Leadership Midterm

what is autonomy?

1. Deals with PATIENT (self determination) 2. Patient have the right to informed consent and full disclosure of treatment so they can make informed choices about their care 3. Right to privacy; freedom of choice •Client's right of self-determination & freedom of decision making

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

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

One mechanism that ensures autonomy in the nursing profession is the: A.American Nurses Association (ANA). B.Department of Health Professionals. C.Nursing Code of Ethics. D.Professional Regulatory Board.

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

A patient who is not fully informed about his or her health status is an example of a violation of which ethical principle? A.Autonomy B.Justice C.Utilitarianism D.Confidentiality

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

4. The Registered Nurse is caring for a client who underwent a hysterectomy. Which tasks can be delegated to the Unlicensed Assistive Personnel (UAP) to provide quality care to the client? Select all that apply: A. Record vital signs B. Assisting the client while bathing C. Administering oral medications D. Preparing the care plan for the client E. Administer intravenous antibiotics

A, B Rationale: Tasks within the scope of practice for a UAP include recording vital signs and providing basic hygiene, such as assisting the client with activities of daily life such as bathing. Administering oral medications is under the scope for a LPN and LVN and depending on the state, the RN is responsible for both IV administration of antibiotics and developing the care plan for their patient.

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

A, C, D, E

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

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

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

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

A new RN is observed breaking sterile technique by the perioperative nurse. This is an example of a violation of which ethical principle? A.Autonomy B.Justice C.Nonmaleficence D.Confidentiality

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

Your patient with peptic ulcer disease has the following vital signs: BP 88/42, apical pulse 132, RR 28. You determine the nursing diagnosis for your patient as "altered tissue perfusion r/t decreased circulatory volume." Which intervention should you implement first? A. Notify the laboratory to draw a type and crossmatch. B. Assess the patient's abdomen for tenderness. C. Insert an 18-gauge catheter and infuse lactated Ringer's. D. Check the patient's pulse oximeter reading.

C - The vital signs indicate hypovolemia, which is a life-threatening emergency that requires you to intervene to support the patient's circulatory volume by infusing lactated Ringer's.

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

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

A nurse is assigned to provide care to a client in labor and will care for the client throughout labor and into the postpartum period. The nurse assists in developing a plan of care and determines that the priority assessment in the fourth stage of labor is which of the following? a) assessing the uterine fundus and lochia b) checking the mother's temperature c) encouraging food and fluid intake d) providing privacy for the parents and their newborn infant

Correct Answer: A The fourth stage of labor is the stage of physical recovery for the mother and newborn infant. It lasts from the delivery of the placenta through the first 1 to 4 hours after birth. A potential complication following delivery is hemorrhage. The most significant source of bleeding is the site where the placenta is implanted. It is critical that the uterus remain contracted and that vaginal blood flow is monitored every 15 minutes for the first 1 to 2 hours. Although options B, C, and D are also interventions during this stage, they are not the priority.

You are providing nursing care for a 24-year-old female patient admitted to the unit with a diagnosis of cystitis. Which intervention should you delegate to the UAP? • A. Teaching the patient how to secure a clean-catch urine sample • B. Assessing the patient's urine for color, odor, and sediment • C. Reviewing the nursing care plan and add nursing interventions • D. Providing the patient with a clean-catch urine sample container

Correct Answer: D Providing the equipment that the patient needs to collect the urine sample is within the scope of practice of a UAP. • Teaching, planning, and assessing all require additional education and skill, which is appropriate to the scope of practice of professional nurses.

The nurse receives change in shift report on four assigned clients. Prioritize the order that the nurse should assess the clients. A. The 47-year-old client two days postoperative who has pain rated at a 2 on a 0 to 10 pain scale B. The 82-year-old client who was unable to void and has a bladder scan showing 300 mL of urine C. The 76-year-old client newly admitted with serum blood urea nitrogen (BUN) of 52 mg/dL D. The 57-year-old client with hypertension who has severe midsternal pain

Correct Answer: D, C, B, A D. The 57-year-old client with hypertension who has severe midsternal pain should be assessed first. The client may be experiencing angina and needs immediate intervention. C. The 76-year-old client newly admitted with serum BUN of 52 mg/dL should be assessed second. The elevated BUN could indicate dehydration. B. The 82-year-old client who was unable to void and has a bladder scan showing 300 mL of urine should be the third client assessed; if the client is unable to void, the nurse should assess the client, initiate other measures to promote voiding and, if unsuccessful, contact the HCP; the client may need intermittent urinary catheterization for the bladder emptying. A. The 47-year-old client two days post-op who has pain rater at 2 on a 0-10 scale should be assessed last of the four clients. A pain level of 2 may be acceptable to the client.

Which patients below are best assigned to the LPN? Select all that apply. • A. A 30-year-old male patient with active GI bleeding that requires multiple blood transfusions • B. A 78-year-old female with osteoporosis who needs assistance performing range of motion exercises and ambulating with a walker • C. A 29-year-old male patient who is post-op day 6 from a colostomy placement that is on a clear liquid diet • D. A 55-year-old male patient who reports chest pain and has ST segment elevation on his EKG

Correct Answers: B and C. LPNs should be assigned stable patients with predicable outcomes and cases that don't require critical thinking or complex analysis.

