EXAM 1 -nclex questions

The nurse should use which guidelines to plan delegation and assignment- making activities? select all that apply 1. ensuring client safety 2. requests from staff 3. the clustering of the rooms on the unit 4. the number of anticipated client discharges 5. client needs and workers needs and abilities

1 & 5, the guidelines should ensure client safety, be aware of individual work abilities, determine which tasks can be delegated and to whom, match the task to the delegate on the basis of the nurse practice act and appropriate position descriptions

A new unit nurse manager is holding the first staff meeting. She instructs staff members to report any problems directly to her. what type of leader and manager approach do the new manager's characteristics suggest? 1. autocratic 2. situational 3. demicratic 4. laissez-faire

1. autocratic leader is focused, maintains strong control, makes decisions, and addresses all problems

The registered nurse is planning the client assignments for the day. which is the MOST APPROPRIATE assignment for an UAP? 1. a client requiring a colostomy irrigation 2. a client receiving a continuous tube feeding 3. a client who requires urine specimen collections 4. a client with difficulty swallowing food and fluid

3. The other tasks are not within the UAP scope of practice

a nurse has received the assignment for the day shift. after making initial rounds and checking all of the assigned clients, which client should the nurse plan to care for first? 1. a client who is ambulatory 2. a client scheduled for PT at 1pm 3. a client with a fever who is diaphoretic and restless 4. a post op client who just received pain medication

3. the client with a fever and restless, their needs take priority

The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. an UAP is resistant to the change and is not taking an active part in facilitating the process of change. which is the BEST approach in dealing with the UAP? 1. ignore the resistance 2. exert coercion on the UAP 3. provide a positive reward system for the UAP 4. confront the UAP to encourage verbalization of feelings regarding the change

4.

The nurse employed in a long-term care facility is planning assignments for the clients on a nursing unit. The nurse needs to assign 4 clients and has a licensed (vocational) nurse and 3 UAPs on the nursing team. Which client would the nurse most appropriately to assign to the licensed practical nurse? 1. a client who requires a bed bath 2. an older client requiring frequent ambulation 3. a client who requires hourly vital sign measurements 4. a client requires abdominal wound irrigations and dressing changes q3hrs

4. The other tasks can be done within the scope of a UAP

The nurse is assigned to care for 4 clients. In planning client rounds, which client should the nurse assess first? 1. a client scheduled for chest xray 2.a client requiring daily dressing change 3. a post-op patient preparing for discharge 4. a client receiving nasal oxygen who had difficulty breathing during the previous shift

4. airway is always highest priority

a nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. the nurse is told that the nursing model is a team nursing approach. the nurse understands that planning care delivery will be based on which characteristics of this type of nursing model of practice? 1. a task approach method is used to provide care to clients 2. managed care concepts and tools are used in providing client care 3. a single registered nurse is responsible for providing care to a group of clients 4. a registered nurse leads nursing personnel in providing care to a group of clients

4. in team nursing, nursing personnel are led by a RN leader in providing care to a group of clients

The nurse employed in the ED is assigned to triage clients coming to the ED for treatment on the evening shift. The nurse should assign priority to which client? 1. a client complaining of muscle aches, HA, and malaise 2. a client who twisted her ankle when she fell while rollerblading 3. a client with a minor laceration on the index finger sustained while cutting an eggplant 4.a client with chest pain who states he just ate pizza that was made with a very spicy sauce

4. in the ED clients with trauma, chest pain, severe resp distress or cardiac arrest, limb amputation, and acute neurological deficits are classified as number 1 priority

The nurse is giving a bed bath to an assigned client when an unlicensed assistive personnel (UAP) enters the client's room and tells the nurse that another assigned client is in pain and needs pain medication. What is the MOST APPROPRIATE nursing action? 1. Finish the bed bath and then administer the pain medication to the other client 2. Ask the UAP to find out when the last pain medication was given to the client 3.Ask the UAP to tell the client in pain that the medication will be administered as soon as the bed bath is completed 4.cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client

4. prioritize. the nurse is responsible for the care provided to assigned clients, provide safety to the client receiving the bed bath and prepare to administer the pain medication