Nurse Leadership and Management Final

A nurse manager is reviewing the stages of conflict resolution with the nursing staff. The nurse manager should instruct the staff to expect the stages of the conflict to occur in what order? 1) perceived conflict 2) felt conflict 3) manifest conflict 4) latent conflict 5) conflict aftermath

order: 4) latent conflict, 1) perceived conflict, 2) felt conflict, 3) manifest conflict, 5) conflict aftermath

A nurse is reviewing medical records for a group of pediatric clients. Which of the following should the nurse report to the local health department? A) Varicella B) Coxsackievirus C) Molluscum contagiosum D) Candidiasis

A) Varicella

A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? SELECT ALL THAT APPLY A) verifying that a client understands what is done during a cardiac catherization B) discussing treatment options for a terminal diagnosis C) Informing members of the healthcare team that a client has do- not resuscitate status D) Reporting that a healthcare member on the previous shift did not provide care as prescribed E) Assisting a client to make a decision about their care based on the nurse recommendations

A) verifying that a client understands what is done during a cardiac catherization C) Informing members of the healthcare team that a client has do-not-resuscitate status D) Reporting that a healthcare member on the previous shift did not provide care as prescribed

A case manager is discussing critical pathways with a group of newly licensed nurses. Which of the following statements indicates understanding? A) "The tune to fill out the pathways often increases the cost of care." B) "The pathway shows an estimate of the number of days the client will be hospitalized." C) "Deviance from the pathway is a sign of improved quality of care." D) "The pathway includes information about the client's history."

B) "The pathway shows an estimate of the number of days the client will be hospitalized."

A nurse is caring for a group of clients. For which of the following client situations should the nurse complete an incident report? A) Vancomycin was administered 30 mins after the scheduled time B) A digoxin level was drawn 8 hours after the last dose was administered C) a client's family voices concern about the hospital costs D) A client's visitor trips over an IV pump stand

D) A client's visitor trips over an IV pump stand Rationale: Giving medication within 30 mins is within the time frame for administration. Digoxin level can be drawn 6-8 hours after administration. Hospital costs should be discussed with a social worker and does not contest an incident report.

A nurse is teaching a client about the Patient Protection and Affordable Care Act and their rights regarding insurance coverage. Which of the following statements by the client indicates an understanding of the teaching? A) "My insurance coverage no longer has lifetime coverage limits." B) "I can provide health insurance coverage for my children on my policy until they turn 21 years old." C) "My insurance will not provide coverage for preexisting conditions." D) "I can lose my insurance coverage since I have been sick so much this year."

A) "My insurance coverage no longer has lifetime coverage limits." Rationale: Children can stay on their parents plan until they turn 26 years old; the act cannot deny those with preexisting conditions; and the act prevents cancellation of insurance due to illness

A nurse witness an assistive personnel they are supervising reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if the urinal is not used more carefully next time. Which of the following torts is the AP committing? A) assault B) battery C) false imprison D) invasion of privacy

A) assault

A nurse manager is observing the actions of a nurse they are supervising. Which of the following actions by the nurse requires the nurse manager to intervene? SELECT ALL THAT APPLY A) reviewing the health care record of a client assigned to another nurse B) making a copy of the client's most current laboratory results for the provider during rounds C) Providing information about the client's condition to hospital clergy D) Discussing a client's condition over the phone with an individual who has provided the client's information code E) Participating in walking rounds that involve the exchange of client-related information outside client's rooms

A) reviewing the health care record of a client assigned to another nurse B) making a copy of the client's most current laboratory results for the provider during rounds C) Providing information about the client's condition to hospital clergy E) Participating in walking rounds that involve the exchange of client-related information outside client's rooms

A nurse on an acute unit is caring for a client following a total hip arthroplasty. The client is a confused, moving the affected leg into positions that could dislocate the new hip joint, and repeatedly attempting to get out of bed. After determining that restraint application is indicated, which of the following actions should the nurse take? SELECT ALL THAT APPLY A) secure the restraint to the frame of the bed B) get a prescription for restraints from the provider C) Have a family member sign the consent for restraints D) Tie the restraint to the side rail using a double knot E) Ensure that only one finger can be inserted between the client and the restraint