•Which ethical principle is violated when there are insufficient community resources to meet the needs of low-income families? A. Nonmaleficence A. Autonomy A. Beneficence A. Justice

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

Nurse managers are able to respond better to ethical dilemmas when they have access to the organization's: A.mission and vision. B.patient safety plan. C.medical staff bylaws. D.ethics committee.

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

what is assault?

Threat or attempt to make bodily contact with another person with our without the person's consent; intentional tort

what is justice?

With regard to individual pts, fairness is expressed as the notion that equal persons should be treated equally •Treating people equitably, fairly and appropriately

What is an incident report? When would it be required to complete this type of report?

a formal recording of the facts related to a workplace accident, injury, or near miss should be completed at the time an incident happens no matter how minor

what are examples of unintentional torts?

•(failing to act responsibly) •Negligence •Malpractice

what is privacy?

•A right of limited physical informational inaccessibility

what is nonmaleficence?

•Acting in a way that avoids harm to others; including risk of harm

what are examples of intentional torts?

•Assault •Battery •Defamation of character - Libel (written) and Slander (oral) •False imprisonment •Invasion of privacy

what is accountability?

•Being answerable for one's actions

what are intentional vs unintentional torts?

•Intentional torts are wrongs committed by individuals who deliberately seek to injure or hurt another person. •Unintentional torts are omissions or acts by individuals that cause unintended harm.

what is confidentiality?

•Prohibiting the disclosure of information

what is veracity?

•Telling the truth and not intentionally deceiving or misleading clients

What is a POA (DPA) and what is the purpose of this type or representation?

it is a type of advance directive; a legal document affecting nurse's practice; •An individual to act on behalf of the principal (patient) •Grants limited or broad powers to the attorney-in-fact or agent •someone cannot make/verbalize their own decisions - there is a legal POA and the documentation needs to be present at all times

When clients struggle to make decisions regarding medical care, they should make the decision based on what determinants?

legal documentation; •Guardian - Appointed by the court via a judge •Parents are legal guardians of their children until age of majority •General guardian - Legal documentation must be presented Guardian ad litem - Temporary appointment adult children with disabilities, emancipated minors psych considerations; ALOC; emergency situations

what are torts?

•wrongs committed against another person that do not involve a contract; •Civil or personal wrong; •Compensates one person because of actions of another; •Civil lawsuit based on tort = monetary damages

what is the purpose of the nurse practice act?

prevent malpractice; The laws and regulations set out in a state's Nurse Practice Act have been put together to reduce the risk of harm to patients and to protect patients by ensuring the highest level of competence. The Nurse Practice Act aims to ensure that patients are receiving quality care and promote patient safety.

what is slander?

spoken/oral defamation of character

who are the only individuals permitted to access client information?

the patient, those directly involved in the care (nurse, doctor, LPN, etc), legal person (POA/parent/guardian)

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

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

A triage nurse encountered a client who complained of mid-sternal chest pain, dizziness, and diaphoresis. Which of the following nursing action should take priority? A. Administer oxygen therapy via nasal cannula B. Notify the physician C. Complete history taking D. Put the client on ECG monitoring

A - The priority goal is to increase myocardial oxygenation.. The other actions are also appropriate and should be performed after oxygen therapy is started..

Which ethical principle is violated when the RN tells the hospital accountant that the patient is HIV-positive? (Select all that apply) A.Beneficence B.Veracity C.Confidentiality D.Autonomy E.Fidelity

A, C

3. As the registered nurse, which tasks below should you NOT delegate to the LPN? A. Performing an assessment on a new admission B. Collecting a urine sample from an indwelling Foley catheter C. Developing a plan of care for a patient who is admitted with Guillain-Barré Syndrome D. Educating a patient about how to monitor for side effects associated with Warfarin E. Auscultating lung and bowel sounds F. Starting a blood transfusion G. Administering IV Morphine 2 mg for pain H. Providing wound care to a stage 3 pressure injury

A, C, D, F, G Rationale: These are all out of the scope of practice for an LPN. Remember anything that deals with assessments, educating, evaluating, developing a plan of care, IV medications, unstable patients, or invasive/complex procedures where there is unpredictability the RN is responsible for doing it, and these tasks can't be delegated. An LPN can perform a focused assessment by listening to lung or bowel sounds and report the findings to the RN but a comprehensive assessment is done by the RN. In addition, the LPN can perform standard procedures that are predictable on stable patients like wound care for a pressure injury, Foley catheter insertion, obtaining an EKG, obtaining blood glucose level etc.

Which are examples of internal disasters that must be accounted for when formulating a disaster response plan? Select all the apply A. Fire B. Hurricane C. Earthquake D. Power Outage E. Act of Terrosim

A, D Fire and Power Outage are considered internal disasters because they can happen within the hospital. All the other responses are examples of external disasters. They happen outside the hospital and often bring people in who need care.

A nurse triages clients arriving at the hospital after a mass casualty. Which clients are correctly classified? (Select all that apply) a. A 35-year-old female with severe chest pain: red tag b. A 42-year-old male with full-thickness body burns: green tag c. A 55-year-old female with a scalp laceration: black tag d. A 60-year-old male with an open fracture with distal pulses: yellow tag e. An 88-year-old male with shortness of breath and chest bruises: green tag

A, D Red-tagged clients need immediate care due to life-threatening injuries. A client with severe chest pain would receive a red tag. Yellow-tagged clients have major injuries that should be treated within 30 minutes to 2 hours. A client with an open fracture with distal pulses would receive a yellow tag. The client with full-thickness body burns would receive a black tag. The client with a scalp laceration would receive a green tag, and the client with shortness of breath would receive a red tag.

