Exam 1: QSEN-Teamwork and Collaboration Questions

Which member of the healthcare team would the nurse claim performs functions through passive delegation? 1. pharmacist 2. unit secretary 3. licensed practical nurse 4. unlicensed assistive personnel

1 rationale: A pharmacist performs functions through passive delegation. Unit secretaries may not be eligible to perform any activity because they do not have formal preparation and legal recognition. The licensed practical nurse does not delegate, but rather acts as a delegatee. The unlicensed assistive personnel are also delegatees.

Which component is the ability to perform duties in a specific role? 1. authority 2. responsibility 3. accountability 4. legal authority

1 rationale: Authority is the ability to perform duties in a specific role. Responsibility refers to reliability, dependability, and obligation to accomplish work. Accountability determines whether a person's actions were appropriate and provides a detailed explanation of what occurred. Legal authority is the ability to transfer selected nursing activities in a given situation to a competent individual.

What is the duty of the nurse as delegator if the delegatee has limited knowledge and ability to perform a task? 1. provide guidance 2. observe and motivate 3. explain what is to be done 4. establish mutual expectations

1 rationale: If the delegatee has limited knowledge and ability to perform a task, the delegator should provide guidance. The delegator is expected to observe and monitor the task performed by the delegatee to ensure he or she has the ability and willingness to establish a relationship and accomplish work. The RN explains the task and how to execute it if the situation involves a new task and the relationship is ongoing. If the delegatee is new to the workplace, but has the ability and willingness to perform a task, the delegator should establish mutual expectations and conditions of performance in order to establish a good relationship.

A nurse leader has prepared an objective for strategic planning. Which point indicates that the nurse possesses the ability to write objectives clearly and concisely? 1. Inclusion of the timeline and deadline 2. Leaving expectations open to interpretation 3. Starting with an article followed by a noun 4. Specifying multiple dates for the attainment of a goal

1 rationale: In order for objectives to be clear and concise, they should have a timeframe within which the activity or improvement must be achieved. The timeline and deadlines should be included in the written objective. A clear and concise objective should leave no question about the expectations; it should not be open to interpretation. An objective should always start with "to" followed by an action verb. A single date for attaining the goal is the indication of a clear and concise objective.

Which leadership skill is least likely to be utilized when the case method of care delivery is used? 1. delegation 2. collaboration 3. communication 4. time management

1 rationale: No aspect of nursing care is delegated when the case method of care delivery is used, thus eliminating the need for supervising others. The nurse will collaborate and communicate with the client, family, and other care providers when providing care through the case method. Time management is essential with the case method because all activities and tasks are to be completed during the nurse's period of work.

During the delegation process, which healthcare professional acts as a liaison between the team leader and healthcare provider? 1. charge nurse 2. nurse manager 3. nursing supervisor 4. chief nursing officer

1 rationale: The charge nurse is responsible for acting as a liaison between the team leaders and healthcare providers. Nurse managers cannot act as a liaison between the team leader and other healthcare providers because they are often responsible for more than one unit and have other managerial responsibilities. The nursing supervisor will be delegated to supervise and ensure effective outcomes for the tasks delegated to the delegatees. The chief nursing officer is responsible for establishing the systems for assessment.

Who acts as a delegator in the absence of the registered nurse? 1. charge nurse 2. patient care associate 3. licensed practical nurse 4. unlicensed nursing personnel

1 rationale: The charge nurses act as a delegator on the basis of knowledge and experience in clinical settings. In the absence of a registered nurse, the charge nurse usually delegates the tasks. A patient care associate assists and monitors vital signs. Licensed practical nurses and unlicensed nursing personnel are considered delegatees due to insufficient experience and training.

A pharmacy technician arrives on the nursing unit to deliver opioids and, following hospital protocol, asks the nurse to receive the medications. The nurse is assisting a confused and unsteady client back to the client's room. How should the nurse respond to the technician? 1. "I can't receive them right now. Please wait a few minutes or come back." 2. "Please leave the medications and sign-out sheet in a location where I can see them." 3. "Please bring them to me and I will be sure to put them away in a couple of minutes." 4. "I can't receive them right now. Please give them to the unlicensed healthcare worker."

