, Prioritization Decreasing the room temperature will decrease the discomforts of heat intolerance. The AP may need to change linens several times a day; showers should be cool, and drinking water should be iced. All of these will help decrease patient discomfort related to heat intolerance and diaphoresis.

The health care provider informs you that Ms. P needs diagnostic testing to confirm an ectopic pregnancy. Which task would be assigned to the LPN)/LVN? A. Assisting the provider to perform a pelvic examination. B. Obtaining a blood sample to test for luteinizing hormone. C. Premedicating before the procedure with a mild analgesic. D. Explaining the purpose and procedure of an ultrasound.

A Focus: Assignment The LPN/LVN can assist the health care provider with the pelvic examination. A blood sample is needed for HcG (human chorionic gonadotropin), which is a hormone that is specifically tested to verify pregnancy. Luteinizing hormone stimulates ovulation and progesterone production. Premedication is usually not needed for the initial diagnostic testing: pelvic examination, pregnancy test, and ultrasound. The provider or RN should explain procedures as needed.

The AP is delegated the task of assisting the patient with TB to complete morning care. Which instruction would the nurse be sure to give the AP? A. Always wear a personal respirator mask when caring for this patient. B. Perform hand washing only after patient care. C. Wear a mask, gown, and gloves even when the patient is no longer infectious. D. Remind the patient that sputum specimens are required every day.

A Focus: Delegation All health care providers should wear a personal respirator mask when caring for a patient with TB who is infectious. Handwashing should be done before and after patient care. Special care precautions are discontinued when the patient is no longer infectious. Sputum specimens are required every 2 to 4 weeks after drug therapy is initiated. When the patient has three consecutive negative sputum cultures, he or she is no longer considered infectious.

The nurse is working as a float in the operative suite (preoperative, operative and post anesthesia care unit (PACU). The first patient is a 49-year-old woman scheduled for an abdominal hysterectomy next week. Which patient factor has the most important implication for her care during the perioperative period? A. She develops a rash after using rubber gloves. B. She expresses anxiety about "being put to sleep." C. She states she has 2 to 3 alcoholic drinks per week. D. She takes a diuretic to control her blood pressure.

A Focus: Prioritization The rash associated with the use of rubber products indicates a latex allergy, which requires avoiding latex in any equipment or products used in the patient's care. The staff will need to be prepared to treat a possible anaphylactic reactions. Anxiety about general anesthesia, moderate alcohol intake, and the use of antihypertensive medication will also require further assessment or interventions but are commonly seen in patients who require surgery.

Which statement by the patient indicates the need for additional teaching? A. "I will take my TB drugs until my sputum is negative for the TB bacteria." B. "I will no longer be considered contagious after I've had three negative sputum cultures." C. "In the future, to check for TB I will need to have chest radiographs (x-rays)." D. "Everyone in my family will need to be tested to determine if they have TB."

A Focus: Prioritization The patient should be taught that although he may be feeling better and his sputum cultures may be negative, he must continue taking the TB medications for 6 months or longer as prescribed by his health care provider. The other statements indicate a correct understanding of care for the diagnosis of TB.

empowerment for nurses may consist of three components. which 3 of the following components may help nurses become empowered to use their power for better patient care? A. a state in which a nurse has assumed control over his or her own practice B. social relationship between two or more groups of people C. a workplace that promotes opportunities for growth D. a nurses sense of meaning expressed in values and work role E. Dependence of personel

ACD

The nurse manager is planning the assignments on an acute care unit. What is the first thing to be considered as staffing and schedule when making the assignments to provide the best quality and effective care to the clients? A. Client acuity levels and skills of staff. B. Clients diversity and age factor. C. Number of clients and agency staff. D. Covering the weekends by the agency staff.

A. Client acuity levels and skills of staff. The level of acuity, or degree of illness, is a factor in making assignments, as are the extensiveness of client needs and the level of expertise of the staff members. Diversity in staffing is a good thing but age and diversity are not priorities. Agency nurses on weekends is not an appropriate option

The nurse calls the health care provider (HCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the HCP, and the medication is due to be administered. Which action should the nurse take? A. Contact the nursing supervisor. B. Administer the dose prescribed. C. Hold the medication until the HCP can be contacted. D. Administer the recommended dose until the HCP can be located.

A. Contact the nursing supervisor. If the HCP writes a prescription that requires clarification, the nurse's responsibility is to contact the HCP. If there is no resolution regarding the prescription because the HCP cannot be located or because the prescription remains as it was written after talking with the HCP, the nurse should contact the nurse manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification.

When delegating client care to unlicensed assistive personnel (UAP) what does the nurse need to communicate? Select all that apply. A. The nurse action that is to be performed. B. What the nurse expects to have reported. C. Significant information regarding the client. D. Information about other clients in adjoining rooms. E. The names of the medications prescribed for the client.

A. The nurse action that is to be performed. B. What the nurse expects to have reported. C. Significant information regarding the client. Not D. Information about other clients in adjoining rooms. The UAP does not need information regarding clients they are not assigned to care for that day. Not E. The names of the medications prescribed for the client. The UAP does not administer medications. When delegating care the nurse needs to communicate significant information about the specific client needs, what actions are to be performed and what the nurse expects to have reported back. THIN Thinking: Top Three- When delegating care, the nurse needs to follow 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

The nurse is the team leader responsible for 5 clients on the acute care unit. What client care can the nurse delegate to a licensed practical/vocational nurse? Select all that apply. A. Wound care for a client with a stage 2 pressure ulcer. B. Assessment of a postoperative client returning to the unit. C. Administering routine medications to assigned clients. D. Conducting discharge teaching for a client. E. Contacting the health care provider regarding lab values.

A. Wound care for a client with a stage 2 pressure ulcer. B. Administering routine medications to assigned clients. E. Contacting the health provider regarding lab values. Assessment and client teaching are roles for the registered nurse and cannot be delegated. The LPN/LVN can collect assessment data but the analysis of the data is the responsibility of the RN. The LPN/LVN can reinforce teaching but the RN is responsible for client teaching. THIN Thinking: Top Three- When delegating, the nurse needs to follow the 5 points which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provider, therefore, appropriate delegation is critical to safe practice.

Which tasks could the nurse assign to the licensed practical nurse/licensed vocational nurse (LPN/LVN) working with you to provide care for this patient? Select all that apply. A. Checking vital signs every 4 hours B. Weighing the patient every day after dialysate drain C. Administering oral analgesics as needed D. Measuring the abdominal circumference every shift E. Creating a nursing care plan for the patient F. Recording the shift physical assessment

ABCD Focus: Assignment Vital signs, weighing patients, administering oral medications, and measuring abdominal circumference are all within the scope of practice for the LPN/LVN. An assistive personnel (AP) could also perform A, B, and D. Creating nursing care plans and assessment are appropriate to the RN's scope of practice. In some states, an LPN/LVN can administer IV drugs and record assessments with additional training. Also in some facilities, if the patient's illness is chronic and stable, the LPN/LVN may be permitted to perform the assessment. In this case, the RN should perform the assessment because it requires formative evaluation of response to therapy.

Mr. D has no history of psychiatric disorders; however, you know that mood can affect recovery. Which questions can you use to assess his mood? Select all that apply. A. Do you feel hopeless or sad? B. Are you interested in resuming your activities? C. Do you feel generally satisfied with your life? D. Have you been hearing voices? E. Are you experiencing palpitations? F. Are you having trouble concentrating? G. Does your family plan to visit you? H. Are you having any negative thoughts? I. Do you have questions about the treatment plan?

ABCFH Focus: Prioritization Feelings of hopelessness, loss of interest in activities, dissatisfaction with life in general, trouble with memory or concentration and negative thoughts are frequently associated with depression. Depression can be accompanied by psychotic symptoms, but hallucinations are not typical. Palpitations occur more with anxiety disorders. Family involvement may influence mood, but this question would have to be rephrased in order to assess mood (e.g., How do you feel when your family visits [or does not visit]?). It is appropriate to ask all patients if they have questions about the treatment plan, but this question is not a direct assessment of mood

Which orders related to Ms. S's urinary system for would you question? Select all that apply. A. Insert an indwelling urinary catheter with a urometer. B. Measure I & O every hour. C. Obtain a urine sample for urinalysis. D. Perform Crede maneuver every 4 hours. E. Up to bedside commode with assistance as needed. F. Apply skin barrier paste to perineal area as needed

ABD Focus: Prioritization Indwelling urinary catheters increase the risk for hospital acquired infections and this patient should be assisted to void in a natural way. In addition, a urometer is an extra cost and hourly measurement of urine would not typically be ordered for stable patients. The Crede maneuver is usually used for neurogenic incontinence (i.e., spinal cord injury patients) to manually compress the bladder. Urinalysis is a baseline test that might be ordered to detect abnormalities that contribute to incontinence (i.e., infection). A bedside commode is useful, particular for nighttime use. All incontinent patients have risk for skin breakdown, so applying barrier cream as needed is appropriate.