A) secure the restraint to the frame of the bed B) get a prescription for restraints from the provider C) Have a family member sign the consent for restraints

A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following information should the manager include in the plan? SELECT ALL THAT APPLY A) skill proficiency B) assignment to a preceptor C) budgetary principles D) computerized charting E) socialization into unit culture F) facility policies and procedures

A) skill proficiency B) assignment to a preceptor D) computerized charting E) socialization into unit culture F) facility policies and procedures

A community experiences an outbreak of meningitis, and hospital beds are urgently needed. Which of the following clients should the nurse recommend for discharge? A) A client newly admitted with angina and a history of myocardial infraction a year ago B) A client who was preadmitted for rotator cuff surgery and has diabetes type 2 C) a client admitted the day before with pneumonia and dehydration D) a client who has a fractured hip and is scheduled for total hip replacement for the next day

B) A client who was preadmitted for rotator cuff surgery and has diabetes type 2

A nurse is caring for a client who has chest pain. The client says, "I am going home immediately." Which of the following actions should the nurse take? SELECT ALL THAT APPLY A) notify the client's family of their intent to leave the facility B) Document the client's intent to leave the facility against medical advice C) Explain to the client the risks involved if they choose to leave D) Ask the client to sign a form relinquishing responsibility of the facility E) Prevent the client from leaving the facility until the provider arrives

B) Document the client's intent to leave the facility against medical advice C) Explain to the client the risks involved if they choose to leave D) Ask the client to sign a form relinquishing responsibility of the facility

A newly licensed nurse is preparing to insert an IV catheter in a client. Which of the following sources should the nurse use to review the procedure and the standard at which it should be performed? A) Website B) Institutional policy and procedure manual C) more experienced nurse D) state nurse practice act

B) Institutional policy and procedure manual

A nurse who has just assumed the role of the unit manager is examining the skills necessary for interprofessional collaboration. Which of the following actions support the nurse's interprofessional collaboration? SELECT ALL THAT APPLY A) use aggressive communication when addressing the team B) Recognize the knowledge and skills of each member of the team C) Ensure that a nurse is assigned to serve as the group facilitator for all interprofessional meetings D) Encourage the client and family to participate in the team meetings E) Support team members requests for referral

B) Recognize the knowledge and skills of each member of the team D) Encourage the client and family to participate in the team meetings E) Support team members requests for referral

A nurse is caring for a group of clients on a unit. Which of the following assessments should the nurse recognize as the priority to report to the charge nurse? A) a client with heart failure and 2+ edema of lower extremities B) a client who is 2 days postoperative with a urine output of 20 ml/hr C) a client who started taking verapamil with a HR of 75/min D) a client who is taking morphine and reports nausea

B) a client who is 2 days postoperative with a urine output of 20 ml/hr Rationale: output is below expected range and can indicate hypovolemia or renal complications. A & C are expected findings for patient scenario. Verapamil affects blood pressure do not take if low BP or heart rate less than 60

A nurse manager suspects that a staff nurse on the unit is impaired. A coworker of the staff nurse reported smelling alcohol on her breath. Which of the following actions should the nurse manager take? A) send the nurse home for the week without pay B) ask the provider about the nurse's behavior C) identify the nurse's performance expectations D) report the nurse to the facility ethics committee

C) identify the nurse's performance expectations Rationale: The nurse manager does not have enough information to confirm the suspicious so sending the nurse home or report to the ethics committee should not be taken yet. Asking the provider will only give subjective information. Talking to the nurse should be the first approach.

A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should the nurse take first? A) call the provider B) ask a staff member for assistance getting the client back in bed C) inspect the client for injuries D) instruct the client to ask for help if they need to get out of bed

C) inspect the client for injuries Rationale: The nurse should always assess the situation first. If the client is injured moving the client can further the injuries. The other options are also important but assessing for injuries should be the priority.