1 rationale: The transfer of controlled substances from one authorized person to another must occur according to protocol. In this situation the controlled substance must be returned to the pharmacy and delivered at a later time. The controlled substances cannot be left unattended. The nurse cannot delay the securing of controlled substances; if time is not available when the medications are delivered, they must be returned to the pharmacy. The unlicensed healthcare worker does not have the authority to receive controlled substances.

Which health care providers should be considered when filling a position as case manager for a community health care center? Select all that apply. 1. social worker 2. registered nurse 3. physician assistant 4. respiratory therapist 5. certified nursing assistant

1, 2 rationale: Social workers and nurses may work as case managers, bringing with them their discipline-specific skills and knowledge. A physician assistant is not identified as being appropriate for case management. The respiratory therapist's scope of practice is limited to respiratory function. The certified nursing assistant does not have adequate education to support the total client's needs in the case management model.

The client is experiencing postoperative pain and requests a pain shot. Which of the following healthcare providers are legally permitted to administer an intramuscular (IM) injection to the client? Select all that apply. 1. registered nurse (RN) 2. licensed practical nurse (LPN) 3. licensed vocational nurse (LVN) 4. unlicensed nursing personnel (UNP) 5. unlicensed assistive personnel (UAP)

1, 2, 3 rationale: In this situation, the LPN and LVN can administer the IM medication; the RN can also administer the medication through IM when the condition is severe. The UNP and UAP can obtain, record, and report vital signs as delegated.

What are the three strategies that the nurse can perform while assisting other nurses in making delegation decisions? Select all that apply. 1. doing 2. telling 3. asking 4. offering 5. participating

1, 3, 4 rationale: The nurse can assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Telling and participating are the strategies used by the nurse to communicate with the delegatee.

Which are considered as nurse competencies within the synergy model of care delivery? Select all that apply. 1. collaboration 2. care planning 3. communication 4. clinical judgment 5. cultural competency

1, 4, 5 rationale: The Synergy Model describes eight nurse competencies, which include collaboration, clinical judgment, advocacy and moral agency, caring practices, facilitation of learning, systems thinking, response to diversity (cultural competency), and clinical inquiry. Care planning and communication are skills that every nurse should demonstrate regardless of the care delivery system being implemented.

The registered nurse (RN) is caring for an older client who has been admitted to the hospital. The RN allocates several tasks to the unlicensed nursing personnel (UNP). In order to evaluate the understanding of the UNP, the RN asks the UNP to describe which tasks have been allocated. Which responses given by the UNP indicate effective understanding of the tasks? Select all that apply. 1. "I must assist the client with oral care." 2. "I must assess the client's health status." 3. "I must administer intravenous drug in accordance with the schedule." 4. "I must give a sponge bath to the client every morning." 5. "I must record the blood pressure of the client at regular intervals."

1, 4, 5 rationale: The registered nurse allocates the tasks to the UNP based on the capabilities and skills of the UNP. The UNP can perform tasks that involve basic hygiene and activities of daily life, such as oral care, toileting, bathing, and eating. The UNP can also perform tasks to record vital signs, such as blood pressure readings and temperature measurement. Assessment of the client's health status and intravenous drug administration are within the scope of practice of registered nurses, not UNP.

How does a nurse leader effectively implement change in an organization? 1. By avoiding using managerial skills 2. By using personal and professional skills 3. By avoiding giving timely feedback to team members 4. By removing the ineffective team members from the group

2 rationale: A nurse leader should use both personal and professional skills to ensure effective implementation of a change in an organization. A nurse leader should also use managerial skills, not avoid them, to ensure effective implementation of a change in an organization. A nurse leader should give regular and timely feedback to the team members to implement change effectively. A nurse leader should motivate the team members to work effectively rather than removing them from the team.

Which behavior would the nurse consider suitable for an executive position according to Gardner's tasks of leading/managing? 1. To inspire clients/families to achieve their vision 2. To assist corporate leaders with planning and priority setting 3. To inspire the staff to achieve the mission of the organization 4. To ensure that the organizational systems work on the client's behalf

2 rationale: According to Gardner's tasks of leading/managing, a behavior of the executive position is to assist corporate leaders with planning and priority setting. Leading inspires client/families to achieve their vision. A behavior of the management position is to inspire the staff to achieve the mission of the organization. A behavior of the clinical position is to ensure that the organizational systems work on the client's behalf.

