Leadership MidTerm Claud's

14. The nurse-manager implements new processes to decrease the incidence of central I.V. line infection. What is the best indicator that the measures have resulted in improved outcomes?

-Retrospective chart audits for infection rate show improvement in clients with central I.V. lines

39.A nurse calls a physician and after identifying herself and the patient, the nurse informs the physician that the patient is vomiting and complaining of abdominal pain. Which component of SBAR communication is being used in this situation?

Situation

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

"Native"

84. A novice nurse is placed in charge just after orientation ends. Which statement by the novice nurse would ensure a smooth delegation experience when delegating to an experienced staff member?

"You have patients in rooms 5 through 10 and I will administer all IV medications. I will let you know if I have to adjust. If you see you need help let me know."

5. An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that:

- he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN.

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

-Circumstance

19. According to Kramer, nurses in the shock phase should ask themselves:

-"What changes can I make to make me feel good about the choice to become a nurse?

47. A nurse is planning to witness the signature on consent forms for multiple clients being prepared for surgery. Which clients are legally able to sign a consent form giving their consent for surgery? Select all that apply.

-16 yr old married/C-section -88 yr old -59 German -30 with antibiotic

51. Which client is most appropriate for an RN to delegate to a CNA?

-A client who is 3 days post-abdominal surgery with decreased breath sounds

13. Which of the following occurrences would be classified as a sentinel event?

-A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin.

9. A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of the delegatee?

-Actually observe the delegatee perform the assigned task.

12. Which action can the nurse be legally liable for?

-Administering cephalosporin when the client has an allergy to penicillin

A nurse learns in orientation that an incident report does not "blame" anyone but concisely documents the events leading up to an occurrence. Which events would warrant completion of an incident report? (select all that apply)

-An intravenous antibiotic given preoperatively does not infuse because of a faulty pump -The nurse is unable to carry out orders written by the specialist because of illegibility. -A client falls while in the shower, although she was told not to get up alone. -The registered nurse is not available to complete the preoperative checklist.

17. An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high risk delegation?

-An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's Disease to ambulate a short distance in the hallway.

90. A nurse is caring for multiple clients on a hospital nursing unit. Which actions should the nurse plan to delegate to an unlicensed ancillary personnel (UAP)?

-Applying a warm compress to a client's arm to enhance vein distention -Reminding a client to use an incentive spirometer (IS) every 1 to 2 hours while awake -Transferring a client from the bed to a chair prior to a meal

54. Stacy is a unit manager in the medical-surgical unit. She is not satisfied with the way things are going in the unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. She decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Stacy?

-Call for a staff meeting to identify issues and trends from the staff.

16. Which of the following would not be considered a violation of HIPAA?

-Discussing the client's condition on the telephone with a family member who has provided the client information code

65. Empathy is the ability to feel sorry for another, and allows the nurse to be emotionally immersed in the situation.

-FALSE

23. According to the National Council of State Boards of Nursing, nurses can positively use electronic media to share workplace experiences, particularly those that are emotional or challenging. Nurses must be very carful not to release any patient information (including protected health information) via social media. Which of the following can be use as identifying information?

-Facility name and room number - geographical location and diagnosis -zip code and initials.

58. An RN observes the hand hygiene routine of a nursing assistant. Additional teaching will be needed if the RN observes that:

-Hands were rubbed together for 10 seconds

45. 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 action first?

-Identify tasks that can be performed safely in the ICU

26. The charge nurse is planning assignments for the nursing staff. One of the staff nurses is pregnant. Which client would not be appropriate to assign to this nurse?

-Infant with respiratory syncytial virus receiving ribavirin

43. An RN observes another RN speaking harshly and reprimanding a client for being incontinent. What action should be taken?

-Intervene and tell the RN that a report on client abuse will be made

67. An RN would be judged negligent if which event occurred during client care?

-Making a medication error resulting in injury

10. The nurse is involved in a legal case against the hospital. Which judgment error by the nurse would be considered most damaging?

-Making illegal changes in the chart

31. An elderly client has been admitted to the medical-surgical unit from the postanesthesia care unit. The client falls out of bed while the bed is in high position, with side rails down, and the client unattended. Which charge is the most appropriate for the nurse's actions?

-Negligence

35. The International Congress of Nursing (1985) declared the term nurse to represent:

-Only registered nurses.

32. A new graduate has worked on a busy unit for 6 months since graduating from nursing school. She tells a friend, "I've never been so upset in all my life! The care that some of the staff give our patients is outrageously bad. There's practically no attention to the principles of asepsis the way I learned them! The staff tells me that we have to cut corners if we're going to get all the work done. I can't stand it!" What phase of reality shock is this graduate experiencing?

-Shock and rejection

30. The use of direct eye contact is a Western value and should be taken into consideration to provide culturally competent care.

-TRUE

46. Entering a client's room to get a neonate for an examination by the physician, the nurse on the maternity unit sees the client holding the crying neonate and slapping his face. Which actions is most appropriate?

-Take the neonate to the nursery, tell the physician so he can examine the neonate for injuries, and notify social services

4. Which of the following would the nurse identify as an indication that the client understands the informed consent document?