A nurse is reviewing the hospital's fire safety policies and procedures with newly hired assistive personnel. The nurse is describing what to do when there is a fire in a client's trash can. Which of the following information should the nurse include? SELECT ALL THAT APPLY A) the first step is pull the alarm B) Use a Class C fire extinguisher to put out the fire C) instruct ambulatory clients to evacuate to a safe place D) pull the pin on the fire extinguisher prior to use E) close all doors

C) instruct ambulatory clients to evacuate to a safe place D) pull the pin on the fire extinguisher prior to use E) close all doors

A nurse is conducting an in-service for a group of newly licensed nurses about delegation. Which of the following instructions should the nurse include in the teaching? A) "teaching a newly diagnosed diabetic client can be assigned to a licensed practical nurse." B) "completion of a dressing change on a central line catheter can be delegated to an assistive personnel." C) "Obtaining vital signs for a client who has a new onset of left sided weakness can be assigned to assistive personnel." D) "Caring for a client who is postoperative following a hysterectomy can be delegated to a nurse floating from the maternal-newborn unit."

D) "Caring for a client who is postoperative following a hysterectomy can be delegated to a nurse floating from the maternal-newborn unit." Rationale: Assistive personnel can not obtain vital signs for a client who is not stable or perform dressing changes/central line care. Licensed practical nurses can not perform initial teaching/education, they can only reinforce learning after the nurse has performed education.

A charge nurse is managing a 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? A) "Would you accept the assignment if we reassign your client who has total care needs and assign another client who can provide more self-care?" B) "Tell me what changes we need to make so that you'll feel comfortable with the assignment." C) "I didn't mean to make you feel overwhelmed. Why don't you look over the assignment with me and suggest changes?" D) "You always complete your work on time and do a great job. I believe you can handle the assignment well."

D) "You always complete your work on time and do a great job. I believe you can handle the assignment well." Rationale: A shows compromising, B shows cooperation, and C shows collaboration

A charge nurse is evaluating a plan of care that a newly licensed nurse developed for a client who is to receive a continuous NG tube feeding. Which of the following interventions should the charge nurse ensure is part of the plan of care? A) flush the tube every 8 hrs with 0.9% sodium chloride irrigation B) use an acidic juice to unclog a blocked tube C) Add dissolvable medications to the tube feeding D) use a 60 ml syringe to flush out a clogged tube

D) use a 60 ml syringe to flush out a clogged tube Rationale: A larger syringe is used to unclogged tubing due to smaller syringes causing higher amounts of pressure. The tubing should be flushed every 4 hours with 30-50 ml of water. Dissolvable medications should be added to 30 ml of water, enteral feeding should be stopped, with tubing flushed prior to admin.

A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following regulations outlines the rights of individuals in health care settings? A) American Nurses Association Code of Ethics B) HIPAA C) Patient Self-Determination Act D) Patient Care Partnership

D) Patient Care Partnership

A charge nurse is instructing a staff nurse who is caring for clients who each have a health care surrogate. The nurse indicates understanding when he contacts the health care surrogate to obtain consent for which of the following client situations? A) An adult client who is experiencing confusion following a head injury and refuses a CT scan B) a client who has terminal illness and requests a DNR prescription C) an adult client who has major depressive disorder and refuses electroconvulsive therapy D) an older adult client who is scheduled for surgery and does not speak in the same language as the nurse

A) An adult client who is experiencing confusion following a head injury and refuses a CT scan Rationale: A client with a head injury can have an impaired judgement due to injury and is a situation where a health care surrogate can give consent. A client with terminal illness is competent, thus is able to make own healthcare decisions. It is the right of the patient to have the ability to refuse medications. When a client and the nurse do not speak the same language an interpreter should be utilized.