A client at 20 weeks' gestation visits the prenatal clinic for the first time. Assessment reveals temperature of 98.8° F (37.1° C), pulse of 80 beats per minute, blood pressure of 128/80 mm Hg, weight of 142 lb (64.4 kg) (pre-pregnancy weight was 132 lb (59.9), fetal heart rate (FHR) of 140 beats per minute, urine that is negative for protein, and fasting blood glucose level of 92 mg/dL (5.2 mmol/L). What should the nurse do after making these assessments? 1. report the findings because the client needs immediate intervention 2. document the results because they are expected at 20 weeks' gestation 3. record the findings in the medical record because they are not within the norm but are not critical 4. prepare the client for an emergency admission because these findings may represent jeopardy to the client and fetus

2 rationale: All data presented are expected for a client at 20 weeks' gestation and should be documented. There is no need for immediate intervention or an emergency admission because all findings are expected.

Which statement is true about the centralization as it relates to organizational structures? 1. It refers to the physical location of units. 2. It refers to the location where a decision is made. 3. It refers to the degree in which organization has rules. 4. It refers to the terms of policies that define a member's function.

2 rationale: Centralization refers to a location where the decision is made. Geographic dispersion refers to the physical location of the units. Formalization refers to the degree to which organization has rules, in terms of policies that define a member's function.

transferring responsibility to multiple players, usually with varying degrees of education and experience, while retaining the ultimate accountability for providing the client care? 1. leadership 2. delegation 3. supervision 4. assignment

2 rationale: Delegation is a process of sharing the responsibility of client care. It involves the transfer of responsibility for the performance of an activity from one individual to another, with the delegator retaining accountability for the outcome. Leadership is the use of individual traits and abilities in relationship with others, the ability to interpret the context where a situation is emerging, and entering that situation in the absence of a script or defined plan that could have been projected. Supervision is defined as the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity. Assignment is the transfer of both the accountability and the responsibility from one person to another.

Who is responsible for client outcomes in the functional model of care? 1. charge nurse 2. nurse manager 3. registered nurse 4. medication nurse

2 rationale: In the functional model of nursing, the nurse manager is responsible for client outcome achievement because staff members are only responsible for specific tasks. The charge nurse coordinates care and assignments. The registered nurse is assigned specific tasks such as assessments and intravenous medications. The medication nurse is responsible for administering medications.

Which healthcare team member is familiar with all the needs of any individual client? 1. orderlies 2. nursing aid 3. charge nurse 4. patient care associate

3 rationale: The charge nurse is involved in the coordination and assignment of care to individual clients. Therefore, the charge nurse is the only person familiar with all the needs of any individual client who is under care. Orderlies are unlicensed assistive personnel who are delegated to care for the client's basic needs and do not have complete knowledge of a client's condition. Nursing aides are not familiar with all client needs, but care for the client according to the tasks delegated to them. The patient care associate is an unlicensed nursing professional involved in basic care of the client.

While auditing unit documents, a nurse finds some omissions. Which term best describes when the nurse meets with the staff to discuss the findings and communicates ways to achieve the desired goals? 1. leadership 2. followership 3. management 4. decision making

3 rationale: The process of guiding, planning, and controlling others in a situation where communication is shared to improve clinical processes and outcomes is referred to as management. Leadership can be defined as a process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve goals. Followership is the process of following the leader or the manager to ensure the best clinical decision making and actions taken to achieve organizational outcomes. Decision making is a process of making crucial decisions.

A client with asthma and depression is admitted to the hospital. Which tasks delegated by the delegator would indicate the task is applicable for the registered nurse? 1. "Administer oral antidepressants." 2. "Administer a pain killer intramuscularly." 3. "Teach the client how to use a meter dose inhaler." 4. "Reinforce tips for stress management with the client."

3 rationale: The registered nurse is delegated to teach the client about using a meter dose inhaler for asthma. Oral administration of drugs is under the scope of practice of a licensed practical nurse (LPN) and a licensed vocational nurse (LVN). Administration of intramuscular medications will also be tasks delegated to an LPN or LVN. Reinforcing teachings is the task of an LPN, LVN, or unlicensed assistive personnel (UAP).