5. For a patient who is experiencing the side effects of radiation therapy, which task would be most appropriate to delegate to the UAP? A. Helping the patient to identify patterns of fatigue B. Recommending participation in a walking program C. Reporting the amount and type of food consumed from the tray D. Checking the skin for redness and irritation after the treatment

Answer C: Reporting the amount and type of food consumed from the tray Rationale: The UAP has a scope of practice that allows them to observe the amount that the patient eats and report to the nurse. Assessing the patterns of fatigue and checking the condition of a patient's skin is the responsibility of the Registered Nurse. Recommending participation in a walking program is the initial responsibility of the physician.

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

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

An RN is caring for an 80-year-old male patient who has been admitted to the hospital. The RN delegates several tasks to the UAP. In order to evaluate the understanding of the UNP, the RN asks the UAP to describe which tasks have been delegated. Which responses given by the UNP indicate effective understanding of the tasks? Select all that apply. A. "I must assist the patient with oral care." B. "I must assess the patient's health status." C. "I must administer intravenous drug pain medication." D. "I must record the blood pressure of the patient at regular intervals."

Answer: A & D Rationale: The registered nurse delegates the tasks to the UAP based on capabilities and skills of the UNP. The UAP can perform tasks that involve basic hygiene. The UAP can also perform tasks to record vital signs. Assessment of the patient's health status and intravenous drug medication administration are within the scope of practice of the RN.

When the nurse described the client as "that nasty old man in 354," the nurse is exhibiting which ethical dilemma? A. Gender bias and ageism B. HIPAA violation C. Beneficence D. Code of ethics violation

Answer: A Stereotyping an "old man" as "nasty" is a gender bias and an ageism issue. The nurse is verbalizing a negative descriptor about the client.

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

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

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.

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

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

Answer: B Nurse practice acts require reporting impaired nurses. This occurrence needs to be reported to the nurse 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

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

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

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.

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

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

Answer: C 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 professional actions that fall below the standard of care for a specific professional group.

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, 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.

Answer: C There are two situations in which informed consent of an adult client is not needed... (1) During an emergency when delaying treatment for the purpose of obtaining informed consent would result in injury or death of the client. (a) Client is unconscious and has a severe head injury, if not treated it could lead to the death of the patient (2) when the client waives the right to give informed consent or is mentally incapacitated. A would cause will delay emergency treatment, B is inappropriate and D is not the best action because it delays necessary emergency treatment- this would be done after emergency care is given

An older woman is brought to the emergency department for treatment of a fractured arm. On physical assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. Which is the most appropriate nursing response? A. "Oh, really? I will discuss this situation with your son." B. "Let's talk about the ways you can manage your time to prevent this from happening." C. "Do you have any friends who can help you out until you resolve these important issues with your son?" D. "As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay."

Answer: D The nurse must report situations related to child or elder abuse. Confidential issues are not to be discussed with nonmedical personnel or the client's family or friends without the client's permission. Clients should be assured that information is kept confidential, unless it places the nurse under a legal obligation.

The nurse is caring for a 56 year old female who started chemotherapy treatments 3 days ago. Which side effect warrants immediate intervention? A.) Nausea & Vomiting B.) Loss of appetite C.) Fatigue D.) Paresthesias

Answer: D - Paresthesias may indicate swelling and compression of nerves, it is important for early intervention to prevent permanent damage of sensation. Incorrect: A.) Nausea and vomiting is a common side effect among those who take chemotherapy drugs. B.) Pain, dehydration, and nausea can reduce a person's appetite while taking chemotherapy medication. C.) Patients may experience fatigue from chemotherapy because the body's attempt to try to repair damaged healthy cells.

After a change of shift, you are assigned to care for the following patients. Which patient should you assess first? A. A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab B. A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation. C. A 70-year old with pneumonia who needs to be started on IV antibiotics. D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.

Answer: D. The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications.

You're making the patient assignments for the next shift. On your unit there are three LPNs, two RNs, and two nursing assistants. Which patients will you assign to the LPNs? Select all that apply:* A. A 68 year-old male patient who is expected to be discharged home with IV antibiotic therapy. B. A 25 year-old female patient newly admitted with diabetic ketoacidosis. C. A 75 year-old male patient with dementia who has an ileostomy and scheduled tube feedings. D. A 65 year-old female patient who has an order to remove the Foley catheter

Answers are C and D. Option A: An RN is the best for this patient because the patient will need discharge teaching AND the nurse will need to teach the patient how to self-administer antibiotics. Option B: This is a new admission and the patient is UNSTABLE. Most patients with DKA (diabetic ketoacidosis) require insulin drips along with close monitoring of the blood glucose levels, which requires critical thinking and interpretation. Options C and D are best for the LPNs: these are standard routine procedures the LPN can perform and these patient cases are stable

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.

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

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.

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

Ethical dilemmas often arise over a conflict of opinion. Once the nurse has determined that the dilemma is ethical, a critical first step in negotiating the difference of opinion would be to: A.Consult a professional ethicist to ensure that the steps of the process occur in full B.Gather all relevant information regarding the clinical, social and spiritual aspects of the dilemma C.List the ethical principles that inform the dilemma so that negotiations agree on the language of the discussion D.Ensure that the attending physician has written an order for an ethics consultation to support the ethics process

B Rationale: Each step in the processing of an ethical dilemma resembles steps in critical thinking. The nurse begins by gathering information and moves through the assessment, identification of the problem, planning, implementation and evaluation.

