Leadership1

A nurse manager observes a newly licensed nurse and an assistive personnel (AP) arguing about the failure of the AP to restock unit supplies. The AP leaves the room. Which of the following is an appropriate statement at this time by the nurse manager to the newly licensed nurse?

" I would like for you to approach the AP to resolve the problem"

A charge nurse is orienting a newly licensed norse to the facility's policies regarding electronic medical records. Which of the following statements by the newly licensed nurse indicates an understanding of the instructions?

"After I finish with the printout of the assignment, I'll put it in the shredder receptacle"

A charge nurse is supervising the care of several clients. Which of the following actions requires intervention by the charge nurse?

A student nurse is photocopying his assigned client's diagnostic test results.

A charge nurse is managing conflict with a staff nurse who does not agree with the client care assignment. Which of the following statements is an example of using the conflict resolution strategy known as smoothing?

"You always complete your work on time and do a great job. I believe you can handle the assignment well."

A charge nurse is supervising the care of several clients. Which of the following actions requires intervention by the charge nurse?

A nurse is photocopying their assigned client's diagnostic test results. Rationale: Photocopying diagnostic test results is a breach of the client's confidentiality and privacy.

A nurse from a medical unit is asked to work on an orthopedic unit. The medical nurse has no orthopedic experience. Which of the following clients should be assigned to the medical nurse?

A client who had a right above-the-knee amputation 24 hours ago rationale: A nurse from a medical unit can care for this client because the surgical dressing is usually left in place for 48 to 72 hr, so the residual limb does not require special care at this time.

A nurse in the emergency department is performing triage for a group of clients following a motor vehicle crash. Which of the following clients should the nurse request the provider assess first?

A client who has arm contusions and manifests asymmetrical thoracic movement

A nurse is receiving report on four clients. Which of the following clients should the nurse plan to assess first?

A client with a potassium level of 6.5mEq/L

A nurse is caring for four clients. Which of the following assessment findings is the priority?

An adult client who has had a femur fracture reports feeling short of breath

The nurse manager is planning daily work and activities for the unit. Which of the following actions is the nurse manager's priority?

Assign client care to staff

A charge nurse is delegating tasks on a nursing unit that is short staffed. A client has a prescription for a wound irrigation twice a day. Which of the following actions should the charge nurse take?

Assign the procedure to a licensed practical nurse (LPN)

A client is considering having a tubal ligation, and she tells the nurse that she is uncertain if this is the right thing to do. Which of the following is an appropriate response by the nurse?

Discuss the client's feelings about the procedure. Rationale: The nurse should encourage the client to discuss any feelings or concerns about the procedure.

A nurse is caring for a client who has a potassium level of 3.2 mEq/L. The nurse has been paging the provider for 1 hour to attempt to report the potassium level. Which of the following interventions should the nurse take next?

Notify the nursing supervisor

A nurse manager is auditing charts and identifies an increase in ventilator-associated pneumonia (VAP). Which of the following actions should the nurse manager take?

Notify the quality improvement team

A nurse assumes care of a client following change-of-shift report and notes that the client's morning laboratory results have not been received. Which of the following actions should the nurse take?

Obtain a capillary blood glucose reading

A nurse is caring for four clients. Which of the following tasks can the nurse assign to an assistive personnel (AP)?

Perform chest compressions on a client who is in cardiac arrest

A nurse manager is planning an in-service for a group of nurses about caring following stem cell transplants. Which of the following instructions should the nurse manager include in the teaching?

Place clients in positive-pressure airflow rooms rationale: The nurse should place a client who requires protective environment precautions following a stem cell transplant in a private, positive-pressure airflow room. The room air is filtered through a HEPA filter and the airflow rate is set at more than 12 air exchanges each hour.

A nurse is reviewing a client's clinical pathway upon discharge following hip arthroplasty. Which of the following information can assist the nurse in evaluating the cost effectiveness of the care?

The length of the client's stay rationale: The client's clinical pathway is a standardized approach to assist the nurse to provide cost-effective client care and shorten the length of stay.