Who is mainly responsible for analyzing the knowledge and work of newly hired unlicensed assistive personnel (UAP) before delegating a task? 1. charge nurse 2. associate nurse 3. registered nurse 4. nursing manager

3 rationale: The registered nurse must analyze any individual's knowledge before delegating a task. The charge nurse mainly functions as a liaison between team leaders and other healthcare providers. The associate nurse follows the care plan in the absence of a registered nurse. The nursing manager is responsible for more than one unit and has other managerial responsibilities.

Which action would the nurse think should be excluded to prevent staff from having posttraumatic stress disorder (PTSD) during a mass casualty assessment? 1. to work less than 12 hours 2. encourage and motivate team members 3. to work continuously without any breaks 4. to discuss feelings with the team members

3 rationale: Working continuously without any breaks will result in increased stress. Working less than 12 hours may reduce stress. By motivating team members, posttraumatic stress disorder can be prevented. By discussing feelings with team members or nurse managers, stress can be reduced.

Which delegation actions may be performed by unlicensed nursing personnel while caring for a client? Select all that apply. 1. Teaching the care plan to the client 2. Infusing intravenous fluids into the client 3. Asking the client to wash the hands before meals 4. Instructing the client to take specific medications 5. Instructing the client to wear footwear while walking

3, 5 rationale: Unlicensed nursing personnel (UNP) can delegate simple and straightforward client teaching, such as asking the client to wash his or her hands before meals and wear footwear while walking. Complex and multifaceted teaching, such as detailing the care plan to the client, cannot be delegated to a UNP. The UNP has less knowledge and professional skills with which to perform complex procedures such as infusing intravenous fluids into the client and does not have a complete knowledge of medications with which to coach the client about medications.

Which component of delegation is retained while the delegator is delegating the client's care task to the nursing aide? 1. authority 2. supervision 3. responsibility 4. accountability

4 rationale: Accountability is retained by the delegator while delegating a client's care task to the nursing aide. Every individual on the healthcare team has authority for the delegated task. The nursing aide is just responsible for the delegated task, so the delegator retains the accountability. Supervision is a right of delegation.

What term began to be used in the 1960s to describe case management? 1. process control 2. risk management 3. quality improvement 4. utilization management

4 rationale: In the 1960s, insurers began to use nursing case management (NCM) as a strategy to manage the needs of complex clients who require coordination over the course of treatment. Acute care hospitals used nurses in this role under the term "utilization management." Process control is not a recognized term for client management. Risk management is a process to manage safety. Quality improvement is a process of ensuring high quality safe client care.

Which term refers to the nurse's ability to plan, direct, control, and evaluate others in different situations? 1. delegation 2. leadership 3. followership 4. management

4 rationale: Management is defined as the ability to plan, direct, control, and evaluate the nurse staff in various situations. Delegation is the transfer of authority to perform some type of task or work. Leadership can be defined as the use of individual traits and abilities in relationship to others and the ability to interpret the context where a situation is emerging. Followership is that each member of a team contributes optimally, but acquiesces to a leader or manager to ensure the best clinical decision-making.

A healthcare team is caring for a client with dental pain. Which task is most suitable to be delegated to unlicensed assistive personnel (UAP) to provide effective client care? 1. administering analgesics 2. administering intravenous antibiotics 3. administering nerve block anesthesia 4. administering mouth wash hygiene

4 rationale: The UAP scope of practice includes administering mouth wash to the client. Instructing the UAP to administer medications such as antibiotics and anesthetics is inappropriate because the UAP is not eligible to do so and may not have the knowledge to administer medications. Administering nerve block anesthesia should be performed by the anesthesiologist.

What does a psychiatric nurse identify as the primary purpose of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition ( DSM-5)? 1. Facilitate communication between researchers and clinicians. 2. Aid in teaching psychopathology to mental health professionals. 3. Assist in collecting accurate public health statistics through the use of diagnostic codes. 4. Provide a classification of types of mental disorders and guidelines to aid in making a diagnosis.

4 rationale: The prime purpose of the DSM-5 is to serve the clinician as a guide in identifying a client's mental health or psychiatric diagnosis. Although the DSM-5 is useful in facilitating communication, the teaching of psychopathology, and the collection of accurate public health statistics, none of these are the primary purpose of this publication.