-The client can give a return verbal explanation of the informed consent document

28. Which identifies accurate nursing documentation notations? Select all that apply.

-The client slept through the night -Abdominal wound dressing is dry and intact without drainage -The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema

27.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 Fto bed, notifies the health care provider of the incident, and completes an incident report. Which statement should the nurse document on the incident report?

-The client was found lying on the floor

59. A nursing manager in the PreOp department has been concerned about the amount if infiltrated IVs that are occurring in the operating room. She investigated best practice on IV placement, analyzed her hospital's data to determine which patients were at highest risk for IV infiltration, and then developed a plan together with the department staff. The department was approved for a new IV securement device to prevent infiltration. What is the next step in the nursing process?

-implementation

55. Several nurses working on a medical unit are unhappy about the use of multiple protocols that place increased demands on nurses time and seemingly increase the number of errors. Which statements, if made by a nursing staff member, suggest a unit culture characteristic of transformational leadership? Select all that apply.

-When I discussed this concern with our nurse manager, the nurse manager suggested that I place this on the weekly staff meeting agenda so we can get staff input." -"We should discuss the use of protocols with our nurse educator to see if there are some strategies we could use to help us better implement the protocols."

25. During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting:

-active listening.

11. A nurse hung an intravenous antibiotic to infuse but failed to check patency of the IV resulting in infiltration causing pain and redness but no tissue damage. This situation would be a(n):

-adverse event.

38. Patient confidentiality can best be assured by:

-all of the above

49. An explosion just occurred at the local factory and hundreds of employees have varying degree of injuries. Which type of nursing leadership is most effective in this situation?

-autocratic

34. A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in place. The nurse respects this decision in keeping with the principle of:

-autonomy

42. Positive communication techniques include all of the following except:

-avoiding eye contact

60. The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of:

-direction of communication.

20. When the client is unable to make medical decisions for himself or herself, authorization that allows another person to make these decisions is called:

-durable power of attorney

24. A nurse in an acute care facility helps patients understand how to prevent diabetic neuropathies. This nurse is functioning in the role of:

-educator.

56.Effective listening is the process of working toward fully being heard. Means of accomplishing effective listening include all of the following except:

-evaluating comments

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

-mentoring.

36. A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer. The surgeon removed the left kidney. Medicare will no longer pay for preventable medical errors known as ____________.

-never events

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

-preconceived idea

37. The nurse is unsure whether it is appropriate to delegate I.V. site observation to the licensed practical nurse. Which is the ultimate authority to consult to make this decision?

-state nurse practice act

53. During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that:

-the nurse practice act and state regulations related to delegation override the organizations's policies.

22. The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to:

-the registered nurse (RN).

29. The surgical team arrives in the operating room and one member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is known as:

-time out

50. Health care is one of the major stories in newspaper and television and a group of nurses are interested in how the economy impacts their nursing practice. The group critiques the relationship between contemporary economic trends and professional nursing practice and finds:

-with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices.

41. One of the hospital-aquired conditions that Medicare will not pay for is falls. The nursing staff is responsible for fall prevention. The best predictor of the likelihood of a client falling while hospitalized is:

A history of falling before admission

8. A nurse is assigned to a unit where 95% of all patients required total care. Most days the assistive personnel are able to complete their assignments and provide high-quality care. A patient returning from a procedure was somehow "skipped" when daily baths were performed and requests that her care now be provided. The nurse discovers the bed is rumpled and damp. The RN joins with some other staff to bathe the patient, change the bed, and help make the patient comfortable. These staff members are demonstrating:

Altruism.

82. To prevent a catheter-associated bloodstream infection, when would hand washing be required? Select all that apply.

Before and after palpating around the site Before and after a dressing change Before and after insertion of the catheter

88. A nursing assistant (NA) employed at a hospital is working under the direction of a nurse. The NA is in the thrid year of a registered nurse program and has been administering medications and performing procedures during clinical experience as a student nurse. Which actions describe appropriate delegation to the NA by the nurse? Select all that apply.

Asks the NA to write the amounts a client has eaten on the menu and post if confidentially outside the client's door Ask the NA to secure a wheelchair and take a client for a chest x-ray

86. Most states have reporting laws that require health care workers to report certain situations and behavior to authorities. Which is not usually a reportable condition?

Attempted suicide

6. A client is prepared for a bronchoscopic examination. The RN gives an IV sedative. Which activity could be delegated to an LPN/LVN?

Checking the client's blood pressure and pulse

74. The nurse-manager notes an unacceptable rate of falls on the unit. Hourly rounds by nursing staff are initiated. What is the best method to determine that the change has made a difference?

Comparing fall rates after the rounds are initiated

87. A transformational leader will win people over to a new idea by:

Making them think the idea was theirs in the first place.

70. What is the nurse's best approach to avoid claims of negligence?

Competent practice of nursing

3. A staff RN and nurse's aide are caring for six clients. The RN delegates the following assignments to the nurse's aide: vital signs, baths, and intake and output for all clients. What is the RNs accountability for the delegated work?