A nurse manager is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following information should the nurse manager include? SELECT ALL THAT APPLY A) Description of the incident should be documented in the client's health care record B) The client should sign as a witness on the incident report C) Incident reports include a description of the incident and actions taken D) A copy of the incident report should be placed in the client's health care record E) The risk management department investigates the incident

A) Description of the incident should be documented in the client's health care record C) Incident reports include a description of the incident and actions taken E) The risk management department investigates the incident

A nurse manager is providing information about the audit process to members of the nursing team. Which of the following information should the nurse manager include? SELECT ALL THAT APPLY A) a structure audit evaluates the setting and resources available to provide care B) An outcome audit evaluates the results of the nursing care provided C) a root cause analysis is indicated when a sentinel event occurs D) Retrospective audits are conducted while the client is receiving care E) after data collection is completed, it is compared to a benchmark

A) a structure audit evaluates the setting and resources available to provide care B) An outcome audit evaluates the results of the nursing care provided C) a root cause analysis is indicated when a sentinel event occurs E) after data collection is completed, it is compared to a benchmark

A charge nurse is observing a newly licensed nurse care for a client who has a prescription for application of an aquathermia pad to the right lower leg. Which of the following actions should indicate to the charge nurse that the nurses know how to use the device? SELECT ALL THAT APPLY!! A) ask client to report of aquathermia pad gets too warm B) check the client's leg 30 mins after applying the aquathermia pad C) show the client how to adjust the temperature D) ensure the client's call light is within reach E) decrease the temperature by 2.8 C (5 F) if the client's skin becomes reddened

A) ask client to report of aquathermia pad gets too warm D) ensure the client's call light is within reach Rationale: Want to check on client 15-20 mins after applying for complications. Adjusting the temperature can affect pain and circulation and should not be done. If patient's skin is reddened it should be discontinued and provider is notified.

A nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nurse notices the nurse unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following conflict resolution strategies is the unit manager demonstrating? A) avoidance B) smoothing C) cooperating D) negotiating

A) avoidance

A nurse is assisting with the discharge planning for a client. Which of the following actions should the nurse take? SELECT ALL THAT APPLY A) determine the client's need for home medical equipment B) provide a list of all medications the client received in the facility C) obtain printed instructions for a medication self administration D) provide the family with a list of community agencies that can provide assistance E) Discuss the importance of attending follow-up appointments

A) determine the client's need for home medical equipment C) obtain printed instructions for a medication self administration D) provide the family with a list of community agencies that can provide assistance E) Discuss the importance of attending follow-up appointments

A nurse is planning safety interventions at a new clinic. Which of the following interventions should the nurse include? A) have staff who will be performing x-rays wear a dosimeter B) provide both latex and non latex gloves for staff C) place sharp containers outside client rooms D) provide electrical tape for staff to report frayed cords

A) have staff who will be performing x-rays wear a dosimeter

A home health nurse is assessing the safety of a client's home. The nurse should identify which of the following factors as increasing the client's risk for falls? SELECT ALL THAT APPLY A) history of a previous fall B) reduced vision C) impaired memory D) takes rosuvastatin E) Uses a night light F) Kyphosis

A) history of a previous fall B) reduced vision C) impaired memory F) Kyphosis

An RN on a medical-surgerical unit is making assignments at the beginning of the shift. Which of the follwoing tasks should the nurse delegate for the PN? A) obtain vital signs for a client who is 2 hours postprocedure following a cardiac catherization B) Administer a unit of packed red blood cells to a client who has cancer C) Instruct a client who is scheduled for discharge in the performance of wound care D) Develop a plan of care for a newly admitted client who has pneumonia

A) obtain vital signs for a client who is 2 hours postprocedure following a cardiac catherization Rationale: PNs are not able to give blood products. PNs can not perform initial teaching to patients. PNs are able to perform vital signs for patients who are stable.

