Management of Care Practice Questions

A patient comes into the ER with COPD exacerbation and is having difficulty breathing. What action, if performed by the nurse, would be considered negligence? 1. The nurse raises the head of the bed to Semi-Fowler's position. 2. The nurse places the patient on 4L of O2. 3. The nurse gives the patient an 8 oz glass of water. 4. The nurse checks the pulse ox of the patient.

2. The nurse places the patient on 4L of O2. A patient with COPD should only receive low-flow oxygen- never more than 2L.

The charge nurse is making patient assignments and assigns the LPN to a patient who had a chest tube inserted 3 hours ago. Which of the following is correct? 1. This is correct delegation. 2. This patient should be assigned to a RN. 3. The LPN will require assistance from a RN for administering the medication by mouth. 4. The charge nurse of the unit should be notified.

2. This patient should be assigned to a RN. Patients with a chest tube require more monitoring and assessment and should therefore be assigned to a RN.

A 55-year-old male patient arrives at the ER with anterior epistaxis that has not resolved after an hour of applying pressure. Which of the following instructions, if given to the UAP by the nurse, would be considered CORRECT? 1. "Please have the patient lean forward while sitting upright." 2. "Have the patient apply direct vertical pressure." 3. "Have the patient blow their nose firmly." 4. "Give the patient a heat pack to use for comfort."

1. "Please have the patient lean forward while sitting upright." An anterior epistaxis is a nosebleed! Have the patient lean forward to prevent blood from entering the stomach, apply direct lateral pressure, avoid blowing their nose, and use ice or cold packs, not warm

The nurse works on a unit caring for chronic pain management patients. A UAP (unlicensed assistive personnel) is pulled from another unit to help out the busy floor. An hour into the shift, the UAP asks the nurse "What is with the patient in room five? He says he's in pain, but he's watching TV!" Which of the following is the nurse's BEST response? 1. "Tell me what you know about chronic pain management." 2. "You're right. I bet she just wants some pain medication for the high." 3. "When I feel sick, I am able to watch TV just fine." 4. "It is normal for a patient with chronic pain to appear normal rather than display typical signs like facial grimacing or inability to focus."

1. "Tell me what you know about chronic pain management." This respnonse assesses what the nurse's aide knows before teaching. On NCLEX, we never assume that a patient's perception of pain is false.

A 101-year-old patient with end stage renal disease is refusing to take her medications "because they don't work and I'm going to die soon anyway." Which of the following responses is most correct? 1. "You have the right to refuse any of your medications. Let's talk about what's been prescribed to you." 2. "Legally, you must take these medications. I'm sorry." 3. "You are quite feisty! But you have to take these medications or I'll be written up." 4. "The physician has ordered these medications, so I'm afraid they're mandatory."

1. "You have the right to refuse any of your medications. Let's talk about what's been prescribed to you." Patients have the legal right to refuse any medications or treatments. Encourage the patient to explain why she is refusing them.

The charge nurse is supervising the nursing care administered on a busy medical/surgical unit. Which of the following situations, if noticed, would require immediate intervention? 1. A UAP (unlicensed assistive personnel) changes the linens on the bed while the patient with Meniere's disease ambulates to the bathroom. 2. A nurse talks with a patient's family with the patient's direct permission. 3. An LPN (licensed practical nurse) gathers all necessary supplies before entering the room of a patient who needs a sterile dressing change. 4. An RN (registered nurse) dresses in a gown and gloves before entering the room of a patient with localized herpes zoster.

1. A UAP (unlicensed assistive personnel) changes the linens on the bed while the patient with Meniere's disease ambulates to the bathroom. The UAP should walk hand in hand with the patient with Meniere's disease. The main characteristic of the disorder is attacks of dizziness that could cause a fall and injury. It is safest to ambulate with them.

The registered nurse is part of a team that includes two LPNs (Licensed Practical Nurses) and a UAP (Unlicensed Assistive Personnel). Which of the following patients would be most appropriate for an LPN? 1. A patient three days post-op rhinoplasty. 2. A patient complaining of substernal chest pain. 3. A patient two hours after hernia repair. 4. A patient with an exacerbation of lupus who needs assistance to the bathroom.