The patient is a 45-year-old man who immigrated from Central America a year ago. He reports fatigue, cough, nausea, and weight loss. His vital signs reveal a low- grade temperature of 99.4°F (37.4°C); blood pressure: 128/82; heart rate 88 beats/minute, and respiratory rate: 18 breaths/minute. The nurse suspects tuberculosis (TB). What additional information would the nurse collect? (Select all that apply.) A. Country of origin B. Previous test results for TB C. Respiratory infections over the past year D. Chest radiograph results E. History of bacillus Calmette-Guérin (BCG) vaccine F. Illness resulting in decreased immune function

ABDEF Focus: Prioritization The nurse will want to know if the patient is from a country where the incidence of TB is high, whether he has any previous positive tests for TB, if his chest radiograph shows evidence of pulmonary TB, and if he has received a BCG vaccine, which contains attenuated tubercle bacilli and is used in some countries to produce increased resistance to TB. Although the patient may have had other respiratory infections over the past year, this knowledge would not necessarily contribute to a diagnosis of TB. People with illness or disease that causes decreased immune function are at greater risk for development of TB.

Which are first-line drugs for treatment of TB and preventing transmission? (Select all that apply.) A. Ethambutol B. Isoniazid C. Ciprofloxacin D. Pyrazinamide E. Amikacin F. Rifampin

ABDF Focus: Prioritization Combination drug therapy is the most effective method of treating TB and preventing transmission. First-Line Drug therapy for TB includes Isoniazid, Rifampin, Pyrazinamide, and Ethambutol. The use of multidrug regimens destroys organisms and reduces the emergence of drug-resistant organisms. Amikacin is a potentially effective drug that is not used widely against TB. When used, Amikacin is given as a single daily dose of 15 mg/kg by intramuscular injection five times weekly.

To prevent poor dialysate flow, which key points would the nurse teach this patient about PD? Select all that apply. A. Be sure to consume a high fiber diet. B. Remember to take your daily stool softener. C. Warm the dialysate bags in your microwave oven. D. An enema before PD may be helpful. E. Expect the PD outflow to be cloudy. F. Check for kinked or clamped connection tubing.

ABDF Focus: Prioritization The most common cause of poor dialysate flow is related to constipation. To prevent constipation, a bowel preparation is usually prescribed before starting PD. An enema before PD may help prevent poor dialysate flow. Other strategies to prevent constipation include stool softeners and high fiber diets. Additional causes of poor dialysate flow include kinked or clamped tubing, patient position, fibrin clot formation, and catheter displacement.

The nurse is preparing a nursing care plan for the patient with focused areas on nutrition, hyperthermia, and fatigue. Which interventions would be appropriate to delegate to the assistive personnel (AP) working with you? (Select all that apply.) A. Checking and reporting the patient's vital signs every 4 hours B. Assisting the patient to the bathroom as needed C. Assessing for signs and symptoms of infection D. Recording intake from every meal E. Administering propylthiouracil (PTU) 50 mg every 8 hour F. Ensuring the patient always has fresh ice water at the bedside

ABDF Focus: Delegation Checking and reporting vital signs is within the scope of practice for APs (be sure to instruct the AP to report any temperature increase immediately and assess cardiac status if this occurs); patient care assistance, recording intake, and providing ice water are within the scope of practice for APs. The administration of medications is appropriate to the RN or the licensed practical nurse/licensed vocational nurse (LPN/LVN) scope of practice, and assessing for manifestations of infection is within the RN scope of practice.

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

ACD 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 are safety precautions for a patient receiving an unsealed radioactive isotope? (Select all that apply.) A. Use a toilet not used by others for 2 weeks. B. Flush the toilet six times after each use. C. Wash clothes separately from others in the household. D. Avoid close contact with pregnant women, infants, and small children. E. Use cotton handkerchiefs to blow your nose. F. Use disposable utensils, plates, and cups.

ACDF Focus: Prioritization Toilets should be flushed three times after each use and disposable tissues should be used. The tissues should be flushed down the toilet or kept in a plastic bag to be turned in to the radiation department of the hospital for disposal. The other statements about safety precautions for a patient receiving an unsealed radioactive isotope are accurate.

Which tasks can the nurse assign to the licensed practical nurse/licensed vocational nurse (LPN/LVN)? Select all that apply. A. Plot the child's height and weight on growth chart. B. Correct the child's technique when using the peak expiratory flow meter. C. Listen to breath sounds before and after administering albuterol via small volume nebulizer. D. Obtain a sputum specimen for culture and sensitivity. E. Provide calming support. F. Collect the child's history from the mother.

ADEF Focus: Assignment Measuring height and weight and plotting on the growth chart, obtaining a sputum specimen for culture and sensitivity, keeping the child calm and collecting data from the mother are all within the scope of practice of the LPN/LVN. The RN is responsible for patient education and would educate the mother as she corrects the child's technique in using the peak expiratory flow meter. Listening to breath sounds is done by the RN although the LPN/LVN can administer a small volume nebulizer.

What lab values would support the diagnosis of hyperthyroidism? (Select all that apply.) A. Increased T3 and T4 B. Decreased T3 and T4 C. Increased thyroid-stimulating hormone (TSH) D. Decreased TSH E. Thyroid antibodies—high titer F. Thyroid scan—increased uptake of radioactive iodine (RAI)

ADEF Focus: Prioritization Thyroid hormones T3 (triiodothyronine) and T4 (thyroxine) are increased; TSH is low in hyperthyroidism caused by Graves disease (most common cause); high titer of antithyroglobulin occurs with hyperthyroidism; a thyroid scan demonstrates an increased uptake of RAI.

The patient is a 10-year-old female with a history of asthma that has been well controlled for 2 years. Medications: montelukast sodium 10mg once a day, fluticasone and salmeterol twice a day and an albuterol inhaler as needed. She presents to the clinic today with coughing and wheezing on expiration. She is alert and oriented. Vital signs: Temperature: T. 99°F (37.2°C ), heart rate: 100, respiratory rate 34, blood pressure 120/74, oxygen saturation 90% on room air. Mother states that the wheezing was not relieved with use of an albuterol inhaler and that the child's Peak expiratory flow was in the yellow zone (50% to 79% of personal best). What is the first action of the nurse? A. Obtain the child's peak expiratory flow B. Apply 2 liters of oxygen by nasal cannula C. Obtain a chest x-ray D. Administer albuterol 2.5mg small volume nebulizer

B Focus: Prioritization Oxygen saturation for a 6-year-old child should be between 97% and 99%. Keeping blood oxygen saturation levels above 92 percent is optimum for tissue oxygenation.

You are interviewing a patient who will undergo diagnostic testing to confirm a diagnosis of chronic pancreatitis. Which symptom is the major clinical manifestation? A. Abdominal ascites B. Burning or gnawing abdominal pain C. Steatorrhea: clay-colored stools D. Left upper quadrant mass

B Focus: Prioritization Relentless abdominal pain that is described as a burning or gnawing sensation is the most likely reason for the patient to seek treatment and the most likely clinical finding. Steatorrhea and ascites occur as the condition progresses. Left upper quadrant pain is present if a pseudocyst or abscess occurs.

While assisting the circulating nurse in the operating room during an abdominal surgery, the patient's condition changes after the administration of an inhaled anesthetic agent and succinylcholine (Anectine). Which finding is most important to report to the surgeon? A. Blood pressure drops from 142/90 to 124/64. B. Patient's trunk and extremities become rigid. C. Heart rate drops from 80 to 62 beats/min. D. Patient does not respond to painful stimulus.

B Focus: Prioritization Rigidity of skeletal muscle suggests that the patient may have malignant hyperthermia, a potentially lethal complication associated with inhaled anesthetic agents and succinylcholine. This will require immediate discontinuation of the anesthetic agents, followed by administration of 100% oxygen and dantrolene (Dantrium). The drop in blood pressure and slowing of the heart rate are common side effects of general anesthesia and will also be addressed but are not as concerning as the skeletal muscle rigidity. Decreased response to pain is an expected effect of general anesthesia.