A nurse on the medical surgerical unit is planning to assess their assigned clients following change of shift report. Which of the following clients should the nurse assess first? A) a client who is 4 hours postoperative following a colostomy and had small amount of blood at the stoma B) a client who is 8 hours postoperative following an amputation and reports phantom limb pain C) a client who has a chest tube drainage system with slight bubbling in the water seal chamber D) a client who has full thickness pressure injury with the presence of eschar at the wound site

B) a client who is 8 hours postoperative following an amputation and reports phantom limb pain Rationale: B is correct because only choice with urgent situation. Small amount of blood at the stoma is normal finding following a colectomy. Bubbling is normal in a water seal chamber, and eschar is an expected finding for a client with full thickness pressure injury

A nurse has just received report on four clients on a medical surgical unit. Which of the following clients should the nurse plan to assist first? A) a client who has COPD and an oxygen saturation level of 92% B) a client who is postoperative following a total knee arthroplasty and has a capillary refill of 4 seconds C) a client who has diabetes and a blood glucose of 150 mg/dL D) a client who is 12 hours postoperative following abdominal surgery and has absent bowl sounds

B) a client who is postoperative following a total knee arthroplasty and has a capillary refill of 4 seconds Rationale: COPD patients with 92% O2 sat is normal, a diabetic with blood glucose over 150 mg/dL is normal, and absent bowel sounds after abdominal surgery is normal. Capillary refill should be less than 3 seconds and the data can indicate a circulatory problem

A nurse is preparing to transfer a client who is 72 hours postoperative to a long term care facility. Which of the following information should the nurse include in the transfer report? SELECT ALL THAT APPLY A) Type of anesthesia used B) advance directives status C) vital signs on the day of admission D) Medical diagnosis E) Need for specific equipment

B) advance directives status D) Medical diagnosis E) Need for specific equipment

A nurse is discussing disaster planning with the board members of a hospital. Which of the following individuals should the nurse expect to request extra supplies and staffing for the facility? A) incident commander B) medical command physician C) triage officer D) medical liaison

B) medical command physician

A nurse on the 6th floor medical surgical unit is advised that a sever weather alert code has been activated. Which of the following actions should the nurse take? SELECT ALL THAT APPLY A) open the window shades or drapes to provide better visibility of the external environment B) move beds of non-ambulatory clients away from windows C) relocate ambulatory clients into hallways D) use the elevator to move clients to lower levels E) turn on the radio for severe weather warnings

B) move beds of non-ambulatory clients away from windows C) relocate ambulatory clients into hallways E) turn on the radio for severe weather warnings

A nurse is preparing to discharge a client from a medical unit to a rehab facility. Which of the following information should the nurse plan to include on the transfer form? A) discontinued medications B) scheduled consultations C) treatments completed while hospitalized D) time of clients last shower

B) scheduled consultations Rationale: The transfer form should include current medications, treatments that need to be continued, as well as scheduled consultations. Routine care information is unnecessary for a transfer form.

A nurse is observing a newly licensed nurse and an assistive personnel pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates an understanding of this technique? A) The nurse stands with both feet together B) the nurse uses their body weight to counter the client's weight C) The nurses feet are pointing inward toward the center of the bed D) the nurse rotates the waist while pulling the client upward

B) the nurse uses their body weight to counter the client's weight

A nurse discovers that a client was administered an antihypertensive medication in error. Identify the appropriate sequence of steps the nurse should take using the following actions: A) call the provider B) check vital signs C) notify the risk manager D) complete an incident report E) instruct the client to remain in bed until further notice

B) vital signs; E) instruct the client to remain in bed until further notice; A) call the provider; D) complete an incident report; C) notify the risk manager

A nurse is teaching an assistive personnel how to clean a bedpan that is soiled with stool infected with clostridium difficile. Which of the following actions by the assistive personnel indicates an understanding of the teaching? A) rinses the stool from the bedpan with hot water B) wear a face shield C) pours a disinfectant into the bedpan containing stool D) Holds the bedpan 30 cm (1 foot) above the toilet when emptying stool

B) wear a face shield Rationale: Stool should be rinsed with cold water due to hot water making stool removal difficult. Stool will inactivate the disinfectant and should be rinsed/removed first. Holding the bedpan high will cause splashing and spread of infection. Wearing a face shield will prevent bacteria exposure when emptying infectious stool

A nurse is speaking with the adult child of a client who has Alzheimer's disease. The child is crying and tells the nurse, "I don't know how much longer I can keep this up." Which of the following responses should the nurse make? A) "I understand how you must be feeling." B) "You should speak with your parent's doctor about this." C) "Let's discuss options for respite care." D) "You'll need to get help if your parent becomes combative."