A nurse in an emergency department is admitting clients following an earthquake. The emergency disaster plan has been implemented due to the anticipated arrival of a large number of casualties. Which of the following clients should the nurse recommend the provider evaluate first?

a client who has a sucking chest wound. rationale: A client who has a sucking chest wound has an immediate threat to life and requires immediate intervention for survival; therefore, when using the survival approach to client care, the nurse should recommend the provider evaluate this client first. (the head injury will be dead)

A nurse is teaching an assistive personnel (AP) about caring for a client who has a do-not-resuscitate (DNR) order. Which of the following statements by the AP indicated an understanding of the teaching?

"I will call for the client's nurse to come to the room if I cannot detect the client's pulse."

A nurse is caring for a client who has breast cancer and is deciding between two treatment options. Which of the following statements should the nurse make?

"Lets talk about the benefits of each treatment"

A nurse is caring for a client who is hospitalized and has expressive aphasia. The client's family reports that the nurse failed to obtain written informed consent before inserting an indwelling urinary catheter. Which of the following responses should the nurse make?

"This is a procedure that does not require written informed consent." Rationale: The client does not need to sign an informed consent form for insertion of an indwelling urinary catheter. The client gives implied consent by complying with the procedure.

A nurse is teaching a client about advance directives. Which of the following statements by the client indicates an understanding of the teaching?

"This means I have outlined my wishes for medication treatment."

A charge nurse is discussing issues with a staff nurse. When evaluating statements by the staff nurse, the charge nurse should recognize that which of the following reflects an intrapersonal conflict?

"i'm not sure whether I want to apply for the unit manager's position or start a family this year"

A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that which of the following clients is the priority?

A client who has peripheral vascular disease and has an absent pulse in the right foot. rationale: When using the airway, breathing, circulation approach to client care, the nurse determines that the priority finding is an absent pulse, which indicates no blood flow to the extremity.

A nurse is planning discharge care for a client who has a stroke and now has left-sided weakness. Which of the following interventions should the nurse include in the plan of care?

Advise the client to install grab bars in her bathroom at home

A nurse manager is presenting an in-service about preventing readmission of clients due to complications following joint replacement surgery. Which of the following leadership tasks is the nurse performing?

Advocacy

A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take to verify the client gave informed consent?

Ask the client to explain the procedure that is being performed. Rationale: The nurse should ask the client to explain the procedure that is being performed. This allows the nurse to verify the client's understanding of the information provided by the provider prior to witnessing the client's signature on the consent form

A client on a general surgical unit tells a nurse that staff members are not answering his call light promptly. The client requests to be transferred to another unit. Which of the following actions should the nurse take first?

Ask the client to verbalize his expectations

A nurse is caring for a client who is terminally ill and receiving nutritional support. The client's adult children disagree about continuing nutritional support. The dilemma is referred to the ethics committee. Which of the following actions should the nurse expect the committee to take?

Assist in weighing the options involved in the decision. Rationale: Ethics committees are members of the interprofessional team who assist with problem solving related to ethical dilemmas. The ethics committee examines all of the facts and provides support for the clients and caregivers.

A nurse in a community health clinic is caring for four clients who each have a communicable disease. Which of the following conditions is considered a nationally notifiable infectious disease?

Chlamydia trachomatis

A nurse in a mental health unit is teaching a newly licensed nurse about client rights. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

Clients on a mental health unit can refuse their medication rationale: Regardless of the type of health care facility or admission status, clients maintain the right to refuse medication

A nurse on quality improvement team is implementing a plan to decrease the rate of pressure ulcers in a long-term care facility. Which of the following actions should the team take to evaluate the effectiveness of the plan?

Compare data from client's records regarding skin integrity with established criteria

A RN is working on the surgical unit when a client who has abdominal pain is admitted. Which of the following activities must be performed by the RN?

Completing the client's initial admission assessment

A charge nurse is leading a committee that is revising the policy for client discharge. After developing the initial plan, which of the following actions should the nurse take next?