1. A patient three days post-op rhinoplasty. This patient is stable and requires nursing care- perfect for the LPN.

The psychiatric unit processed four new admissions on the previous shift. Which of the new patients should the admissions nurse see FIRST? 1. A police officer with a history of hearing voices who was admitted for depressive statements by his wife. 2. A salesperson who tearfully tells the nurse that her husband is leaving her and she doesn't know what to do. 3. A businessman diagnosed with depression after he lost a huge sales contract in his company. 4. A college student who is on the verge of failing all his classes due to agoraphobia and tells the nurse, "I can't take it anymore."

1. A police officer with a history of hearing voices who was admitted for depressive statements by his wife. The police officer should be seen first because he has a history of hearing voices (may contain command hallucinations) and has access to a gun.

The nurse in an emergency room receives a call from an ambulance alerting that a bomb has gone off in a nearby shopping center and a minimum of forty victims will be arriving shortly for medical care. What action should the nurse take NEXT? 1. Alert the nursing supervisor. 2. Tell the ambulance crew to take half the victims to the next-nearest hospital. 3. Prepare enough stretchers to accommodate overflow. 4. Alert the rest of the ER nurses that they will be working mandatory double shifts.

1. Alert the nursing supervisor. There is most likely a disaster plan in place, which must be implemented by the nursing supervisor. The ER nurse must go up the chain of command to resolve this issue.

Which of the following must be performed by an RN and NOT a UAP (unlicensed assistive personnel)? SELECT ALL THAT APPLY: 1. Amulation post-op day 1. 2. Patient teaching. 3. Ambulation post-op day 5. 4. Wound care. 5. Activities of daily living.

1. Amulation post-op day 1. 2. Patient teaching. 4. Wound care. First time ambulation after surgery, any teaching, and special wound care may not be performed by a UAP.

The charge nurse in the emergency department receives a call that four patients will be arriving immediately with various injuries. Based on the following reports, order the patients from first to last to be seen. An adult with no obvious injuries, a heart rate of 135, and confusion. A child with a break through the skin and obvious deformity of the right leg who is pale and complains he feels dizzy. An adult with an obvious deformity of the left forearm, a strong radial pulse, and complaints of extreme pain. A child who cries loudly with a cut on her forehead and a heart rate of 105.

1. An adult with no obvious injuries, a heart rate of 135, and confusion. 2. A child with a break through the skin and obvious deformity of the right leg who is pale and complains he feels dizzy. 3. An adult with an obvious deformity of the left forearm, a strong radial pulse, and complaints of extreme pain. 4. A child who cries loudly with a cut on her forehead and a heart rate of 105. Change of level of consciousness is the first sign shock or head injury. No obvious injuries mean that they could be internal, leading the nurse to suspect internal hemorrhage. The child who is pale may be about to go into shock and should be seen next. See the adult in pain next, then the child upset about the cut.

The LPN (licensed practical nurse) observes nursing care administered by a UAP (unlicensed assistive personnel). Which of the following actions, if noted by the LPN, would require further teaching? 1. The UAP places the eye shield of a patient with Bell's palsy on the bedside table and turns out the lights so that the patient can nap. 2. The UAP ambulates a patient two days post-hysterectomy. 3. The UAP gives a blanket to a patient who complains she is cold. 4. The UAP administers a bed bath to a comatose patient with the help of another UAP.

1. The UAP places the eye shield of a patient with Bell's palsy on the bedside table and turns out the lights so that the patient can nap. The eye shield of a Bell's palsy patient must be worn in sleep to protect the eye against damage. Remember, a Bell's palsy patient has a side of the face with no sensation- it could be dangerous for them to roll over in their sleep onto this side.

A nurse observes a student nurse assess infants in the nursery. Which of the following, if observed by the nurse, would require an IMMEDIATE intervention? 1. The student nurse documents a negative red light reflex in a 2-day-old infant. 2. The student nurse notes the presence of overabundant lanugo in a preterm infant. 3. The student nurse lays an infant on his stomach to sleep. 4. The student nurse tests the rooting reflex by stroking the corner of the infant's mouth.

1. The student nurse documents a negative red light reflex in a 2-day-old infant. Although sleeping on the stomach is not the recommended sleeping position, this does not require immediate correction. The more serious concern is the negative red light reflex. This reflex comes from the reflection of light off the inner retina. If absent, it indicates a severe neurological deficit, possibly caused by increased ICP and must be evaluated immediately.