You are the supervising nurse in an Emergency Department (ED) following a mass casualty. Which of the following patients is improperly tagged by your staff? A. Black: A 32 y/o female patient with extensive head injuries, a thready pulse and agonal breathing. B. Yellow: A 57 y/o male patient limping with several minor lacerations on extremities. C. Red: An 80 y/o female patient with a laceration on the head, altered mental status and respirations of 45 breaths per minute. D. Yellow: A 47 y/o male patient complaining of 7/10 abdominal pain with notable bruising on the abdomen.

B Rationale: The patient in option A is correctly tagged, her agonal breaths and thready pulse indicate a low chance of survival. The patient in option C is correctly tagged because she is a critical patient that cannot wait for care. Her increased respirations and changed LOC indicate that she needs immediate intervention. Option D is correct because the patient is able to verbalize pain and injury, however will need medical attention as soon as possible. Patient B is incorrectly tagged. He should be labeled with a green tag. He is able to move with a limp and has minimal injury. He would be considered "walking wounded."

The major responsibility for upholding patient care standards belongs to the: A.chief executive officer of the facility B.nurse manager. C.on-call physician. D.staff nurse providing patient care.

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

1. Which of the following tasks is appropriate for the nurse to delegate to an experienced UAP? A. Obtain a 24-hour diet recall from a client recently admitted with anorexia nervosa. B. Obtain a clean-catch urine specimen from a client suspected of having a urinary tract infection. C. Observe the amount and characteristics of the returns from a continuous bladder irrigation for a client after a transurethral resection. D. Observe a client newly diagnosed with diabetes mellitus practice injection techniques using an orange.

B - Rationale: A nurse is able to delegate activities which involve standard, unchanging procedures. There is no indication that the client has a catheter, so this is seen as a routine procedure. Option A and C both involve an assessment, while option D requires the evaluation of client teaching.

2. When assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the most appropriate to assign to an LPN under the supervision of the RN? A. A patient with severe anemia secondary to GI bleeding B. A patient who needs enemas and antibiotics to control GI bacteria C. A patient who needs preoperative teaching for bowel resection surgery D. A patient who needs central line insertion for chemotherapy

B - Rationale: Administering enemas and antibiotics are within the scope of practice of LPNs. Although some states and facilities may allow the LPN to administer blood, in general, administering blood, providing preoperative teaching, and assisting with central line insertion are the responsibilities of the RN.

Professional safeguards that protect the nurse from being wrongfully accused of malpractice include which of the following? (Select all that apply). A.Code of Ethics B.Statute of Limitations C.Affidavit of Merit D.Standard of Proof E.Sources of Law

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

Which of the following are examples of intentional torts that may occur in the health care field? (Select all that apply) A.Slip and fall in the hospital cafeteria B.Patient restrained by the neck utilizing the nurse's arm C.Ovary removal against the patient's signed consent D.Restraining a patient without a physician's order E.Hospital-acquired pressure ulcer

B, D Rationale: Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment.

The nurse is called from the hospital to assist the emergency medical technicians in a disaster response. The nurse classifies some victims into the "black-tagged" category bases on what assessment findings? A. Leg Fracture B. Massive head trauma C. Abrasions and contusions D. Full-thickness body burns E. High cervical spinal cord injury

B, D, E Rationale: Black-tagged category patients are those who are expected to die. Patients with massive head trauma. Fill=thickness body burns, and high cervical spinal cord injury are generally expected to die. Victims with leg fractures or abrasions and contusions can be given delayed treatment and are therefore classified as green-tagged victims.

The primary care provider wrote a do-not-resuscitate (DNR) order. The nurse recognizes that which applies in the planning of nursing care for this client? A. The client may no longer make decisions regarding his or her own health care. B. The client and family know that the client will most likely die within the next 48 hours. C. The nurses will continue to implement all treatments focused on comfort and symptom management. A DNR order from a previous admission is valid for the current admission

C A DNR order only controls CPR and similar life-saving treatments. All other care continues as previously ordered. Competent clients can still decide about their own care (including the DNR order.)

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 oriented 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 occurrence. D.Call the laboratory and ask for the name of the individual who sent the photograph.

C Rationale: Ensuring a safe workplace is a responsibility of an employing institution. Sexual harassment in the workplace is prohibited by state and federal laws. If the nurse believes that he or she is being subjected to unwelcome sexual conduct, these concerns should be reported to the nursing supervisor immediately. Option 1 is unnecessary at this time. Options 2 and 4 are inappropriate initial actions.