Determine goals and objectives

An older adult client is being discharged with postoperative infection, requiring daily home IV antibiotics through a peripherally inserted central catheter (PICC) line. Which of the following actions should the case manager perform prior to discharge?

Ensure that home infusion therapy has been arranged

A facility has identified an increase in health care-associated urinary tract infections (UTIs) on the medical-surgical unit. A nurse is participating in quality improvement process to address this problem. Which of the following should be the first step in this process?

Establish best practice guidelines for reducing the incidence of UTIs

A charge nurse recognizes a trend in poor attendance at monthly staff meetings. To address this issue, which of the following actions should the charge nurse take first?

Explore the reasons that staff are not attending the meetings

A nurse is caring for a client who requests pain medication. The nurse fulfills a promise to return with the medication within 15 min. The nurse is demonstrating which of the following ethical principles?

Fidelity rationale: The nurse is demonstrating fidelity by returning to the client's room with the medication in a timely manner. Fidelity is an ethical principle in which the nurse's actions are taken to display loyalty and keep a promise made to the client.

A charge nurse observes that a staff nurse's behavior has changed over the past few weeks. Which of the following behaviors should the charge nurse identify as an indication that the staff nurse might be working while impaired?

Frequent use of restroom Rationale: Frequent use of the restroom can indicate that the nurse might be working while impaired. Other indications can include frequent errors, mood swings, inability to focus, and excessive wasting of controlled substances.

A charge nurse is observing a newly licensed nurse's use of time management skills. Which of the following actions by the newly licensed nurse indicates effective use of this skill?

Groups tasks that are in the same location rationale: The newly licensed nurse should group tasks that are in the same location to effectively use time. This prevents the nurse from going back and forth from one area to another. This action promotes effective time-management skills.

A nurse is planning the discharge of a newborn who requires apnea monitoring at home. To which of the following community agencies should the nurse anticipate referring the guardian of the newborn?

Home health Rationale: A home health agency can provide nurses who will visit the home and help the guardian learn necessary skills, as well as assess the progress of the infant.

An assistive personnel (AP) tells a charge nurse that it is unfair that they have to take care of all the clients who are incontinent. Which of the following responses should the charge nurse make?

I delegate tasks to personnel based on their job descriptions rationale: This response addresses the AP's concerns and provides clear information about the charge nurse's responsibility when delegating tasks.

A nurse in a mental health facility is teaching a newly licensed nurse about the use of mechanical restraints. Which of the following statements by the newly licensed nurse indicates understanding of the teaching?

I should request the provider to examine the client within 1 hour of applying mechanical restraints

A facility has been notified of a train derailment resulting in multiple clients experiencing life-threatening injuries. The external disaster plan has been activated. Which of the following is an appropriate action of the charge nurse on the PACU?

Identify stable clients for transfer to a surgical unit rationale: It is within the charge nurse's scope of practice to identify stable clients for transfer to a surgical unit. This action will enable the facility to do the most good for the greatest number of clients.

A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the following actions should the nurse plan to take?

Inform the assistive personnel of the client's weight-bearing status. rationale: Assistive personnel can assist clients with ambulation in most cases with appropriate delegation from the nurse. The nurse should inform the AP of postoperative prescriptions for weight-bearing as part of safe care delegation.

A nurse on a medical surgical unit has arrived late to work multiple times over the past several weeks. The nurse manager is planning to use progressive discipline to address this problem. Identify the sequence the nurse should follow.

Issue an informal verbal reprimand Give the nurse a formal written reprimand Suspend the nurse without pay Terminate the nurse's employment

A nurse in a long-term care facility is transferring a resident to an acute care facility. Which of the following information should the nurse include in the transfer paperwork?

List of current medications

A nurse is planning care for a group of clients on a medical-surgical unit. Which of the following tasks should the nurse delegate to an assistive personnel?

Measuring a client's hourly intake and output

A nurse is providing change-of-shift report on four clients. Which of the following statements would the nurse include in the report?

Miss Graves needs her pain reassessed within the half hour

A nurse is caring for a client who has cancer and vomits blood on the bed linens and the floor. Which of the following action should the nurse take to safely clean the environment?