The patient's outflow (effluent) is cloudy as reported by the LPN/LVN. What would the nurse instruct the LPN/LVN to do at this time? A. Empty the outflow bag into the sink. B. Send a sample of effluent to the laboratory. C. Tell the patient to drink lots of fluids. D. Change the dressing around the patient's dialysis catheter.

B Focus: Assignment, Prioritization Cloudy or opaque effluent is the earliest sign of peritonitis and is an indication of infection. A sample should be collected and sent to the lab for culture and sensitivity, gram stain, and cell count to identify the infecting organism. The outflow bag will need to be emptied after the sample is sent. The LPN/LVN should change the dressing if needed, and encourage the patient to drink adequate fluids, but these are not specific to the patient's cloudy outflow.

The health care provider orders the following laboratory tests. Which is the nurse's first priority? A. Sputum for acid-fast bacilli B. Automated nucleic acid amplification (NAA) C.Chest radiograph D. Mantoux test 0.1 mL intradermally

B Focus: Prioritization A new rapid test for TB has been developed and approved by the World Health Organization. This test is the fully automated NAA test for TB. Results are available in less than 2 hours. Use of this test is recommended by the CDC to replace other diagnostic methods for patients who are suspected of TB. If sputum for acid-fast bacilli is positive, it is a quick method to determine whether TB precautions should be initiated until more definitive testing can be completed. The Mantoux test (tuberculin test) result is the most commonly used reliable test of TB infection, but it takes 48 to 72 hours to get results. Once a patient's Mantoux test is positive, a chest radiograph is needed to detect clinically active TB.

Which patient statement most indicates a need for follow-up by the nurse about CAPD? A. "I am supposed to use sterile technique when connecting or disconnecting the catheter tubing." B. "I usually perform my dialysis exchanges in the dining room on the table." C."I run the dialysate in quickly over 10 to 20 minutes." D."I will be able to travel on vacation with my PD."

B Focus: Prioritization CAPD must be performed by the patient using sterile technique; performing exchanges on the dining room table may expose the patient to organisms and lead to peritonitis. It would be essential that the nurse clarify how the patient will accomplish the exchanges. Use of sterile technique is essential to prevent infection. The dialysate is infused quickly over 10 to 20 minutes, and patients can travel with PD.

The patient tells you that he experiences nausea when his TB medications are given at 9 am each day. What action is the nurse's priority at this time? A. Teach the patient to follow the drug regimen exactly as prescribed. B. Reschedule the patient's medication for 9 pm before going to bed. C. Ask the dietitian to send up a snack for the patient to eat with the medications. D. Contact the health care provider requesting an order for an oral antacid.

B Focus: Prioritization TB drugs often cause patients to experience nausea. Reschedule the medication for bedtime to prevent nausea and teach the patient about this. Food or antacids slow or prevent absorption of some TB medications and should be avoided.

Ms. S is a 55-year-old woman who is morbidly obese and 2 days postoperation for knee surgery. You notice a strong scent of urine when you enter the room. There is a bedside commode and a bedpan in the room. What should you do first? A. Instruct assistive personnel (AP) to assist the patient with hygiene. B. Try to determine the source of the urine odor. C. Check records for urine output and the nurses' notes for problems with voiding. D. Review the medical records for a history of urinary incontinence.

B Focus: Prioritization Seek the source of the odor, which might be a dirty commode or bedpan, an unflushed toilet, soiled linens, or the patient's body. Based on your findings you may decide to pursue the other options.

The patient is a 29-year-old woman who comes to the emergency department with a history of diaphoresis, unplanned weight loss despite increased appetite, and palpitations. Assessment reveals a wide-eyed look, a small thyroid mass, and vital signs including blood pressure (BP) 148/92, heart rate (HR) 104 beats/minute, temperature 98.4°F (36.9°C), and respiratory rate (RR) 24 breaths/minute. Her history includes decreased menstrual flow, increased fatigue, and weakness. Which nursing concept will the nurse use to interpret data and plan care for this patient? A. Safety B. Hormonal regulation C. Perfusion D. Cellular regulation

B Focus: Prioritization The thyroid gland produces thyroid hormones (T3 and T4) which are important in control of metabolism. Both hormones increase metabolism. Weight loss, diaphoresis (heat intolerance), palpitations, exophthalmos (wide-eyed, startled look), presence of goiter (thyroid mass), decreased menstrual, as well and increased BP, HR, and RR are all classic manifestations of hyperthyroidism. A patient with hypothyroidism would present with the opposite picture such as weight gain, cold intolerance, bradycardia, hypotension, and decreased respiratory function.

A 60-year-old male patient with vomiting and diarrhea for the last 2 days arrives in the Emergency Department. Vital signs are: Temperature: 101.8° F (38.8° C); Pulse: 112; Respirations: 24; Blood Pressure (BP): 88/60; Oxygen Saturation 96% on 2 liters of oxygen. Which action prescribed by the health care provider will you implement first? A. Give metoclopramide (Reglan) 10 mg IV. B. Administer 1 L of normal saline over 60 minutes. C. Draw blood for complete blood count and blood chemistries. D. Administer acetaminophen (Tylenol) 650 mg rectal suppository.

B Focus: Prioritization Volume depletion is the most common cause of acute kidney injury. This patient's history, BP, and pulse indicate severe hypovolemia; rapid isotonic fluid replacement is needed to improve perfusion to the kidneys and avoid acute prerenal kidney injury. The other actions are also appropriate, but replacement of volume loss and maintenance of perfusion to vital organs is the most immediate need for this patient.

a hospital nurse manager is involved in conflict management between 2 staff members. the process of collaborating occurs when: a. one person seeks to satisfy her own interests b. both sides strive to meet the interests of both parties c. a person chooses to withdraw from conflict d. one party seeks to appease the other

B - 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 accomodating

The charge nurse is reviewing another nurse's documentation for a postoperative client who just returned to the unit following abdominal surgery with a general anesthetic. The nurse caring for the client documented that active bowel sounds were heard in all 4 quadrants. What is the most appropriate action by the charge nurse? A. Compliment the nurse on documenting a complete post-operative assessment. B. Question the nurse about hearing bowel sounds when assessing this client. C. Go into client's room and assess the client with a focus on an abdominal assessment. D. Do nothing and wait to see what the nurse documents the next time the client is assessed.

B Question the nurse about hearing bowel sounds when assessing this client. Not A. Compliment the nurse on documenting a complete post-operative assessment. Rationale providing feedback is important but it is not the priority in this situation. Not C. Go into client's room and assess the client with a focus on an abdominal assessment. After questioning the nurse, it may be appropriate to follow-up with another assessment but it is not the first action.Not D. Do nothing and wait to see what the nurse documents the next time the client is assessed. The charge nurse the overall responsibility of the unit and needs to follow-up as needed. A client who had abdominal surgery under general anesthesia will not have active bowel sounds immediately postoperatively. Therefore, the charge nurse is responsible for questioning the nurse in a non-threatening manner. THIN Thinking: Nursing Process- The nurse needs to understand what assessment data is "normal: at various stages of recovery following a general anesthetic. The assessment may be accurate but the charge nurse should question it because it does not fit the "normal" expectation.

The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which best action? A. Refuse to float to the ICU based on lack of unit orientation. B. Clarify with the team leader to make a safe ICU client assignment. C. Ask the nursing supervisor to review the hospital policy on floating. D. Submit a written protest to nursing administration, and then call the hospital lawyer.

B. Clarify with the team leader to make a safe ICU client assignment. Floating is an acceptable practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. That is why clarifying the client assignment with the team leader to ensure that it is a safe one is the best option. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. It is premature to submit a written protest and call the hospital lawyer.​

The nurse has made an error in a narrative documentation of an assessment finding on a client and obtains the client's record to correct the error. The nurse should take which actions to correct the error? Select all that apply. A. Document a late entry in the client's record. B. Draw one line through the error, initialing and dating it. C. Try to erase the error for space to write in the correct data. D. Use whiteout to delete the error to write in the correct data. E. Write a concise statement to explain why the correction was needed. F. Document the correct information and end with the nurse's signature and title.

B. Draw one line through the error, initialing and dating it. E. Document the correct information and end with the nurse's signature and title. If the nurse makes an error in narrative documentation in the client's record, the nurse should follow agency policies to correct the error. This includes drawing one line through the error, initialing and dating the line, and then documenting the correct information. A late entry is used to document additional information not remembered at the initial time of documentation, not to make a correction of an error. Documenting the correct information with the nurse's signature and title is correct. Erasing data from the client's record and the use of whiteout are prohibited. There is no need to write a statement to explain why the correction was necessary. ​

The nurse manager is discussing the facility protocol in the event of a tornado with the staff. Which instructions should the nurse manager include in the discussion? Select all that apply. A. Open doors to client rooms. B. Move beds away from windows. C. Close window shades and curtains. D. Place blankets over clients who are confined to bed. E. Relocate ambulatory clients from the hallways back into their rooms.