The emergency medical service has transported a client with severe chest pain. As the client is being transferred to the emergency stretcher, you note unresponsiveness, cessation of breathing, and an impalpable pulse. Which of the following task is appropriate to delegate to the nursing assistant? A. Assisting with the intubation B. Placing the defibrillator pads C. Doing chest compressions D. Initiating bag valve mask ventilation

C Rationale: Performing chest compressions are within the training of a nurse assistant. The use of the bag valve mask requires practice, and usually a respiratory therapist will perform the function. The defibrillator pads are clearly marked; however placement should be done by the RN or physician because of the potential for skin damage and electrical arcing

Community stakeholders (local government, fire and rescue workers, hospitals) have been focused on gathering information from a variety of resources, developing collaborative response plans, and preparing for a probable disaster. As nurse managers and leaders, what steps are essential first? A. Engaging acute care facilities to be prepared and have a plan in place only for external disasters B. The Health Insurance Portability and Accountability Act (HIPAA) and The Joint Commission (TJC) require all health care facilities to have detailed all-hazard preparedness plans and to conduct drills internally. C. Establishing an all-hazards preparedness plan to create an all-hazards preparedness task force (AHPTF) that includes knowledge of the national response plan and state and local disaster response plans D. Designing an all-hazards preparedness plan that includes only those in the internal organization

C - Establishing an all-hazards preparedness plan to create an AHPTF and local, state, and national response plans is the first step. The AHPTF includes nurses who understand the critical processes for patient care and resource needs for this care.

The most common source of legal liability for nurse managers is a(n): A.medical malpractice suit. B.organizational nursing issue. C.tort. D.vicarious liability.

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

A primary care provider's orders indicated that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement "best" illustrates the nurse fulfilling the client advocate role? A. "The doctor has asked that you sign the consent form." B. "Do you have any questions about the procedure?" C. "What were you told about the procedure you are going to have?" D. "Remember that you can change your mind and cancel the procedure."

C - Rationale: This is the best answer because the nurse is assessing the client's level of knowledge as a result of the discussion with the primary care provider. Based on this assessment, the nurse may initiate other actions (call the primary care provider if the client has any questions)

When a client is confused, left alone with the side rails down, and the bed is in a high positions, the client falls and breaks a hip. What law has been broken? A. Assault B. Battery C. Negligence D. Civil Tort

C. Negligence Ensuring that the patient is safe in their environment is a part of the standards of basic care for all nurses to follow. Not performing these measures means they are not providing the standard of care for their patient. Negligence is conduct that falls below the standard of care. This patient's injury could have been prevented if the nurse had performed all of these safety measures prior to leaving the patient alone

The nurse is making telemetry unit assignments. Which patient assignment should be given to the licensed practical nurse? A. Client 2 days after having aortic valve surgery who needs a urinary catheter inserted due to inability to void. B. Client discharged after DVT who needs teaching on Lovenox administration. C. Client recently admitted to unit with suspected myocardial infarction. D. Client on a nitroglycerin infusion drip with titration prescription from MD.

Correct Answer: A Rationale 1: Inserting a urinary catheter is within the scope of practice for the LPN. This patient is predictable and stable. Rationale 2: The RN is responsible for initial teaching. The LPN is able to reinforce previous teaching. Rationale 3: This patient requires frequent clinical assessment and judgment due to the potential MI. Rationale 4: Nitroglycerin drips/titrations are complex and would be best suited for an RN

Which statement represents a situation is which delegation is ineffective or inappropriate? A. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms. B. The RN delegates administration of oral medications for a group of clients to the LPN. C. The LPN directs the unlicensed assistant to report vital sign changes on a post-operative client to the RN. D. The nurse manager asks the RN to act as chairperson for todays unit council meeting since the charge nurse went home sick.

Correct Answer: A Rationale 1: The RN is the only caregiver legally responsible for assessing clients. Thus, the RN cannot delegate this to the LPN, and this is an example of overdelegation. Rationale 2: It is within the LPNs scope of practice to administer oral medications. Rationale 3: The LPN can delegate tasks to the unlicensed assistant. Reporting vital sign changes to the RN is within the scope of an unlicensed assistant. Rationale 4: The nurse manager can delegate to the RN. An RN is a logical substitute for the charge nurse in this situation

The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? • A. Observe how well the patient performs pursed-lip breathing. • B. Plan a nursing care regimen that gradually increases activity intolerance. • C. Assist the patient with basic activities of daily living. • D. Consult with the physical therapy department about reconditioning exercises

Correct Answer: A. Observe how well the patient performs pursed-lip breathing. • ◦Option A: Experienced LPNs/LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. • ◦Options B and D: Planning and consulting require additional education and skills, appropriate to an RN. • ◦Option C: Assisting patients with ADLs is more appropriately delegated to a nursing assistant.

The high-pressure alarm on a patient's ventilator goes off. When the nurse enters the room to assess the patient who has ARDS, the oxygen saturation monitor reads 87% and the patient is struggling to sit up. Which action should the nurse take next? A. Reassure the patient that the ventilator will do the work of breathing for him. B. Manually ventilate the patient while assessing possible reasons for the high-pressure alarm. C. Increase the fraction of inspired oxygen on the ventilator to 100% in preparation for endotracheal suctioning. D. Insert an oral airway to prevent the patient from biting on the endotracheal tube.

Correct Answer: B Option B: Manual ventilation of the patient will allow you to deliver a FiO2 of 100% to the patient while you attempt to determine the cause of the high pressure alarm.

The client's nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to fluid management should be delegated to a UAP? • A. Administering IV fluids as prescribed by the physician • B. Providing straws and offering fluids between meals • C. Developing a plan for added fluid intake over 24 hours • D. Teaching family members to assist the client with fluid intake

Correct Answer: B • Rationale: UAPs can reinforce additional fluid intake once it is part of the care plan. Administering IV fluids, developing plans, and teaching families require additional education and skills that are within the scope of practice of an RN.