Define client parameters to the nurse's aide that must be reported to the RN

89. While providing care to a 26-year-old, married, female client, a nurse notes multiple ecchymotic areas on her arms and trunk. The color of the ecchymotic areas range from blue to purple to yellow. When asked by the nurse how she got these bruises, the client responds, "Oh, I tripped." How should the nurse respond? Select all that apply.

Document the client's statement and injuries Ask about current administration of antiplatelet medications

91. While performing an assessment of a 75-year-old client in the emergency department, a nurse notes many ecchymotic area in various stages of healing on his body. Which action should the nurse perform first?

Document the findings

85. Which statements concerning licensure as a registered nurse are correct? (Select all that apply.)

Each nurse practice act describes requirement for initial licensure Candidates for licensure must present proof of graduation as required by the state.

44. A nurse is respected by his peers for his clinical skills and effective interpersonal relationships. He has studied diabetic-patient educational needs and consults with several units. What type of power does this nurse possess?

Expert

81. A cardiac rehabilitation clinic hired a nurse practitioner to manage the clinic. The nurse practitioner had recently obtained critical care certification. What type of power does the nurse practitioner have?

Expert power

77. A registered nurse is on break and checking emails. One email contains a picture of a celebrity who is a patient in the hospital, and on the same floor, where the nurse works. Included with the photo is a message, "check out my Facebook," which contains additional photographs of the patient. The nurse immediately deletes the picture to prevent having to report the "friend" to supervisors. Based on the action of the nurse who received the message, which statement is correct?

Failing to report receiving the message places the nurse at risk for discipline.

69. A new graduate of less than a year describes her perception of her staff nurse position: "It feels great to be a nurse! In fact, it's a snap! I can hardly believe there's no instructor looking over my shoulder." What phase of reality shock is the graduate experiencing?

Honeymoon

71. During orientation the novice nurse sits in orientation and "virtually spends" the first few paychecks, envisioning the money going into her bank account. In her dream state she smiles and knows the pain of nursing school was worth it. Which phase of reality shock is the nurse experiencing?

Honeymoon

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

Shock or rejection

48. A nurse receives a verbal order which was understood to be for Avert 6. The physician actually ordered Antivert 25 mg daily. The patient is also taking Prozac®/Sarafem® (fluoxetine), which when taken with Avert can be life threatening. The patient's condition stabilizes and an interdisciplinary team meets to perform a root cause analysis hoping to learn from the mistake. The nurse was part of the group formed to help identify ways the system could be changed to prevent similar errors. This situation describes:

Just culture

57. The nurse in the long-term care setting decides that the nursing assistants should be given autonomy to plan their own days without her telling them what to do. This nurse is using which management style?

Laissez faire

83. Professional responses to verbal conflict include all of the following except:

Maintain a closed body stance with your arms folded across your chest

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

PASSIVE

62. 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 next?

Reassess the client

52. During which stage of Levin's Change Theory is support given so that change continues?

Refreeze

2. A client has a gastrostomy tube in place and needs assistance with personal care, toileting, and feeding. When considering delegation of aspects of the client's care, which components of delegation should a nurse consider? Select all that apply.

Right person, task, circumstance, supervision, direction/communication

79. When delegating care, the RN assigns one nurse to care for a patient with shingles and a different nurse to care for a patient with human immunodeficiency virus/acquired immunodeficiency disease syndrome (HIV/AIDS). This represents which category of nursing care?

Safe and effective care environment

72. The novice nurse arrives on the nursing unit, is introduced to the staff, is assigned a preceptor, and is asked to participate in the next staff meeting. This introduction into nursing is appropriately termed:

Socialization

75. The physician asks the nurse to give a client a medication that the nurse knows the client is allergic to. When the nurse tries to point this out to the physician, the physician threatens to tell the nurse's supervisor. What is the best response?

Suggest a meeting between the nurse, supervisor, and physician

68. What is essential for an informed consent?

The client has been informed of the facts, consequences, and implications of the scheduled procedure

40. Which circumstance would keep the nurse from being liable for professional negligence when the nurse made an error when administering a drug?

The excess drug administered did not cause any client harm

73. Nurses have been terminated from their position or had disciplinary action taken against their license because they have posted pictures of patients on a social media site.

True

63. A patient who is deciding whether to have chemotherapy asks the nurse if many side effects would likely accompany this treatment. The nurse who knows that side effects are very common but does not want the patient to dread the treatments responds by saying, "I seriously doubt it." The nurse has violated which ethical principle?

Veracity

80. A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by supporting a soldier's head is an artistic representation of nurses who served in which war?

Vietnam War

78. A nurse has been asked to serve as the charge nurse on the evening shift. The agency where the nurse is employed is considering unionization. If the charge nurse position is accepted, this nurse:

can be represented by the union because charge nurses are not considered part of the management team.

66. A nurse who functions in the role of team leader can be held negligent for matters involving:

delegation of client care tasks.

18. In order to be able to use nonjudgmental acceptance as a helping technique the nurse must:

develop an awareness for different cultures

76. A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient's condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under:

the Health Insurance Portability and Accountability Act.