C) "Let's discuss options for respite care." Rationale: The choice of A causes a barrier to communication due to involving personal feelings as well as does not address the concern; B and D also do not address the family's concern. Respite care will help the family decrease stress and get a break from caregiving

A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following information will the provide data regarding the efficacy of the procedure? A) Frequency with which procedure is performed B) client satisfaction with performance of procedure C) Incidence of complications related to procedure D) accurate documentation of how the procedure was performed

C) Incidence of complications related to procedure Rationale:

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? A) critical pathway B) incident reporting C) SBAR framework D) root cause analysis

C) SBAR framework Rationale: root cause analysis helps to identify why a standard is not being met, incident reporting is when an error or incident occurs between clients and nursing staff, and critical pathway is for determining best care for certain medical conditions or procedures. SBAR is used to communicate patient information and for finding the best solution.

A nurse is caring for a child who is being treated in the emergency department following a head contusion from a fall. History reveals the child lives at home with one parent. The provider's discharge instructions include walking the child every hour to assess for indications of a possible head injury. In which of the following situations should the nurse intervene and attempt to prevent discharge? A) the parent states they do not have insurance or money for a follow-up visit B) The child states, "My head hurts and I want to go home." C) The nurse smells alcohol on the parent's breath D) the parents verbalizes fear about taking the child home and requests they be kept overnight

C) The nurse smells alcohol on the parent's breath

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 see first? A) a client who has a closed leg fracture and reports peripheral paresthesia B) a client who reports a sprained ankle and has a laceration over the medial ankle C) a client who has arm contusions and manifests asymmetrical thoracic movements D) a client who has abrasions to the face and is requesting medications for severe pain

C) a client who has arm contusions and manifests asymmetrical thoracic movements Rationale: ABC's! Asymmetrical thoracic movements can indicate a tension pneumothorax and needs immediate intervention. The client with peripheral paresthesia requires intervention but following ABC's this patient is not first priority.

A nurse is evaluating clients who can be discharged to make room for new clients following a mass causality event. Which of the following clients should the nurse recommend for discharge? A) a client who has pancreatitis and is receiving gastric decompression B) a client who has type 1 diabetes and has positive serum ketones C) a client who is receiving warfarin for a deep vein thrombosis and has an INR of 1.8 D) a client who is receiving chemotherapy and has a platelet count of 10,000/mm3

C) a client who is receiving warfarin for a deep vein thrombosis and has an INR of 1.8 Rationale: All the rest of the patients are unstable and should not be discharged (platelet count too low, positive ketones, gastric decompression). An INR of 1.8 is within the normal range of 1.5 to 2.0 so this patient is safe to discharge

A PN ending their shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? A) Complete an incident report B) Delegate the task to the PN C) ask the AP if they need assistance D) notify the nurse manager

C) ask the AP if they need assistance Rationale: An incident report is not necessary. Notifying the nurse manager is not necessary as the nurse can handle the situation. Asking the AP if they need assistance helps to better assess the situation and provide clients with interventions they need

A nurse is caring for a client who is scheduled for surgery. The client hands the nurse information about advanced directives and states, "Here I don't need this, I'm too young to worry about life-sustaining measures and what I want done for me." Which of the following actions should the nurse take? A) return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time B) Explain to the client that you never know what can happen during surgery and to fill out the papers out just in case C) contact a client representative to talk with the client and offer additional information about the purpose of advanced directives D) Inform the client that surgery cannot be conducted unless the advance directives forms are completed

C) contact a client representative to talk with the client and offer additional information about the purpose of advanced directives

A nurse case manager is planning a teaching session on the use of critical pathways with a group of newly licensed nurses. Which of the following information should the nurse include in the teaching? A) critical pathways promote individual care B) critical pathways decreased administrative work time C) critical pathways prevent unnecessary expense D) critical pathways incorporate provider preferences

C) critical pathways prevent unnecessary expense Rationale: Critical pathways use evidence based practice strategies and can increase administrative work due to amount of paperwork and review time for the nurse case manager. Using best practice helps to decrease unnecessary expense