B. Move beds away from windows. C. Close window shades and curtains. D. Place blankets over clients confined to bed. In this weather event, the appropriate nursing actions focus on protecting clients from flying debris or glass. The nurse should close doors to each client's room and move beds away from windows, and close window shades and curtains to protect clients, visitors, and staff from shattering glass and flying debris. Blankets should be placed over clients confined to bed. Ambulatory clients should be moved into the hallways from their rooms, away from windows

Nursing staff members are sitting in the lounge taking their morning break. An unlicensed assistive personnel (UAP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS). The UAP proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. The registered nurse should inform the UAP that making this accusation has violated which legal tort? A. Libel B. Slander C. Assault D. Negligence

B. Slander Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or offensive contact. Negligence involves the actions of professionals that fall below the standard of care for a specific professional group.

The nurse manager is orienting a new nurse to the charge nurse role. What needs to be included in the orientation regarding delegation? A. When delegating to an LPN/LVN the nurse is also delegating accountability. B. The delegating nurse retains accountability for care delegated to non-RN staff. C. The LPN/LVN can re-delegate an assignment to unlicensed assistive personnel (UAP). D. The unlicensed assistive personnel (UAP) has the authority to refuse a delegating.

B. The delegating nurse retains accountability for care delegated to non-RN staff. The nurse delegating to an LPN/LVN or unlicensed personnel remains accountable for the care provided. The individual doing the delegating is personally responsible for making prudent decisions based on the 5 rights of delegation. THIN Thinking: Help Quick- When delegating care, the nurse needs to follow the 5 rights which includes understanding the scope of practice of each of the team members. The nurse remains accountable for the care provided therefore, appropriate delegation is critical to safe practice.

For Ms. S, which tasks related to urinary incontinence would be delegated to the AP? Select all that apply. A. Assist the patient to use the bedpan as needed. B. Empty and clean the commode chair after every use. C. Assist the patient to don and change absorbent pads or undergarments as needed. D. Assist the patient to get up to the bedside commode whenever she calls for help. E. Frequently check the bed linens and the patient's clothes for moisture and change as needed. F. Coach the patient to perform Kegel exercises.

BCDE Focus: Delegation For stress incontinence, absorbent undergarments are a good temporary solution. For functional incontinence, she needs help to get up to the commode. The AP can clean the commode and check for soiled linens and change as needed (obese patients cannot always sense when linens are wet). Using the bedpan is not the best option; bedpans are hard to position and are generally uncomfortable for the patient. In addition, this patient will benefit by getting out of bed. The nurse can help the patient gain control by teaching and coaching Kegel exercises.

Which information is key to include when teaching the patient about RAI therapy? (Select all that apply.) A. RAI is performed on an inpatient basis. B. RAI may be administered orally. C. Complete symptom relief may take 6 to 8 weeks. D. Some patients may need a second or third dose of RAI. E. The radiation dose is usually eliminated within a week. F. Some patients require lifelong therapy with thyroid hormone replacement.

BCDF Focus: Prioritization RAI therapy is usually performed on an outpatient basis. The radiation dose is usually eliminated within a month. All of the other statements about RAI are accurate and should be included in a teaching plan for a patient who is to receive RAI therapy.

Which comments by Mr. D suggest that it is unsafe to discharge him? Select all that apply. A. "My niece will pick me up tomorrow to take me to see my family doctor for a follow-up appointment." B. "I want you to have this necklace. It belonged to my wife and you remind me of her." C. "I am willing to take my medication if someone can go to the pharmacy and pick it up for me." D. "I don't want to participate in any rehabilitation programs, but I would like to have a physical therapist do home visits." E. "I have a few items of business to finish, but most of my personal affairs are in order."

BE Focus: Prioritization For depressed patients, giving away cherished items or trying to get personal affairs in order can suggest suicidal intent or thoughts about dying. These comments need further assessment. The other comments suggest that he has some future intentions to comply or adapt to the treatment plan.

You are the RN team leader. which tasks related to the care of the patient with chronic pancreatitis would be best to assign to the LPN/LVN? Select all that apply. A. Weigh daily at the same time of day and record the findings. B. Administer pancreatic enzymes with meals as prescribed. C. Evaluate the effectiveness of the pancreatic enzyme therapy. D. Teach about long-term dietary management. E. Assist patient to eat high-carbohydrate and low-fat foods. F. Observe for respiratory complications such as orthopnea. G. Assess for previous use of nonpharmacologic pain strategies H. Assess daily for pancreatic ascites I. Measure and record abdominal girth.

BFHI Focus: Assignment The LPN/LVN can administer the medications and perform routine or daily assessments and collect data on stable patients. The RN is responsible for the initial assessment of all patients and the assessment of unstable patients and for evaluating the therapeutic outcomes. The AP can weigh the patient and assist the patient with eating. The dietician would be consulted for the initial teaching about long-term dietary management.

The LPN/LVN is administering the patient's oral TB drugs. The patient is on the phone and asks the LPN/LVN to leave the drugs so he can take them when he is off the phone. What is the LPN/LVN's best response? A. "That is fine but be sure you take them." B. "If you don't take these drugs now you may develop drug resistant TB." C."I can come back but I must watch you take these drugs." D."I will tell the nurses on the next shift to bring your drugs to you."

C Focus: Assignment, Prioritization Absolute adherence to the drug therapy for TB is essential and critical for survival and cure of the disease, especially for patient with drug-resistant TB. These drugs require directly observed therapy (DOT).

The health care provider (HCP) informs the nurse that the patient has a fibrin clot formation on the PD catheter. What is the nurse's best action at this time? A. Clamp the catheter tubing B. Reposition the catheter C. Milk the catheter tubing D. Reposition the patient

C Focus: Prioritization Fibrin clot formation can occur after PD catheter placement. Milking the tubing can dislodge the clot and improve dialysate flow. An x-ray may be ordered to verify the position of the PD catheter and if displacement has occurred, the HCP will reposition the PD catheter.

Mr. D, a 70-year-old widower, was admitted to the medical-surgical unit for respiratory distress secondary to heart failure. He needs discharge teaching. However, he appears tired, distracted, and disinterested. What is your best response? A. "You seem tired right now. Let's postpone the teaching until you feel better." B. "Considering what you have been through, getting more information must be overwhelming." C. "You seem distracted today. Is there anything that I could do to help?" D. "Let's proceed with the teaching and when you need to take a break, we will stop."

C Focus: Prioritization First try to determine the barriers to learning. Physical fatigue appears to be one consideration, but there may be other physical problems such as pain, social problems such as being discharged to an empty house, or psychological problems such as anxiety or depression. The other options might be used depending upon your assessment findings.

Based on Mr. D's answers to your assessment questions, you suspect that Mr. D might be depressed. What should you do first? A. Locate community resources that he can use after he is discharged. B. Call the health care provide and obtain an order for antidepressant medication. C. Identify nursing concerns that are based on your assessment findings. D. Contact the psychiatric clinical nurse specialist and report your concerns.

C Focus: Prioritization First, use the nursing process to identify problems that you and the patient can immediately address. The other options are interventions that may eventually become part of the overall care plan.

The AP reports that the patient's oral temperature with 8 AM vital signs is 99.8°F (37.7°C). What is the nurse's priority action at this time? A. Administer two tablets of acetaminophen. B. Lower the patient's room temperature. C. Notify the health care provider. D. Instruct the patient to rest quietly.

C Focus: Prioritization Increases in the temperature of a patient with hyperthyroidism may indicate the onset of thyroid storm, a life-threatening event that occurs with uncontrolled hyperthyroidism, characterized by high fever and hypertension. You should immediately report a temperature increase of even one degree. If a AP is checking vital signs, be sure to instruct them to report the patient's temperature as soon as it is obtained. If the temperature is elevated, immediately assess the patient's cardiovascular status and if the patient is on a cardiac monitor, check for dysrhythmias.