The nurse changes a dressing on a client with an abdominal wound with a Penrose drain in place. What priority information should the nurse chart about this procedure? 1. The time the dressing was changed, a general description of the wound, and the amount of drainage overall. 2. The amount of pain the client experienced during the dressing change and a general description of the wound. 3. The color and the amount of drainage from the wound and the time the dressing was changed. 4. A picture of the wound and a description of its healing process.

1. The time the dressing was changed, a general description of the wound, and the amount of drainage overall. This includes the best overall picture of drainage and how the wound appears. Time is a factor that allows the next nurse to assess correctly.

The nurse on a locked psychiatric unit is administering morning medications to a patient with schizophrenia. The patient refuses and says, "I'm not going to take that!" What is the nurse's BEST response? 1. "The doctor has ordered it for you so you have to take it." 2. "You have the right to refuse this medication, but the doctor may get a second opinion and have it ordered as an intramuscular injection." 3. "You do not have the right to refuse this medication because you are on a locked unit." 4. "Why not? This medication will make you feel a lot better."

2. "You have the right to refuse this medication, but the doctor may get a second opinion and have it ordered as an intramuscular injection." A 'locked unit' does not mean that patients are forced to take the medications. If they refuse enough, however, their prescribing doctor can get a second opinion from another doctor and the medication is made mandatory if refused by mouth.

The RN (registered nurse) supervises nursing care administered at a nursing home. A patient is ordered by the doctor to receive a tonometry exam. The RN calls to schedule the appointment with the ophthalmologist's office and receives four different appointment times. Which of the following times would be BEST for this patient's exam? 1. 2:00pm. 2. 9:00am. 3. 12:00pm. 4. 4:30pm.

2. 9:00am. The earliest time is best because eye pressure (which tonometry measures) is highest in the morning. A later time may give a false negative reading.

The nurse cares for children at a daycare. On a hot summer day, four children return from recess with various complaints. Which of the following children should the nurse see FIRST? 1. A child diagnosed with type one diabetes is sweaty, pale, and complains of shakiness. 2. A child diagnosed with leukemia was stung by a bee and is complaining of feeling hot and itchy all over. 3. A child diagnosed with hemophilia says she has a headache and has slurred speech. 4. A child with asthma is complaining of dizziness and a sore throat.

2. A child diagnosed with leukemia was stung by a bee and is complaining of feeling hot and itchy all over. This patient is beginning to experience anaphylactic shock and needs emergency treatment. The others also need treatment, but are more potential problems than immediate ones.

The nurse receives a report on the medical/surgical unit. Which of the following clients should the nurse see FIRST? 1. A client with a respiratory rate of 24 and an oxygen saturation of 93%. 2. A client two hours after a cast was put on his left arm complaining his arm feels "funny." 3. A client diagnosed with peptic ulcer disease who is scheduled for stomach surgery in two hours. 4. A client six hours after a hysterectomy complaining of nausea.

2. A client two hours after a cast was put on his left arm complaining his arm feels "funny." Complaining of nausea after a hysterectomy is a potential problem, not a current one. On the other hand, an arm in a cast that "feels funny" is related to impaired circulation and needs immediate assessment. The client with the O2 saturation of 93% may sound tempting to pick, but no where does it indicate that the client is in distress.

The nursing team consists of one RN, two LPNs, and one nursing assistant. The nurse determines that assignments are appropriate if the nursing assistant is assigned to which of the following patients? 1. A patient diagnosed with cerebral palsy requiring medication. 2. A patient diagnosed with CVA three days ago who needs assistance ambulating to the bathroom. 3. A client with a colostomy requesting assistance with an irrigation. 4. A patient with sepsis who needs an IV push medication.

2. A patient diagnosed with CVA three days ago who needs assistance ambulating to the bathroom. The nursing assistant can walk patients to the bathroom. The patient with cerebral palsy and the client with the colostomy can each see an LPN. The patient with sepsis needs an RN.