A nurse is caring for a 6 year old client who becomes physically violent towards others and requires the application of restraints. Which of the following actions should the nurse plan to take? A) assess the child every hour while in restraints B) obtain a new prescription for restraints every 12 hours C) discontinue the use of restraints when the child's behavior is no longer aggressive D) call the provider to obtain a prescription for PRN use of restraints

C) discontinue the use of restraints when the child's behavior is no longer aggressive Rationale: Patients in restraints should be frequently monitored every 15-20 mins. Children under age 9 need renewal every hour, children between 9-17 years old need renewal every 2 hours. When using restraints PRN prescriptions are not applicable.

A newly licensed nurse is planning care for a group of clients. Prior to delegating tasks to various team members, which of the following actions should the nurse make? A) ask each team member which tasks they would like to perform B) perform competency checks on each of the team members C) review the job descriptions of various team members D) discuss prior performance of the team members with other nursing staff

C) review the job descriptions of various team members Rationale: Asking team members about tasks they want to perform is unreliable. Performing competency checks is the responsibility of the health care organization. Discussing team members with others on the nursing staff is unreliable, the nurse should evaluate the abilities of the team member prior to delegation. Reviewing the job descriptions will help the nurse know which team members are competent for delegation certain tasks.

A nurse is discussing ethical frameworks with another nurse. Which of the following client care situations is an example of using the utilitarianism theory in nursing practice? A) the nurse provides life-prolonging treatment for a client who is not expected to survive B) the nurse assists with health care screenings for migrant farmers C) the nurse uses a disaster triage tag system following a mass casualty incident D) the nurse prays with a client and the client's family as the client nears death

C) the nurse uses a disaster triage tag system following a mass casualty incident Rationale: A shows deontological ethical theory, B shows rights-based reasoning, and D shows ethical relativism theory. C shows the utilitarianism theory because the nurse is making decisions based on what actions will provide the greatest amount of benefit for the greatest number of people.

A nurse is presenting information on health care law to a group of newly licensed nurses. Which of the following information should the nurse include? A) Good Samaritan law provide protection for nurses who are negligent when providing volunteer services B) The emergency medical treatment and active labor act provides nursing guidelines for providing client care outside the health care facility C) the patient self determination act requires a nurse to give clients information about end of life options D) state nurse practice acts are informal guidelines that direct professional nursing practice

C) the patient self determination act requires a nurse to give clients information about end of life options Rationale: The emergency medical treatment and active labor act is used for care given within a health care facility. Good Samaritan law protect healthcare professionals but they are still accountable for providing standards of care. The state nurse practice act are formal guidelines that act as administrative law

A nurse is reviewing a client's health record and discovers that the client's DNR prescription has expired. The client's condition is not stable. Which of the following actions should the nurse take? A) Assume that the client does not want to be resuscitated, and take no action if they experience cardiac arrest B) write a note on the front of the provider's prescription sheet asking that the DNR be represcribed C) Anticipate that CPR will be instituted if the client goes into cardiopulmonary arrest D) Call the provider to determine whether the prescription should be immediately reinstated

D) Call the provider to determine whether the prescription should be immediately reinstated

A nurse in a community health clinic is caring for four clients who each have a communicable disease. Which of the following is considered a nationally notifiable infectious disease? A) Respiratory Syncytial Virus (RSV) B) Methicillin-resistant Staphylococcus aureus (MRSA) C) Clostridium Difficile D) Chlamydia trachomatis

D) Chlamydia trachomatis

A clinical nurse leader is part of a health care team on an acute care unit. Which of the following tasks is the role of the clinical nurse leader? A) develop a fiscal-year budget for the unit B) conduct annual performance appraisals for each unit staff member C) intervene when there is conflict between clients and nursing staff D) gather research-based data to develop clients plan of care

D) gather research-based data to develop clients plan of care Rationale: Developing a fiscal year budget, conducting annual performance appraisals, and intervening where there is a conflict between clients and nursing staff are the responsibilities of the unit nurse manager.