Mop the floors with a bleach solution

A nurse is caring for a client who has osteoarthritis and reports difficulty buttoning her clothes. Which of the following referrals should the nurse recommend?

Occupational Therapy rationale: The nurse should recommend a referral to an occupational therapist for a client who has osteoarthritis and reports difficulty with ADLs, such as buttoning clothing. Occupational therapy can assist the client with exercises to help the client complete these tasks.

A charge nurse on a medical-surgical unit is planning care for a client who has dementia and is being admitted for surgery. Which of the following would promote safety when caring for this client?

Placing the client in a room near the nurses' station

A charge nurse is planning client care assignments for a unit. Which of the following tasks should the nurse assign to a licensed practical nurse (LPN)?

Provide an enteral feeding to a client who has Crohn's disease. Rationale: Administration of an enteral feeding is within the scope of practice of an LPN; therefore, it is appropriate for the charge nurse to assign this task to an LPN.

A nurse is reviewing safe use of a wheelchair with a group of assistive personnel. Which of the following should the nurse include?

Raise the footplates of the wheelchair before transferring the client rationale:The nurse should raise the footplates of the wheelchair before transferring the client to prevent injury.

A nurse on a medical-surgical unit is caring for a client transferred from another department. The nurse should verify that the client has given informed consent prior to which of the following procedures?

Receiving moderate sedation rationale: The nurse should verify that the client has given informed consent prior to receiving moderate sedation because this involves anesthesia.

An RN delegates the task of obtaining the blood pressure of a client who is 2 hours postoperative following a cholecystectomy to a licensed practical nurse (LPN). The LPN reports a blood pressure that is significantly higher than the client's previous reading. Which of the following actions should the RN take first?

Recheck the client's blood pressure

A nurse walks into the nurses' station and sees several staff members looking at the electronic medical record for a celebrity client on another unit. Which actions should the nurse take first?

Remind the staff members that this is a breach of confidentiality

A nurse notices a frayed cord attached to an infusion pump in a clients room. Which of the following actions should the nurse take?

Report the pump with the frayed cord to the maintenance department

A nurse at an urgent care clinic notices that a pain assessment is not being performed for all clients as required by policy. Which of the following actions should the nurse take?

Report this issue to the nurse manager

A nurse asks a newly hired assistive personnel (AP) to remove a client's indwelling urinary catheter. Which of the following actions should the nurse take to ensure the AP is qualified to perform this task?

Review the AP's skill competency checklist rationale:A review of the AP's checklist should validate that they have demonstrated the ability to safely perform the procedure.

A nurse is caring for a client who is experiencing adverse effects after receiving a new medication. Which of the following communication tools should the nurse use for management of this complication?

SBAR framework

A nurse manager confronts a nurse who has the smell of alcohol on her breath. After the nurse is sent home, which of the following actions should the nurse manager take?

Set up a formal meeting with the nurse within 24 hours

A nurse is serving on a committee that is considering the creation of a policy that will allow nurses to insert peripherally inserted central catheters in the intensive care unit. Which of the following resources should the nurse consult in planning for this policy?

State Nurse Practice Act (NPA) Rationale: The nurse should consult the NPA in this situation because the NPA defines the scope and boundaries of professional nursing practice. The NPA provides guidelines for developing standardized procedures within specific facilities where expanded nursing functions have been approved in collaboration with nurses, providers, and administration.

A nurse is delegating tasks for a group of clients to an assistive personnel (AP). Which of the following statements by the nurse provides the right direction of communication with the AP?

Tell me what time the client in Room 205 voids for the first time after his catheter is removed

A nurse is developing a plan of care for a school-age child whose family is homeless. Which of the following findings should the nurse identify as the priority

The child has red fissures at the corners of the mouth. Rationale: Using Maslow's hierarchy of needs, the nurse should determine that the priority finding is red fissures at the corners of the child's mouth. This can indicate a vitamin B deficiency, which is a physiological need.