The nurse has just received report on four patients in her assignment. Which of the following patients should the nurse see FIRST? 1. A patient four hours post-gastrectomy who is resting comfortably in bed. 2. A patient four days post-appendectomy who complains of sudden warmth and pain at the incision site. 3. A patient who complains of a headache and has a history of migraines. 4. A patient who has just returned from a CT scan.

2. A patient four days post-appendectomy who complains of sudden warmth and pain at the incision site. Sudden warmth and pain at an incision site past the 48 hour post op period may indicate infection.

Performing a procedure on a client in the absence of an informed consent can lead to which of the following charges? 1. Harassment. 2. Assault and battery. 3. Breach of confidentiality. 4. Fraud.

2. Assault and battery. Assault and battery is the unlawful touching of another individual without his consent. Fraud is an act of deliberate deception performed to acquire an unlawful benefit, such as the improper coding of health services in a claim for payment. Harassment is the act of systematic and/or continued unwanted and annoying actions of one party or a group, including threats and demands. Breach of confidentiality is the unauthorized release of confidential information.

The nurse in the outpatient care clinic cares for a client diagnosed with heart failure. Which of the following orders, if written by the physician, should the nurse question? 1. "Administer Lasix 40mg twice daily PO." 2. "Administer Potassium 40mEq tab once daily PO." 3. "Administer 0.9% NS solution IV at a rate of 125mL/hr." 4. "Administer Lactated Ringers solution IV at a rate of 50mL/hr."

3. "Administer 0.9% NS solution IV at a rate of 125mL/hr." The rate listed is too high for a heart failure patient, who cannot handle so much fluid on their cardiac system.

An older client is admitted to the cardiac floor for new-onset atrial fibrillation. As the nurse is gathering admission history on the client, the client states, "Did you know that they can keep people alive even after they're brain dead? I never want to end up on those breathing machines." Which of the following questions should the nurse ask NEXT? 1. "Have you talked with your family about this?" 2. "I will make a note in your chart just in case." 3. "Do you have an advance directive?" 4. "Your lawyer can help you draft up papers to deal with this situation."

3. "Do you have an advance directive?" An advance directive is a legal document that will ensure the patient's wishes are carried out, independent of what his family would like to do.

The nurse answers the phone on a busy medical/surgical floor. A family member requests information on a patient by name. What response, if given by the nurse, is CORRECT? 1. "If I do not have you listed as an emergency contact, I cannot give you that information." 2. "I will tell the patient you called." 3. "I cannot give you that information due to patient confidentiality." 4. "If you give me your name, I will have the patient call you back."

3. "I cannot give you that information due to patient confidentiality." HIPPA means that you cannot give information out over the phone that even confirms a patient's presence in the hospital. If the person is the POA (power of attorney), that is the only time you may give out information in person.

A nurse's aide comes to the nurse and expresses concerns about a patient's T-tube. The aide says, "I'm kind of worried because it's drained 700mL over the course of our shift. That's a lot!" Which of the following responses does the nurse give to the aide? 1. "That is a small amount of drainage for a T-tube. Once I had a patient who drained 2,000mL in one shift!" 2. "That is an excessive amount of drainage for a T-tube. I will further assess the patient." 3. "That is a normal amount of drainage for a T-tube because this is his first day after surgery." 4. "That is a normal amount of drainage for a T-tube because this is his fifth day after surgery."

3. "That is a normal amount of drainage for a T-tube because this is his first day after surgery." First day post-op, a T-tube can drain anywhere between 500mL to 1000mL. After the first day, it decreases and eventually tapers off.

The nursing team on the medical/surgical unit consists of an RN, two LPNs, and a nursing assistant. Which of the following clients should be assigned to the nursing assistant? 1. A client recovering from electrolyte imbalance. 2. A client recovering from appendicitis who has a few questions about recovery. 3. A client two days post op a vaginal hysterectomy who needs to use the bathroom. 4. A client recently diagnosed with a seizure disorder.

3. A client two days post op a vaginal hysterectomy who needs to use the bathroom. A client who has been diagnosed with a seizure disorder needs teaching and assessment by the RN, and the RN should also answer follow-up questions. The LPN can care for the electrolyte imbalance patient who is recovering. The nursing assistant helps with ADLs and therefore can assist the patient to the bathroom.