Which of these patients recovering in the PACU will you need to care for first? A. 19-year-old with purulent wound drainage after an emergency appendectomy B. 30-year-old with a heart rate of 108 after having a laparoscopic cholecystectomy C. 40-year-old who had a thyroidectomy and has a respiratory rate of 10 D. 61-year-old who had a right total hip replacement and is reporting 9/10 hip pain

C Focus: Prioritization The patient's low respiratory rate requires that the nurse rapidly assess and intervene to prevent hypoxemia caused by decreased respiratory drive or airway obstruction. The other patients also need ongoing assessment and interventions, but the nurse's first action should be to ensure that patient oxygenation is maintained. Emergency appendectomy is usually done when a ruptured appendix is suspected, so purulent drainage is not unusual in this situation. The nurse should assess the patient with tachycardia for bleeding and address the postoperative pain expressed by the patient with a hip replacement. Addressing possible airway problems is always the higher priority.

The patient was admitted to the medical unit with a diagnosis of dehydration. Which result is most important to report to the health care provider? A. Blood urea nitrogen (BUN) 76 mg/dL B. Hematocrit 33% C. Serum potassium 7.2 mEq/L D. Glomerular filtration rate (GFR) 25 mL/minute

C Focus: Prioritization The serum potassium level indicates severe hyperkalemia, which may result in bradycardia and cardiac arrest unless it is corrected quickly. The elevated BUN and decreased GFR indicate that the patient has developed acute kidney injury and will also need to be reported but are not immediately life threatening. The patient's anemia may be chronic or caused by hemodilution or by decreased erythropoietin production by the injured kidneys, but does not need to be addressed immediately.

The provider recommends an emergency laparoscopy. You overhear the LPN/LVN telling Ms. P that methotrexate can be successfully used to treat cases of ectopic pregnancy. What should you do first? A. Take the LPN/LVN aside and gently advise her to stop confusing the patient. B. Direct the LPN/LVN to take her concerns directly to the provider instead of the patient. C. Review the criteria for use of methotrexate for ectopic pregnancy with the LPN/LVN and patient. D. Support the LPN/LVN in advocating for the patient's free choice of therapy.

C Focus: Supervision, Prioritization Methotrexate must be used in the early stage of pregnancy. In emergency situations, laparoscopy is more reliable. Once the information is clarified, then the patient or LPN/LVN may decide to talk to the provider about the treatment advice. Praise the LPN/LVN for the underlying motivation of advocating for the patient, but encourage her to consider how the flow of information affects the patient.

The patient's NAA test is positive for TB. He is placed on Airborne Precautions. Which intervention could the RN delegate to the assistive personnel (AP)? A. Administering oral TB medications once daily B. Collecting additional sputum specimens for TB bacilli C. Assisting the patient to the bathroom D. Assessing the patient's diet preferences

C Focus: Delegation Assisting the patient with activities of daily living (ADLs) is within the scope of practice for APs. Administering medications and collecting specimens would be appropriate for an RN or a licensed practical nurse/licensed vocational nurse (LPN/LVN). Assessing diet preferences is within the scope of dietary care, but the nurse could also do this. If delegating to the AP, be sure that they are familiar with Airborne Precautions and have an appropriately fitted HEPA (high efficiency particulate air) mask before entering the patient's room.

The patient is a 54-year-old man with chronic kidney disease (CKD) who has performed continuous ambulatory peritoneal dialysis (CAPD) QID, 7 days a week for the past 6 months. During the nurse's initial assessment, the patient reports abdominal pain, nausea with vomiting, and constipation. Assessment findings include diminished bowel sounds, rebound tenderness, and abdominal distention. Vital signs include heart rate: 112/minutes, and temperature: 101.8°F (38.8°C). What major complication does the nurse suspect? A. Hemorrhage B. Fibrin clot formation C. Peritonitis D. Exit site infection

C Focus: Prioritization Peritonitis is the major complication of peritoneal dialysis (PD). The cardinal signs of peritonitis are abdominal pain and tenderness. Other manifestations include nausea and vomiting, constipation, decreased bowel sounds, rebound tenderness, abdominal distention, tachycardia, and high fever.

Mr. A is a 70-year-old man with Alzheimer who was admitted for pneumonia. The family reports that he is usually independent with ADLs at home, but has been very confused in the hospital. You find him urinating in the corner of his room. What is the priority response? A. "Would you be willing to wear a condom catheter and leg bag so that we can keep you dry?" B. "If you feel like you need to urinate, just push the call bell and someone will come to help you." C. "Let me help you clean up and then I will call your family to come and sit with you." D. "Mr. A., you are in the hospital. I am your nurse. The doctor is treating you for pneumonia. "

C Focus: Prioritization The patient is confused by the environment (must also be observed for mental status changes secondary to pneumonia) and familiar faces will help. Family can also advise you about his usual patterns. Condom catheters are usually not used with confused patients, because they are easily removed. Telling the patient to call for help is okay, but expecting him to remember to call is not realistic. Orienting to person, place, and time are appropriate for this patient, but take care of his immediate needs first.

The nurse notes that the patient has poor dialysate flow. Which question will the nurse ask to determine the cause of this complication? A. "How much fluid did you consume today?" B. "Do you have a regular exercise regimen?" C. "When was your last bowel movement?" D. "Which drugs have been prescribed for you?"

C Focus: Prioritization The most common cause of poor dialysate flow is related to constipation. To prevent constipation, a bowel preparation is usually prescribed before starting PD.

The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an unlicensed assistive personnel (UAP)? A. A client requiring a colostomy irrigation. B. A client receiving continuous tube feedings. C. A client who requires urine specimen collections. D. A client with difficulty swallowing food and fluids.

C. A client who requires urine specimen collections. The nurse must determine the most appropriate assignment based on the skills of the staff member and the needs of the client. In this case, the most appropriate assignment for the UAP would be to care for the client who requires urine specimen collections. The UAP is skilled in this procedure. Colostomy irrigations and tube feedings are not performed by UAPs because these are invasive procedures. The client with difficulty swallowing food and fluids is at risk for aspiration.

The nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually-explicit photograph. Which is the most appropriate initial nursing action? A. Call the police. B. Cut up the photograph and throw it away. C. Call the nursing supervisor and report the incident. D. Call the laboratory and ask for the name of the individual who sent the photograph.

C. Call the nursing supervisor and report the incident

The nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around their upper arm. The co-worker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse? A. Call security. B. Call the police. C. Call the nursing supervisor. D. Lock the co-worker in the medication room until help is obtain

C. Call the nursing supervisor. Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This incident needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Option D is an inappropriate and unsafe action​

The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the health care provider of the incident, and completes an incident report. Which statement should the nurse document on the incident report? A. The client fell out of bed. B. The client climbed over the side rails. C. The client was found lying on the floor. D. The client became restless and tried to get out of bed.

C. The client was found lying on the floor

The nurse plans assignments for the day after receiving the nigh shift's report. Which client does the nurse see first? 1.An adolescent client who took 100mg methylphenidate and has a blood pressure of 160/100. 2.A young adult client who requires a metered-dose inhaler. 3.A young adult client with a short arm cast on the left arm. 4.A middle-aged client diagnosed with hypothyroidism requiring a TSH level.

Correct: 1) An adolescent client who took 100mg methylphenidate and has a blood pressure of 160/100. This is the most unstable client. Methylphenidate is a CNS stimulant used for ADHD. The blood pressure is elevated. Assess the client for restlessness, dilated pupils, tremors, and possible tonic-clonic seizures. Incorrect: 2) The use of an inhaler may be a potential problem, but this is not the priority client. 3) There are no indications of complications with the cast or fracture. Assess the client for complications such as circulatory impairment and peripheral nerve damage. This is not the priority client. The client would be seen second to assess for possible complications of cast placement. 4) Routine monitoring of TSH levels is required during initial medication therapy. This client is stable. Symptoms of hypothyroidism include decreased activity level, sensitivity to cold, obesity, and weight gain.

The nurse on the oncology unit prepares to admit the client to the unit and reviews the physician's orders. Which tasks are appropriate to assign to the unlicensed assistive personnel (UAP)? Select all that apply. 1.Assisting the client to the bathroom as needed 2.Assisting client with chlorhexidine shower as needed 3.Performing venipuncture to obtain lab work 4.Obtaining the 12-lead ECG 5.Answering the client's questions about a subcutaneous venous access device 6.Obtaining and recording the client's vital signs 7.Assessing the client's pain 8.Obtaining the client's signature on the surgical consent

Correct: 1) Assisting the client to the bathroom as needed 2) Assisting client with chlorhexidine shower as needed 6) Obtaining and recording the client's vital signs These are appropriate tasks for the UAP. Assign standard unchanging procedures. Incorrect: 3,4,5,7, & 8 The nurse cannot delegate assessment, teaching, or nursing judgement. The nurse cannot delegate tasks outside the scope of practice of the UAP.