A client who has a hemoglobin of 6 gm/dL (60 mmol/L) is refusing blood because of religious reasons. What is the most appropriate action by the nurse? A. Call the chaplain to convince the client to receive the blood transfusion. B. Discuss the case with coworkers. C. Notify the primary healthcare provider of the client's refusal of blood products. D. Explain to the client that they will die if they refuse the blood transfusion.

Correct Answer: C Rationale: The nurse serves as an advocate for the client to uphold their wishes. Synthetic blood products are available but must be prescribed by the primary healthcare provider. Therefore the primary healthcare provider needs to be notified of the client's refusal for blood so alternatives can be considered. The chaplain's role is to offer support, not to convince the client to go against beliefs. It is a Health Insurance Portability and Accountability Act (HIPAA) (Canada: Personal Health Information Protection Act [PHIPA]) violation to discuss the case with coworkers unless they are involved in the care of the client. The nurse should not use threats or fear to coerce the client.

The nurse has just received report on four patients. Which patient should the nurse assess first? A. A postoperative cholecystectomy patient who is complaining of pain but received an IM injection of Morphine 5 minutes ago. B. A postoperative appendectomy patient who will be discharged in the next few hours. C. A patient with asthma who had difficulty breathing during the prior shift. D. An elderly patient with diabetes who is on the bedpan.

Correct Answer: C Airway, breathing & circulation must always be the priority. In this case, all other patients are stable and this patient may require a breathing treatment or another type of intervention to address their breathing difficulties. If this is not addressed, the patient could deteriorate further and a condition or code may need to be called.

A nurse is caring for a client who has wrist restraints applied. Which nursing intervention would receive highest priority regarding the wrist restraints? A. Providing range-of-motion exercises to the wrists B. Removing the restraints periodically per agency guidelines C. Applying lotion to the skin under the restraints D. Assessing color, sensation, and pulses distal to the restraint

Correct Answer: D Assessing color, sensation, and pulses distal to the restraint determines the presence of neurovascular compromise that is associated with the use of restraints. All of the other interventions should be implemented, but option D is the priority.

The nurse has received the client assignment for the day. Which client should the nurse care for first? A. The client receiving chemotherapy who is on day 3 of a 5-day regimen and has question about nutrition. B. The client receiving external radiation who has complaints of dryness and itching skin at the treatment area. C. The client who had a radical mastectomy 36 hours ago and is complaining of tightness and pulling at the incision site. D. The client admitted with the medical diagnosis of neutropenia who is afebrile and is complaining of pain with urination.

Correct Answer: D- The client admitted with the medical diagnosis of neutropenia who is afebrile and is complaining of pain with urination. The client is neutropenic, having lost their primary defense against infections becoming susceptible to bacterial infections. Painful urination is an indication of a urinary tract infection.

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

Correct answer: B - Management of hypoglycemia depends on the severity of the reaction. Incorrect: A: 50% dextrose is used to treat severe hypoglycemia, particularly in the unconscious client. C: A blood glucose test should be performed first as soon as manifestations begin. If a meter is not available, it is the next safest way to treat the hypoglycemia. D: Subcutaneous glucagon hydrochloride is also used to treat severe hypoglycemia.

While caring for the postoperative client following a total laryngectomy with radical neck dissection, the nurse observes that the client is restless and has a respiratory rate of 28 BPM. Which action is the nurse's priority? 1. Suction the client's laryngectomy tube 2. Apply oxygen by mask at 4 liters per minute 3. Elevate the head of the client's bed to 45 degrees 4. Assess the client's oxygen saturation level

D Assess the client's oxygen saturation level ● 1. Suction the client's laryngectomy tube - this could disturb the client's healing process and cause harm ● 2. Apply oxygen by mask at 4 liters per minute - if unnecessary, it could harm ABG's ● 3. Elevate the head of the client's bed to 45 degrees - this could disturb the client's healing process and cause harm ● 4. Assess the client's oxygen saturation levels - RN needs to assess before doing anything in order to prevent harm

An emergency department (ED) charge nurse prepares to receive clients from a mass casualty within the community. What is the role of this nurse during the event? a. Ask ED staff to discharge clients from the medical-surgical units in order to make room for critically injured victims. b. Call additional medical-surgical and critical care nursing staff to come to the hospital to assist when victims are brought in. c. Inform the incident commander at the mass casualty scene about how many victims may be handled by the ED. d. Direct medical-surgical and critical care nurses to assist with clients currently in the ED while emergency staff prepare to receive the mass casualty victims.

D Rationale: The ED charge nurse should direct additional nursing staff to help care for current ED clients while the ED staff prepares to receive mass casualty victims; however, they should not be assigned to the most critically ill or injured clients. The house supervisor and unit directors would collaborate to discharge stable clients. The hospital incident commander is responsible for mobilizing resources and would have the responsibility for calling in staff. The medical command physician would be the person best able to communicate with on-scene personnel regarding the ability to take more clients.

1. People are knowledgeable about natural disasters within their local regions; however, many have not had to consider the devastation that can be caused by terreorism such as radiological exposures, nuclear blasts, conventional bombings, or agricultural contamination. Identify the correct statement. A. A chemical disaster is an incident involving a natural or deliberate outbreak of a pathogen affecting large numbers of adults and children. B. A biological disaster is a catastrophic event caused by the use of weapons such as guns, bombs, missiles, and grenades. C. A radiological/nuclear disaster is a foreseen and often sudden event with radioactive materials that causes great damage, destruction, and human suffering. D. A cyber disaster is a catastrophic event affecting large numbers of people and lasting more than a few hours that impacts the ability to use information technology.