The nurse cares for four clients in labor on the maternity unit. Which of the following patients should the nurse see FIRST? 1. A multigravida at thirty-five weeks gestation whose fetal heartbeat is 160 with variation of plus or minus five beats. 2. A primigravida, two weeks preterm, who is entering the transitional phase of labor and requests to use the bathroom. 3. A primigravida at thirty-nine weeks gestation whose fetal heartbeat is 147 with minimal variation and dips twenty beats at a time, independent of contractions. 4. A multigravida at forty-one weeks gestation whose fetal heartbeat is 132 and dips with each contraction before returning to baseline at its conclusion.

3. A primigravida at thirty-nine weeks gestation whose fetal heartbeat is 147 with minimal variation and dips twenty beats at a time, independent of contractions. It is normal to feel increased pressure with the transition phase of labor. A fetal heartbeat of 160 plus or minus five beats describes good variation. A fetal heartbeat that dips during a contraction before returning to baseline "at its conclusion" perfectly describes early decelerations. The correct answer, however, describes variable decelerations (unrelated to contractions) which are due to cord compression.

The nurse cares for a patient on an acute cardiac unit. The nurse writes her note for the next shift. It is vital to communicate which of the following information to the next shift? 1. Vital signs during the shift, lab work drawn on the patient, and nutritional intake. 2. The patient's physician's name, the patient's age, and activity tolerance. 3. Any respiratory difficulty the patient encountered, activity tolerance, EKG interpretation results, and any instability in vital signs during the shift. 4. Vital signs and what the patient still requires in terms of education.

3. Any respiratory difficulty the patient encountered, activity tolerance, EKG interpretation results, and any instability in vital signs during the shift. All the information listed above is important, but the correct answer is the only answer that includes reports of the patient's overall tolerance to care and cardiac results.

Which of the following should be included in performance evaluations of nursing staff? 1. Areas needing improvement with full written documentation. 2. Other nurses' evaluations. 3. Strengths and areas needing improvement. 4. Praise for the nurse's skills.

3. Strengths and areas needing improvement. Both strengths and weaknesses should be examined during a performance evaluation.

The nurse supervises a UAP (unlicensed assistive personnel) assist a legally blind patient with their meal at dinner time. What action, if performed by the UAP, is correct? 1. The UAP tells the patient which quadrant the food is in on the plate. 2. The UAP feeds the patient and tells them "Open." when it is time for the next bite. 3. The UAP tells the patient where each food item is located on the plate by referring to the image of a clock face. 4. The UAP cuts up the food for the patient and hands them the knife and fork.

3. The UAP tells the patient where each food item is located on the plate by referring to the image of a clock face. Use a clock-face image for legally blind patients to tell them where things are on a plate or in the room.

A patient is diagnosed with a DVT. Which of the following, if stated by a UAP (Unlicensed Assistive Personnel), requires intervention by the nurse? 1. "The patient states that her leg is warm, swollen, and painful." 2. "Sometimes I wish the patient would talk a little less. It's hard to get out of the room." 3. "The patient and I were talking, and we both play softball!" 4. "I am going to ambulate the patient to the bathroom and assist her with using the toilet."

4. "I am going to ambulate the patient to the bathroom and assist her with using the toilet." This patient is on strict bedrest to prevent the clot in her leg from moving.

A local congressman is admitted to the psychiatric unit with a diagnosis of major depression with intent to self-harm. A nurse who works in the pediatric unit asks the psychiatric nurse why the patient has been admitted. Which of the following responses by the nurse is BEST? 1. "He's depressed. Take a look at the chart." 2. "Mind your own business." 3. "If I tell you, you have to promise not to tell anyone." 4. "I can't share that information with you."

4. "I can't share that information with you." Due to HIPPA, that information is private and can't be shared with a nurse who is not directly caring for him.

The licensed practical nurse may NOT assume the primary care for which of the following patients? 1. A 15-year-old with Down syndrome and is on 2nd day post-appendectomy. 2. A 38-year-old, gravida 4 para 3, in the fourth stage of labor. 3. A 30-year-old, with bipolar disorder. 4. A 52-year-old, diagnosed with congestive heart failure, with a venous access device.

4. A 52-year-old, diagnosed with congestive heart failure, with a venous access device. The Licensed Practical Nurse has limited duties and responsibilities when it comes to IV therapy. All IV therapy provided by the LPN must by supervised by an RN who has completed a formal educational program with theory and clinical components and has demonstrated and maintains competence in IV therapy.