When the client's spouse arrives, the spouse states, "Just give me the consent forms, and I will sign them because I am her durable power of attorney for health care (DPOA-HC)." For each situation below, specify the relevant associated ethical principle which applies. Only one ethical principle will be chosen for each situation. Beneficence Autonomy Justice 1.The nurse sits down with the client and encourages the client to share concerns and feelings. 2.The nurse manager ensures the nurse's other assigned clients receive ordered care while the nurse is working with the anxious client. 3.The nurse recognizes the client has the right to make health care decisions for self, including surgery.

Correct: 1) Beneficence The duty to act to benefit or promote the good of others (e.g., spending extra time to help calm an anxious client). 2) Justice The duty to distribute resources or care equally, regardless of clients' personal attributes (e.g., the nurse manager ensures the nurses have needed resources to provide competent care. The nurse devotes equal attention to each client based on acuity of need. One client does not receive preferential treatment at the expense of others). 3) Autonomy Respecting the rights of clients to make their own decisions (e.g., acknowledging the client's right to refuse medication or treatment).

The nurse manager observes the response of several staff to change that occurs on the medical surgical unit. The staff are classified as "early adopters" if which behavioral patterns are observed? 1.The staff are open and receptive to new ideas and are sought out by others. 2.The staff thrive on change and see it as an exiting adventure which can advance their careers. 3.The staff are not the first to accept a change nor are the last. 4.The staff are openly negative about changes and adopt them only after most others have done so.

Correct: 1) The staff are open and receptive to new ideas and are sought out by others. "Early Adopters" are open and receptive to new ideas. Peers tend to respect them and seek them out for information and advice about changes that are proposed or implemented. Incorrect: 2) This describes the "innovators" who are enthusiastic and energetic about change, possibly to the point of seeking it out and being disruptive to unit stability. 3) "Early majority" people have a preference for the status quo, or what has been done in the past. However, they will accept new ideas eventually, usually before the average person has done so. The listing of behavioral patterns in response to change proceeds from quickest to adopt to slowest to adopt (innovators, early adopters, early majority, late majority, laggards and rejectors). 4) This describes the "late majority" who are followers. They are skeptical about change, express their negativity openly, and only adopt a change once the majority of other people have done so.

Identify the appropriate nursing response to the client's anxiety. Select all that apply. 1.Continue to encourage client to share concerns. 2.Notify OR that there will likely be a delay or cancellation of the client's surgery. 3.Document the client's statements in the medical record. 4.Reassure the client by sharing the surgeon's online satisfaction ratings. 5.Review the consent for surgery and answer any questions the client has about the procedure. 6.Administer lorazepam 1 mg PO now. 7.Contact the client's surgeon and communicate the client's concerns. 8.Contact the hospital chaplain to come and sit with the client.

Correct: 1,3 & 7 The nurse will address the situation by using therapeutic communication. The nurse will encourage the client to continue to share feelings and concerns to determine the source of the client's anxiety. For a client having a mastectomy, there are numerous factors contributing to the client's fear. The nurse will avoid naming the client's emotions or inferring information from the client's statements and will document what the client states in quotations. The nurse will contact the surgeon and provide information about the client's mounting anxiety and ask an approximate time the surgeon anticipates seeing the client. Incorrect: 2,4,5,6, & 8 It is not appropriate for the nurse to notify the operation room (OR) of a potential delay or cancellation. Reviewing the consent forms and discussion the procedure is the responsibility of the surgeon. Sharing online ratings of any health care professional, administering the lorazepam early, and/or contacting spiritual care before asking the client are all inappropriate interventions.

On the morning of surgery, the nurse reviews the physician's orders that were written the night before surgery, checks the clint's medication administration record (MAR), and completes an assessment of the client. Which data indicates the client may be experiencing anxiety. Select all that apply. 1.BP 156/94, HR 117 2.RR 18 SpO2 (on room air) 95% 3.Client oriented to person, place, time, and situation 4.Client asks repeatedly, "What time is it now?" 5.Abdomen soft with (+) bowel sounds x 4 6.Client denies hunger, but states, "My stomach is in knots." 7.Lungs are clear but diminished throughout 8.Client pleasant but tearful throughout assessment. 9.Client states, "I'm afraid. I'm really terrified." 10.Client states, " I just wish the doctor would get here so I can sign the papers and git it over with."

Correct: 1,4,6,8,9,10 The client's anxiety is exhibited in subjective and/or objective data. Elevated heart rate, elevated blood pressure (in the absence of hypertension) and tachypnea are objective indicators that the client is having physical manifestations of increased stress and sympathetic stimulation. Reports of stomach upset, or distress may also indicate anxiety. Repeating question, being tearful or emotional, and making statements, such as being "terrified," wanting to "get it over with" are subjective findings of anxiety. Incorrect: 2,3,5 & 7 These findings are within normal limits and do not indicate the client is experiencing anxiety.

The nurse reviews a client's medical record. The nurse understands which document entry is an example of objective data? 1."Client reports, 'I feel so anxious.'" 2."Skin of left leg is pale, cool, and dry." 3."Client reports pain in left leg which worsens with movement." 4."Client is anxious and defensive."

Correct: 2) "Skin of left leg is pale, cool, and dry." Objective data is information that is observable and measurable by healthcare providers. It may add to or validate subjective data that has been given. Incorrect: 1) Subjective data is information given by the client and reflects feelings and perceptions as well as concerns. It is best documented in the client's own words. 3) Subjective data is information given by the client and reflects feelings and perceptions as well as concerns. It is best documented in the client's own words. 4) This is a judgement by the one documenting. It is not measurable and therefore is not objective data. Subjective data is given by the client. "Client states, 'I feel so anxious.'" is an example of subjective data.

A client is an outpatient psychiatric clinic tells the nurse, "I'm going to kill my spouse. That will make my life much better." Which mandate must the nurse follow to meet legal nursing responsibility? 1.Good Samaritan 2.Duty to Warn 3.Confidentiality 4.Advocacy

Correct: 2) Duty to Warn The nurse must warn third parties of potential violence to them by a client. This mandate supersedes client confidentiality. Incorrect: 1) Good Samaritan acts or laws exist to provide civil immunity for individuals who give care at the scene of an emergency such as an accident or disaster. For health care providers to be covered, the care they render in such circumstances must be in accordance with the appropriate standards of care. 3) Confidentiality refers to the ethical obligation of the nurse to protect the personal information of a a client. Personal information generally cannot be divulged to third parties without the express consent of the client. Duty to warn supersedes confidentiality. 4) Advocacy is when the nurse represents the client or the community as a client. The nurse acts to protect the rights of the client to be informed and to participate in the decision-making processes regarding health care.

The surgeon visits and obtains signed consent from the client. Once the surgeon has left the room, the client's spouse states to the nurse, "She was worried abut dying! You need to explain to her that people don't die during surgery anymore." Which 2 statements are appropriate for the nurse to make to the client? 1."That's right. This hospital has a very high surgical success rate." 2."You made a good choice selecting your surgeon." 3."I can't tell you that, but I can say that the health care team will do everything possible to keep you safe." 4."What else can I do to help you as you wait to be taken to the preoperative area?" 5."I think your spouse should go to the cafeteria. Maybe you should ask a different family member to come in." 6."I've worked here for four years and in all that time, there have only been a few clients with really bad outcomes."

Correct: 3) "I can't tell you that, but I can say that the health care team will do everything possible to keep you safe." 4) "What else can I do to help you as you wait to be taken to the preoperative area?" Therapeutic communication requires the nurse to use honesty and a direct, non-confrontational approach without providing false reassurance. The nurse is unable to promise that there will be no complications but assures the client that the health care team is competent, capable, and will do everything possible to ensure safety. It is also not therapeutic to avoid answering the client's question by providing data on the hospital and/or surgeon, and the client is not concerned with how may clients the nurse has seen with "really bad outcomes." Finally, dismissing the client's spouse or suggesting someone else come in, potentially removes the client's support system.

A nurse manager terminates a nurse for falsifying an entry in a medical record. Several months later, the manager receives a call from an agency asking for a reference for the terminated employee. Which is the nurse manager's most appropriate response to the potential employee? 1."I will have to consult an attorney before speaking with you." 2."The nurse did a good job and then resigned." 3."That employee did work for me and was terminated for poor performance." 4."I can't speak with you about that employee."