D - A. A chemical disaster is an unintentional or deliberate release of poisonous vapors, liquids, or solids that have a toxic effect on people, plants, and animals. B. A biological disaster includes disease epidemics and insect/animal plaques or an incident occurring from deliberate or unintentional release of biological materials that adversely affect health to those exposed and is not a catastrophic event caused by the use of weapons such as guns, bombs, missiles, and grenades. C. A radiological/nuclear disaster may be an intentional (foreseen) by terrorists or an unintentional (unforeseen) accident within a facility or with a vehicle transporting radioactive materials that expose a region. The incident is often a sudden event that causes human suffering D. A cyber disaster is a catastrophic event affecting large numbers of people and lasting more than a few hours that impacts the ability to use information technology

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

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

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

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

A client was brought to the emergency department after suffering a closed head injury and lacerations around the face due to a hit-run accident. The client is unconscious and has a minimal response to noxious stimuli. Which of the following assessment findings if observed after few hours, should be reported to the physician immediately? A. Drainage of a clear fluid from the clients nose B. Withdrawal of the client in response to painful stimuli C. Bruises and minimal edema of the eyelids D. Bleeding around the lacerations

The answer is: A. Drainage of a clear fluid from the client's nose Option A is the correct answer because clear drainage from the client's nose indicates that there is a leakage of CSF and should be reported to the physician immediately. Option B (Withdrawal of the client in response to painful stimuli) could indicate that his condition is improving. Option C (Bruises and minimal edema of the eyelids) and options D (Bleeding around the lacerations) are expected when lacerations on the face are present.

A nurse receives report and starts making her plan for the day. Which patient should the nurse see first? A. 90 year old patient with resolving aspiration pneumonia complaining of SOB. B. 60 year old bilateral AKA patient complaining of pain in the legs. C. 35 year old 2 days post op from a colostomy with no stool excretion. D. 44 year old patient on a PCA pump who has reached lock out now showing respirations of 5 breaths per minute

correct answer: D - this patient has reached lockout on the PCA pump and is experiencing respiratory depression and must be evaluated immediately. Incorrect: A - the patient's aspiration pneumonia is resolving some SOB is expected B - this is phantom limb pain and relatively common in AKA pts C - since the colon is the last part of the GI tract stool can be expected as late as 4 days post op

what is fidelity?

Keeping ones promises/commitments; •The principle requiring us to act in ways that are trustworthy

what is an advocate?

a person who acts on behalf of another person; •Supporting or promoting the interests of others or of a cause greater than ourselves

what is libel?

written defamation of character

You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP? • A. Assisting the patient with oral hygiene • B. Observing the patient's response to feedings • C. Facilitating expression of grief or anxiety • D. Initiating daily weights

• Correct Answer: A Oral hygiene is within the scope of duties of the UAP. • It is the responsibility of the nurse to observe response to treatments and to help the patient deal with loss or anxiety. The UAP can be directed to weigh the patient but should not be expected to know when to initiate that measurement.

The charge nurse handed out daily assignments to the nurse, which patient should be seen first? A.) A patient who recently had abdominal surgery complaining of right flank pain. B.) A patients whose blood pressure is 90/70. C.) A patient who had circumoral burns who is now complaining of shortness of breath. D.) A patient who is on antihypertensives who is complaining of dizziness

Answer: C. The airway is compromised from the circumoral burns and should be seen immediately to prevent apnea.

The role of the _____ is to provide leadership and direction for all aspects of nursing services with a focus on integrating the system and building a culture. A.nurse manager B.care provider C.nurse executive senior leader

Answer: D The nurse executive's role and functions concentrate on long-term administration of an institution or program that delivers nursing services, focusing on integrating the system and building a culture

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

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

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. Management is more important than leadership.

B

The nurse puts a restraint jacket on a patient without the patient's permission and without a physician's order. The nurse could be found guilty of: A.Assault B.Battery C.Invasion of privacy D.An unintentional tort

B Rationale: Battery is the physical harm of a person. Assault is a threat to a patient. Invasion of privacy would not be applicable in this situation. An unintentional tort is failing to act responsibility (negligence).

People are knowledgeable about natural disasters within their local regions; however, many have not had to consider the devastation that can be caused by terrorism such as radiological exposures, nuclear blasts, conventional bombings, or agricultural contamination. Identify the correct statement. 1. A chemical disaster is an incident involving a natural or deliberate outbreak of a pathogen affecting large numbers of adults and children. 2. A biological disaster is a catastrophic event caused by the use of weapons such as guns, bombs, missiles, and grenades. 3. A cyber disaster is a catastrophic event affecting large numbers of people and lasting more than a few hours that impacts the ability to use information technology 4. A radiological/nuclear disaster is a foreseen and often sudden event with radioactive materials that causes great damage, destruction, and human suffering

3 Rationale: A cyber disaster is a catastrophic event affecting large numbers of people and lasting more than a few hours that impacts the ability to use information technology A chemical disaster is an unintentional or deliberate release of poisonous vapors/liquids A biological disaster includes disease epidemics or an incident occurring from deliberate or unintentional release of biological materials A radiological/nuclear disaster may be an intentional (foreseen) by terrorists or an unintentional (unforeseen) accident within a facility or with a vehicle transporting radioactive materials that expose a region

the nurse has just assisted a client back to bed after a fall. The nurse and health care provider have assessed the client and have determined that the client is not injured. After completing the incident report, the nurse should implement which action net? a. Reassess the client b. Conduct a staff meeting to describe the fall c. Document in the nurse's notes that an incident report was completed. d. Contact the nursing supervisor to update information regarding the fall