The nursing team includes two RNs, one LPN, a nursing assistant, and a nurse reassigned from the postpartum unit. The nurse should consider the assignments appropriate if the reassigned nurse cares for which of the following patients? 1. A client with a spinal cord injury requiring assistance with meals. 2. A client diagnosed with COPD who displays Cheyne-Stokes respirations.. 3. A client diagnosed with a head injury and a Glasgow coma scale of 5. 4. A client diagnosed with a myocardial infarction complaining of burning on urination.

4. A client diagnosed with a myocardial infarction complaining of burning on urination. The reassigned nurse can care for the patient with the UTI. Remember, reassigned nurses need stable patients.

The nurse working on the diabetic specialty unit cares for four patients. A nursing assistant reports that each of the patients requires the nurse's attention. Which of the following patients, if described as detailed below by the nursing assistant, should be seen FIRST? 1. A diabetes type one patient who reported feeling weak and clammy and is now eating a simple-carbohydrate snack. 2. A diabetes type one patient who wants the nurse to change the dressing for his foot ulcer. 3. A diabetes type two patient who wants to know what to eat before she exercises. 4. A diabetes type two patient who reports headache, hot, dry skin and fruity odor to his breath.

4. A diabetes type two patient who reports headache, hot, dry skin and fruity odor to his breath. The patient reporting hot, dry skin and fruity odor to breath shows signs of entering ketoacidosis and needs to be assessed immediately. The diabetes type one patient with low blood sugar (cool, clammy skin) is already eating a snack and should be seen second.

The charge nurse works with two LPNs (licensed practical nurses) and one UAP (unlicensed assistive personnel). Which of the following assignments, if selected for the UAP, would be considered appropriate? 1. A patient rings the call bell and asks for a Tylenol. 2. A terminal cancer patient is being transferred to hospice home care. 3. A patient two days post-op cholecystectomy requires a sterile dressing change. 4. A patient with new onset seizures needs assistance to the bathroom.

4. A patient with new onset seizures needs assistance to the bathroom. This patient needs basic ADLs care. The LPN can do the sterile dressing change. Only RNs can do discharge teaching (like transfers) or assess pain.

Which of the following tasks can be delegated to a UAP (unlicensed assistive personnel)? 1. Setting up a PCA (patient-controlled analgesia) pump. 2. Irrigating a nasogastric tube. 3. Nasotracheal suctioning of a patient for the first time. 4. Ambulating a patient three days post-op appendectomy in the hallway.

4. Ambulating a patient three days post-op appendectomy in the hallway. Ambulating the patient three days post-op with no mentioned complications is absolutely appropriate. The other tasks fall under the delegation of an RN or LPN.

The charge nurse implements a change in the nursing assistant's job description. The change increases the nursing assistant's responsibilities. A nurse with 20 years of service on the unit verbally agrees to the change, but her behaviors indicate otherwise. Which of the following actions by the charge nurse is MOST appropriate? 1. Schedule an appointment to speak with the nurse in private. 2. Ask the nursing assistants to accommodate the nurse. 3. Inform the charge nurse that you have observed her verbal agreement differs from her behavior. 4. Enable an open discussion during a prescheduled meeting. Check

4. Enable an open discussion during a prescheduled meeting. Do not directly confront the nurse or ask anyone to accommodate her. Instead, use a meeting to bring up the issue and allow her peers to speak positively about the change. Peer pressure can be an effective tool.

The nurse works on a medical/surgical unit. She asks a UAP (unlicensed assistive personnel) to ambulate a client recovering from a hysterectomy. Two hours later, the patient rings her call bell and asks to be walked, claiming that she has not seen the UAP this shift. The nurse finds the UAP talking on her cell phone in the break room. Which of the following actions should the nurse take NEXT? 1. Remind the UAP of what the nurse asked her to do. 2. Fill out an incident report as soon as possible. 3. Demand the UAP get off her cell phone while not on break. 4. Report the UAP to the nursing supervisor.

4. Report the UAP to the nursing supervisor. This is a question that wants the nurse to utilize the chain of command to solve problems.