Correct: 3) "That employee did work for me and was terminated for poor performance." There are no federal laws that address what an employer can or can't say about a worker. Many states however have enacted legislation that gives employers a qualified immunity when providing information for a reference check. These statutes generally provide that an employer is immune from civil liability when it responds to a reference check in good faith. The immunity is lost, however, if it can be shown that the employer knowingly or recklessly provided false or misleading information or acted with malicious intent. The manager can freely acknowledge the employee's dates of employment, and that the employee was terminated. The manager should reference the potential employer to the HR department for further information. Incorrect: 1) The nurse manager is potentially liable if the new employer is not warned about employee incompetency or impairment. 2) The potential employer should be given information about the terminated employee. The nurse manager can inform the potential employer that the employee was terminated, and that the employee did not perform to the level as was expected. 4) The manager can freely acknowledge the employee's dates of employment, and that the employee was terminated. The manager should reference the potential employer to the HR department for further information.

The nursing team includes two RNs, one licensed practical/vocational nurse (LPN/LVN), and two unlicensed assistive personnel (UAP). The nurse considers which assignment(s) appropriate for the LPN/LVN to complete? Select all that apply. 1.Obtain vital signs for the client immediately after ECT. 2.Assist the client with bathing and feeding. 3.Administer a tube feeding for the client with dysphagia. 4.Discharge the client diagnosed with multiple sclerosis. 5.Teach the client how to administer a subcutaneous injection. 6.Change the clean dressing for a client with a venous ulcer.

Correct: 3) Administer a tube feeding for the client with dysphagia. 6) Change the clean dressing for a client with a venous ulcer. These are appropriate assignments for the LPN/LVN. The nurse will assign stable clients with expected outcomes to the LPN/LVN. Incorrect: 1) This requires assessment by the nurse. Immediately after the procedure, orient client, take blood pressure and respirations, and stay with the client during times of confusion. Unlicensed assistive personnel (UAP) can obtain vital signs after the client is alert, oriented and stable. 2) This is an appropriate assignment for the UAP. Assign standard unchanging procedures. 4) This is an appropriate activity for the nurse. The nurse cannot delegate assessment, teaching, or nursing judgement. 5) This is an appropriate activity for the nurse. The nurse cannot delegate assessment, teaching, or nursing judgement.

The nurse overhears the unit secretary tell a joke with sexual overtones to another staff member. The nurse is offended by the sexual nature and language of the joke. Which action does the nurse take first? 1.Immediately document the incident. 2.Immediately report the incident to the supervisor. 3.Immediately inform the unit secretary that the nurse is offended. 4.Immediately file a sexual harassment complaint with human resources.

Correct: 3) Immediately inform the unit secretary that the nurse is offended. The nurse should inform the unit secretary clearly that the sexual nature of the joke is offensive. Sexual harassment is prohibited by Title VII of the Civil Rights Act of 1964 and includes unwelcome sexual conduct such as pressure to participate in sexual activities, making sexual jokes, or sexual gestures. Incorrect: 1) This is an appropriate actions, but not the first action. The nurse should keep thorough records, and not keep the records at work. 2) This is the appropriate chain of command, but first the nurse should inform the unit secretary that the nurse is offended by the joke. 4) If the unit secretary does not cease offending the nurse, the nurse should talk to the supervisor and should document the incident. If the supervisor does not take appropriate measures to remedy the situation, the nurse should talk with HR.

The nurse sees clients in the adolescent psychiatric clinic. Which client does the nurse see first? 1.The school age client who reports impulsivity and poor attention span. 2.The adolescent client who displays frequent loss of temper and argues with teachers. 3.The adolescent client who wants to be a model and only drinks water and eats vegetables. 4.The adolescent client who bullies, threatens, and intimidates others and frequently initiates physical fights.

Correct: 3) The adolescent client who wants to be a model and only drinks water and eats vegetables. This client is the most unstable with actual behaviors that could cause physical harm. The nurse should assess nutritional status and monitor for an eating disorder. Incorrect: 1) This client is displaying attention deficit disorder. The behaviors are not an immediate concern. 2) The client is displaying oppositional-defiant disorder. The client has a potential to hurt others and will need further assessment. 4) The client would be the second client to be seen. The behaviors suggest a more immediate potential to harm others. The nurse will assess for conduct disorder.

The nurse must use critical thinking skills while providing care for a client receiving a blood transfusion. Which is the best example of critical thinking in the care of this client? 1.The nurse reviews the procedure for blood administration. 2.The nurse checks a unit of blood with another nurse. 3.The nurse evaluates changes in the client's vital signs during the procedure. 4.The nurse documents the procedure in the medical record.

Correct: 3) The nurse evaluates changes in the client's vital signs during the procedure. Critical thinking skills involve complex thinking processes and cognitive activities used in problem solving and decisions making. Nurses who use the nursing process engage in critical thinking. The nurse assesses the client's vital signs during a blood transfusion to determine normal vs. abnormal, expected vs. unexpected, to then plan care, implement actions, and evaluate the client's response to those actions. Incorrect: 1) Reviewing a procedure prior to implementation of the procedure does not involve problem solving. 2) Completing a procedure is not an example of critical thinking. If the nurse discovers a discrepancy while checking the blood, critical thinking would be used to problem solve. 4) Documentation is part of the procedure and does not involve complex thinking and problem-solving skills.

The nurse delegates tasks to staff on the night shift. Which task is appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1.Begin a blood transfusion on a postoperative client. 2.Change the colostomy bag on a client with an ileostomy. 3.Administer morning insulin to a client on a sliding scale. 4.Obtain a client's daily weight and shift intake and output.

Correct: 4) Obtain a client's daily weight and shift intake and output. This is a standard, unchanging procedure. UAPs assist with direct client care activities such as bathing, transferring, ambulating, feeding, toileting, obtaining vital signs, height and weight, intake and output, housekeeping, transporting stable clients, and stocking supplies. Incorrect: 1) This is an assignment for the nurse. The nurse must assess this client frequently. The nurse cannot delegate clients who require assessment, teaching, or nursing judgement. Once a transfusion is started, the nurse may assign the LPN/LVN to monitor the client's vital signs. 2) This assignment is within the scope of practice for the LPN/LVN. 3) The LPN/LVN can obtain the blood glucose and administer insulin according to a sliding scale. According to the policy on the unit, the LPN/LVN may need to check the insulin dosage with another nurse.

The nurse begins employment in a hospital using the SOAP system of documentation. Th nurse understands that SOAP is an acronym for which information? 1.Strategic, Operational, Accountability, Protocol 2.Status, Orders, Actions, Precautions 3.Secure, Orderly, Appropriate, Precise 4.Subjective, Objective, Assessment, Plan

Correct: 4) Subjective, Objective, Assessment, Plan SOAP documentation is problem-oriented documentation. There is an interdisciplinary master problem list, and all notes reflect back to an item on that list. Notes are organized in a standard format: S (subjective data: What the client or family tells the nurse or other healthcare provider) O (objective data: Objective findings of the nurse or other healthcare provider, obtained from observation, assessment including laboratory findings and examination). A (assessment data: Assessment of the meaning of the subjective and objective data by the nurse or other healthcare provider), P (plan of action: Planned interventions to address the problem). Critical thinking is inherent in this documentation.

which of the folllowing 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

Which task related to diagnostic testing of chronic pancreatitis can be delegated to the assistive personnel (AP)? A. Ensuring the patient's NPO status before endoscopic retrograde cholangiopancreatography B. Transporting the patient's blood sample to the laboratory for a Helicobacter pylori antibody test C. Saving the patient's stool specimen and observing the stool for steatorrhea D. Assisting the patient to remove metallic objects in preparation for magnetic resonance imaging

D Focus: Delegation The AP can assist the patient to remove metallic objects. Before delegating this task, the nurse should explain to the patient and AP why metal must be removed for magnetic resonance imaging. The AP should not give food or fluids, but the nurse is responsible for explaining NPO status to the patient and ensuring that the NPO order is communicated to all team members. An H. pylori antibody test is done for ulcers, gastritis, or esophagitis. The AP could collect the stool specimen but is not expected to observe for steatorrhea.

After the albuterol small volume nebulizer was administered, the response to treatment was evaluated. Which finding must be immediately reported to the health care provider? A. Blood pressure 158/88mm Hg B. Apical pulse rate 160 beats/minute C. Hand tremors and generalized shakiness D. Absent wheezes and decreased breath sounds

D Focus: Prioritization Absent wheezes and in particular, decreased breath sounds may indicate an imminent respiratory arrest. High blood pressure, a high a heart rate and hand tremors and shakiness are side effects from the beta stimulation of the albuterol.