A Reassess the patient Rationale ~ After a client's fall, the nurse must frequently reassess the client because potential complications do not always appear immediately after the fall. The client's fall should be treated as private information and shared on a "need to know" basis. Communication regarding the event should involve only the individuals participating in the client's care. An incident report is a problem-solving document; however, its completion is not documented in the nurse's notes. If the nursing supervisor has been made aware of the incident, the supervisor will contact the nurse if status update is necessary

The RN is planning assignments for the day. What is the most appropriate assignment that the RN can delegate to the UAP? A. A client requiring colostomy irrigation B. A client requiring continuous tube feedings initiated C. A client requiring a urine specimen collection D. A client with difficulty swallowing both foods and liquids

Answer is C. The most appropriate assignment for the UAP would be the client needing urine specimen collections. Colostomy irrigations and tube feedings are invasive procedures - so not performed by the UAP. The client who is have difficulty swallowing foods and liquids should not be given to the UAP because of the risk for aspiration.

Following a motor vehicle crash, a nurse stops and offers assistance. Which of the following actions are most appropriate? Select all that apply 1. The nurse needs to know the Good Samaritan Act for the state. 2. The nurse is not held liable unless there is gross negligence 3. After assessing the situation, the nurse can leave to obtain help. 4. The nurse can expect compensation for helping. 5. The nurse offers to help but cannot insist on helping

Answer: 1, 2, 5 Rationale: The nurse is subject to the limitations of state law and should be familiar with the Good Samaritan laws in the specific state. Gross negligence (conscious/voluntary recklessness) would be described by the individual state law. Unless there is another equally or more qualified person present, the nurse needs to stay until the injured person leaves. The nurse should ask someone else to call or go for additional help. The same client rights apply at the scene of an accident as well as those in the workplace, so they cannot insist on helping or expect compensation.

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

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

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

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

The nurse receives report on the medical/surgical unit. Which client should the nurse see first? a. a client with an IV of NS at 125/hr complaining of slight swelling at the insertion site b. client 3 days post-op total knee replacement complaining of right calf pain with movement c. client with a respiratory rate of 24 and an O2 sat of 94% on room air d. a client 12 hours after a hysterectomy reporting nausea

B. Assessment for possible DVT takes priority and should be reported to the physician. It could evolve to an embolism resulting in stroke, heart attack, or pulmonary embolism. Next - Assess site for client's comfort and prevent complications associated with IV infusion (client A), respiratory rate of client C is within normal range, give client D an antiemetic but is not priority.

what is negligence and unintentional negligence?

Improper or unethical conduct or unreasonable lack of skill by someone in a professional or official position; The negligent or unskilled performance of duties when professional skills are required; Violation of the professional standard of care that results in injury to the patient - Negligent conduct by the nurse places a patient at risk for harm Someone is negligent if they unintentionally cause injury to someone in a situation where a "reasonable" person would have been aware of their actions enough to not cause harm

The nurse is assigned to telephone triage. A client called who was stung by a honeybee and is asking for help. The client reports pain and localized swelling but has no respiratory distress or other symptoms of anaphylactic shock. What is the appropriate initial action that the nurse should direct the client to perform? A. Removing the stinger by scraping it B. Applying a cold compress C. Taking an oral antihistamine D. Calling 911

The answer is A: Removing the stinger by scraping it. Option A is the correct answer because the stinger will continue to release venom into the skin, and so removing the stinger should be the first action that the nurse should direct to the client. Options B (cold compress) and option C (antihistamine) would be steps to take following the removal of the stinger. Option D (call 911) would be chosen if the patient was experiencing more severe symptoms.

A catastrophic disaster has occurred 5 miles from the hospital you are working in. The hospital's disaster plan is activated and the wounded are brought to the hospital. You're helping triage the survivors. One of the wounded is able to walk around and has minor lacerations on the arms, hands, chest, and legs. You would place what color tag on this survivor? A. Red B. Yellow C. Green D. Black

The answer is C: Green Green tags are for patients who have MINOR injuries. If the patient can walk around they are tagged as green. Sometimes they are referred to as the "walking wounded".

You're working as a triage nurse during a disaster situation. Based on the triage color code tags placed on each of the wounded, which tag color represents the wounded who have the highest priority of being treated first? A. Green B. Yellow C. Red D. Black

The answer is C: Red The red tag indicates the patient must be seen first because they have life-threatening injuries, but could survive if treated quickly. The patient is still alive but there is a severe alteration in their breathing, circulation, or mental status that requires immediate medical attention.

The resources for nurse executives, nurse leaders, or other nurse representatives would include some of the following references, but where should the managers begin to access knowledge about planning for disasters? A. Agency for Healthcare Research and Quality (AHRQ) B. American Hospital Association (AHA) C. Centers for Disease Control and Prevention (CDC) D. Federal Emergency Management Association (FEMA)

The answer is D: Federal Emergency Management Association (FEMA) Nurse leaders should start with FEMA resources to collaborate with the communities needs. FEMA primary focuses on disaster and emergency preparedness and how hospitals should respond in these incidents. Answers A, B, and C all provide areas of information regarding emergency preparedness but is not the primary focus.