A case manager is planning an interprofessional conference for a client who is 3 days postoperative following an open reduction and internal fixation of the right hip. Which of the following concerns is the priority for discussion at the conference?

The client refuses to attend physical therapy sessions. Rationale: The greatest risk to this client is postoperative complications due to immobility, such as atelectasis or pneumonia; therefore, the priority for discussion is the client's refusal to participate in physical therapy.

A charge nurse is observing a nurse perform a sterile dressing change for a client. Which of the following actions should the charge nurse identify as appropriate sterile technique?

The nurse places the sterile package with the top flap opening away from her.

An 18-year-old client in remission with rhabdomyosarcoma has just been diagnosed with metastasis to the bone. The client says that he does not want to have chemotherapy again. Which of the following statements is consistent with the client's rights?

The nurse states, "I can gather information about palliative care for you."

A nurse manager is reviewing the actions a staff nurse took when she observed smoke coming from a wastebasket in a client's room. The nurse manager should verify that the nurse acted appropriately when she performed which of the following actions first?

Transported the client to the hallway

A nurse is applying restraints to a client who is combative. Which of the following actions should the nurse take?

Use a quick release tie to secure the restraint

A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge nurse should expect the newly licensed nurse to take which of the following actions?

Wear an N95 respirator mask when in the client's room. Rationale: The nurse should wear an N95 respirator mask when caring for clients who have suspected pulmonary tuberculosis.

A home health nurse is making an initial visit to an older adult client who has COPD and is receiving oxygen. While assessing the home environment for safety, which of the following findings should the nurse recognize as increasing the client's risk for injury?

an office chair with wheels at the client's computer desk an oxygen tank standing on the floor next to the client's recliner a throw rug over vinyl flooring in the client's bathroom

A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take to verify the client gave informed consent?

ask the client to explain the procedure being performed

A nurse manager is teaching about confidentiality requirements to the staff. Which of the following staff comments indicates an understanding of the teaching?

change-of-shift report report can be given at the client's bedside rationale: Change-of-shift report is often given at the client's bedside to help protect the client's privacy. This allows the client to be involved with their care. The nurse should avoid giving report in public areas, such as in the hallway.

A nurse manager needs to address an increased rate of client medication errors. Which of the following strategies represents an authoritarian approach to managing this issue?

inform the staff of the penalties that can result from medication errors. rationale: The nurse manager is using penalties to promote behavior change; this is characteristic of authoritarian leadership.

A nurse is caring for a client who reports vomiting and diarrhea for the past 6 hr. The nurse should identify that which of the following assessments is the priority?

obtain client's serum potassium level rationale: Because vomiting and diarrhea contribute to the loss of potassium through body fluids, the greatest risk to this client is life-threatening cardiac dysrhythmias as a result of hypokalemia; therefore, the nurse should identify that the priority assessment is the client's serum potassium level.

A nurse is observing a newly licensed nurse perform a sterile dressing change on a client who has a central venous catheter. Which of the following actions should the newly licensed nurse take?

pick up the first sterile glove by grasping the folded cuff edge rationale: The nurse should pick up the first sterile glove by grasping the folded cuff edge, which is the palmar side, to prevent contamination of the outside of the glove.

A charge nurse is preparing to observe a newly licensed nurse perform a routine abdominal assessment. Which of the following actions should the charge nurse expect the newly licensed nurse to take?

place the client in a dorsal recumbent position for the examination rationale: To prepare the client for a routine abdominal assessment, the nurse should place the client in a dorsal recumbent or supine position and ensure that the client relaxes her abdominal muscles.

A nurse is receiving report from the assistive personnel (AP) assigned to the nurse's group of clients. Which of the following statements from the AP indicates the client the nurse should assess first?

the client who had an indwelling urinary catheter removed 8hr ago reports an inability to void rationale: Not voiding for 6 to 8 hr after indwelling urinary catheter removal indicates this client is at risk for urinary retention, which can cause a urinary tract infection. Overdistention of the bladder can cause damage to the mucosa. Therefore, the nurse should assess this client first and report findings to the provider.