The second patient will be having a left total knee replacement today. Which information is most important to report to the surgeon? A. The patient had a cup of tea about 3 hours ago. B. The patient is reporting bilateral knee pain. C.The patient's BP is 148/92 mm Hg and pulse rate is 98. D.The patient says, "I don't really think I need this surgery."

D Focus: Prioritization Consent for surgery can be withdrawn by the patient at any time, even after the informed consent form is signed. The surgeon should be notified so the surgery can be discussed, and the patient's consent is assured before proceeding. The other data will also be reported but are not indicators of a need to delay surgery. According to the American Society of Anesthesiologists guidelines, clear liquids can be taken up to 2 hours before surgery without increasing aspiration risk. A slightly elevated BP and pulse rate are not unusual before a stressful event such as surgery. Knee pain is an expected symptom before knee surgery.

Ms. P reports that the abdominal pain is suddenly sharp and severe. She is pale, diaphoretic, and light-headed. What should you do first? A. Assess for an increase in vaginal bleeding. B. Take a complete set of vital signs. C.Establish a peripheral intravenous site. D.Place the patient in a supine position.

D Focus: Prioritization With her symptoms, you suspect that there has been a rupture of the ectopic pregnancy. Immediately placing her in a supine position will increase blood flow to the brain. The other options are also correct actions.

You are supervising a nursing student who is giving the patient instructions about how to use the pancreatic enzymes at home. The student tells the patient to mix the enzyme in a soft food like low-fat cottage cheese. What should you do first? A. Allow the student to finish the patient teaching and then give the student positive feedback. B. Stop the student and give the patient the correct information. C. Encourage the student to report to the instructor and review medication instructions. D. Let the student finish and then take the student aside and review the information.

D Focus: Prioritization, Supervision The student has made an error (pancreatic enzymes should not be mixed with protein-based foods because the enzymes will cause the food to liquefy), but it is not an error that will cause immediate danger to the patient. Once you are away from the bedside, you can review what the student said and determine why the student gave the patient that specific information. Based on your assessment you may decide that the student should return to the patient and give the correct information, or you may decide that the student should report to the instructor and you will give the patient the correct information yourself.

The health care provider orders RAI therapy for the patient. What priority question would the nurse be sure to ask the patient before this therapy is given? A. "Have you noticed any increased tearing or a bloodshot appearance of your eyes?" B. "Do you have periods of amenorrhea or decreased menstrual flow?" C. "How many bowel movements do you have in a typical day? D. "Are you pregnant or trying to become pregnant?"

D Focus: Prioritization RAI therapy is not used with pregnant women because it crosses the placenta and can damage the fetal thyroid gland. It is important to ask all of these questions, but the question about pregnancy is a priority.

Mr. A urinates in the bed and his daughter is very upset. "He never said he wanted to pee. You people should do something! You're responsible for taking care of him!" What is the best way to handle this situation? A. Instruct the AP to clean up Mr. A and then stay with the patient. B. Clean up Mr. A yourself and have the daughter speak with the patient advocate. C. Instruct the AP to clean up Mr. A while you obtain an order for an indwelling catheter. D. Clean up Mr. A and then talk to the daughter about ways that the staff/family can help.

D Focus: Prioritization The patient should be immediately cleaned up; ideally you and the AP should work to maximize the effort. Then try to determine what the daughter sees as the family's role versus the staff's role. The daughter's response may seem out of proportion, but she may have caregiver burnout, or she may feel unsure about how to perform in the hospital setting. Explain to her that her presence is the major therapeutic benefit and that staff are more than happy to perform the tasks associated with the patient's care. Once rapport is established, her needs and her abilities can be clarified.

A hospitalized client tells the nurse that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client? A. "I will sign as a witness to your signature." B. "You will need to find a witness on your own." C. "Whoever is available at the time will sign as a witness for you." D. "I will call the nursing supervisor to seek assistance regarding your request."

D. "I will call the nursing supervisor to seek assistance regarding your request." Instructional directives (living wills) are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding instructional directives vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness.

The nurse employed in a long-term care facility is planning assignments for the clients on a nursing unit. The nurse needs to assign four clients and has a licensed practical (vocational) nurse and 3 unlicensed assistive personnel (UAPs) on a nursing team. Which client would the nurse most appropriately assign to the licensed practical (vocational) nurse? A. A client who requires a bed bath. B. An older client requiring frequent ambulation. C. A client who requires hourly vital sign measurements. D. A client requiring abdominal wound irrigations and dressing changes every 3 hours.

D. A client requiring abdominal wound irrigations and dressing changes every 3 hours. When delegating nursing assignments, the nurse needs to consider the skills and educational level of the nursing staff. Giving a bed bath, assisting with frequent ambulation, and taking vital signs can be provided most appropriately by a UAP. The licensed practical (vocational) nurse is skilled in wound irrigations and dressing changes and most appropriately would be assigned to the client who needs this care.

The nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on the evening shift. The nurse should assign priority to which client? A. A client complaining of muscle aches, a headache, and history of seizures. B. A client who twisted her ankle when rollerblading and is requesting medication for pain. C. A client with a minor laceration on the index finger sustained while cutting an eggplant. D. A client with chest pain who states that he just ate pizza that was made with a very spicy sauce.

D. A client with chest pain who states that he just ate pizza that was made with a very spicy sauce. Chest pain is a priority to rule out a myocardial infarction. Immediate attention is needed.

A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse determines that which scenario is characteristic of the team-based model of nursing practice? A. Each staff member is assigned a specific task for a group of clients. B. A staff member is assigned to determine the client's needs at home and begin discharge planning. C. A single registered nurse (RN) is responsible for providing care to a group of 6 clients with the aid of an unlicensed assistive personnel (UAP). D. An RN leads 2 licensed practical nurses (LPNs) and 3 UAPs in providing care to a group of 12 clients.

D. An RN leads 2 licensed practical nurses (LPNs) and 3 UAPs in providing care to a group of 12 clients. In team nursing, nursing personnel is led by a registered nurse leader in providing care to a group of clients. Not A. identifies functional nursing Not B. identifies a component of case management Not C. identifies primary nursing (relationship-based practice)

The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. An unlicensed assistive personnel (UAP) is resistant to the change and is not taking an active part in facilitating the process of change. Which is the best approach in dealing with the UAP? A. Ignore the resistance. B. Exert coercion on the UAP. C. Provide a positive reward system for the UAP. D. Confront the UAP to encourage verbalization of feelings regarding the change.

D. Confront the UAP to encourage verbalization of feelings regarding the change. Confrontation is an important strategy to meet resistance head-on. Face-to-face meetings to confront the issue at hand will allow verbalization of feelings, identification of problems and issues, and development of strategies to solve the problem. Option A will not address the problem. Option B may produce additional resistance. Option C may provide a temporary solution to the resistance, but will not address the concern specifically.

The nurse is giving a bed bath to an assigned client when an unlicensed assistive personnel (UAP) enters the client's room and tells the nurse that another assigned client is in pain and needs pain medication. Which is the most appropriate nursing action? A. Finish the bed bath and then administer the pain medication to the other client. B. Ask the UAP to find out when the last pain medication was given to the client. C. Ask the UAP to tell the client in pain that medication will be administered as soon as the bed bath is complete. D. Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client.

D. Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client. The nurse is responsible for the care provided to assigned clients. The appropriate action in this situation is to provide safety to the client who is receiving the bed bath and prepare to administer the pain medication. Options A and C delay the administration of medication to the client in pain. Option B is not a responsibility of the UAP.

A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of invation of client privacy? A. Performing a procedure without consent. B. Threatening to give a client a medication. C. Telling the client that he or she cannot leave the hospital. D. Observing care provided to the client, without the client's permission.

D. Observing care provided to the client, without the client's permission. Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Not A. Performing a procedure without consent is an example of battery. Not B. Threatening to give a client a medication constitutes assault. Not C. Telling the client that the client cannot leave the hospital constitutes false imprisonment.​

An ectopic pregnancy occurs when a fertilized ovum implants outside the uterus. What is the most common site for implantation of an ectopic pregnancy?

Fallopian Tube Almost all ectopic pregnancies are implanted within the fallopian tube. Blockage of the fallopian tube or decreased peristalsis of the tube hinders or slows the passage of the fertilized ovum as it moves toward the uterus.

where do nurses derive much of their power from

central to the delivery of healthcare services - professional nurses have a high degree of centrality within hc organizations. they are critical to the operation of most hc organizations.

the nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work on additional 8 hour shift, they will be reported to the state for patient abandonment. this type of power is known as

coercive