The nurse notices a significant increase in the number of patients admitted to the medical/surgical unit who do not have ID bracelets on their wrists. Instead, the ID bracelets are taped to the chart and are often lost in the process. Which of the following actions, if taken by the nurse, is BEST to resolve this issue? 1. Call down to the ER and demand to speak with the charge nurse about this problem. 2. Encourage the nurses to place the ID band on the patient as soon as they arrive on the unit. 3. Address the issue during a prescheduled meeting and ask why the nurses in the ER have not been doing their job correctly. 4. Schedule a meeting with the charge nurse of the ER to discuss a solution that will benefit everyone.

4. Schedule a meeting with the charge nurse of the ER to discuss a solution that will benefit everyone. This issue can be resolved with minimal fuss in a brainstorming session to discuss solutions. This option avoids blame (unlike 1 and 3) and does not put all the responsibility on the unit nurses.

A nursing assistant on the nurse's unit was injured four months ago in a fire. Her right leg was badly burned. She has just been cleared for work by a rehabilitation facility, but she walks with a prominent limp and an extremely unsteady gait. The nursing assistant wants to return to work on her unit, which has a critical care level of acuity. To assist the nursing assistant, the nurse should take which of the following actions? 1. Recommend the assistant take a leave of absence without pay until her rehab is more complete. 2. Transfer the nursing assistant to a surgical unit. 3. Offer the nursing assistant a secretarial position on the nursing unit. 4. Survey other units for positions more suitable for the nursing assistant's abilities.

4. Survey other units for positions more suitable for the nursing assistant's abilities. The ADA requires reasonable accommodations, but the nursing assistant should also be able to perform the job. The surgical unit will also be demanding. The nurse is unable to offer the secretarial position, as this is a different job type. The nursing assistant needs a position more appropriate, so other units should be investigated.

A charge nurse on the cardiac unit observes a new graduate nurse as she suctions a patient with a tracheostomy. What action, if performed by the graduate nurse, would require intervention from the charge nurse? 1. The graduate nurse hyperoxygenates the client for three minutes before suctioning. 2. The graduate nurse withdraws the catheter and intermittently applies suction for no longer than nine seconds. 3. The graduate nurse elevates the head of the bed to Semi-Fowler's position before beginning. 4. The graduate nurse withdraws the catheter and intermittently applies suction for no longer than fifteen seconds.

4. The graduate nurse withdraws the catheter and intermittently applies suction for no longer than fifteen seconds. The nurse should suction a patient for no longer than ten seconds.

Which of the following situations is an example of negligence? 1. The nurse observes a UAP enter the room of a patient on contact precautions wearing gloves and a gown. 2. A nurse transcribes a new medication order: Questran powder 2 oz bid with wet food or one full glass of water. 3. The UAP (Unlicensed Assistive Personnel) fills a water basin with warm water while the patient with depression combs her hair. 4. The nurse checks the distal pulses of a patient's legs two hours after they have returned from a cardiac catheterization.

4. The nurse checks the distal pulses of a patient's legs two hours after they have returned from a cardiac catheterization. The nurse should have checked the patient's distal pulse immediately after the cardiac catheterization.

A student nurse is giving a child with suspected otitis media an ear examination. Which of the following actions, if taken by the student nurse, would require correction? 1. The student nurse allows the two-year-old to sit on her mother's lap during the exam. 2. The student nurse talks with the child as she looks into her ear. 3. The student nurse applies a disposable cover to the tip of the otoscope. 4. The student nurse gently pulls the pinna of the ear up and back to straighten the ear canal.

4. The student nurse gently pulls the pinna of the ear up and back to straighten the ear canal. The student nurse should pull the pinna down and back in a child to straighten the ear canal. It's fine to talk with the child and sit them in the mother's lap, and the application of a disposable cover is a responsible action.

A Hindu patient dies after a long, drawn-out battle with pancreatic cancer. The family is gathered by the bedside. Which of the following interventions, if offered by the nurse, would be MOST appropriate? 1. Bring a crisp white sheet to the room. 2. Bring water and a basin. 3. Ask the family if they would like a priest in the room. 4. Turn the patient's bed so that his head faces east.

4. Turn the patient's bed so that his head faces east. Turning the patient to face east is the proper death ritual in the Hindu religion.