HESI Leadership
What are the steps of performing a primary survey according to priority to assess a client with severe injuries from a bomb blast? 1. Disability 2. Airway 3. Exposure 4. Breathing 5. Circulation
Airway Breathing Circulation Disability Exposure The initial assessment of a client with severe injuries in a bomb blast is called the primary survey. It is based on a standard "ABC" mnemonic plus a "D" and "E." Here, A stands for airway/cervical spine, B for breathing, C for circulation, D for disability, and E for exposure.
A licensed practical nurse (LPN) was hired recently. Which strategy should be applied by the registered nurse (RN) to open lines of communication between them? 1 Telling 2 Selling 3 Asking 4 Offering
Asking Asking is the first strategy and begins with questions that open lines of communication between the newly hired LPN and RN. Telling is helpful when the delegatee and delegator have a new relationship. Selling is the supervision by the delegator when the delegator and delegatee have a long relationship and have been working together for a while. Offering is also a strategy that can be followed after using the asking strategy by making a suggestion.
The healthcare team is caring for a client who has undergone surgery for lung cancer. The client needs respiratory therapy. Which task can be safely delegated to a respiratory therapist paired with a registered nurse? 1 Placing a Foley catheter 2 Assessing the respirations 3 Placing an intravenous (IV) catheter 4 Administering patient-controlled analgesia
Assessing the respirations Respiratory therapy is needed in clients who undergo surgery for lung cancer. Assessing respiration can be safely delegated to the respiratory therapist. Placing a Foley catheter, an IV catheter, or administering patient-controlled analgesia is within the scope of a registered nurse's practice.
During the activation of an emergency preparedness plan, which individual should communicate with the media? 1 Medical director 2 Emergency room nurse 3 Director of Human Resources 4 Hospital chief executive officer
Director of Human Resources The person who would most likely serve as a liaison between the healthcare facility and the media would be the Director of Human Resources. The Medical Director would most likely decide the number, acuity, and resource needs of clients. The Emergency Room Nurse would most likely evaluate each client to determine priorities for treatment. The Hospital Chief Executive Officer would most likely assume overall leadership for implementing the emergency plan.
Which characteristics of the delegatee should be considered to determine that he or she is the "right person"? Select all that apply. 1 Experience 2 Supervision 3 Willingness 4 Competence 5 Communication
Experience Willingness Competence The delegatee should be assigned a task if he or she has experience that would allow the delegator to provide minimal guidance. The willingness of the delegatee is also important to consider before assigning the task. The competence of the delegatee must be assessed before assigning the task. The delegator should supervise the tasks performed by the delegatee. The delegatee's communication skills are assessed to ensure right direction and communication.
Which hospital care setting is most appropriate for a case manager to perform tasks as a delegatee? 1 Hospice care 2 Extended care 3 Long-term care 4 Rehabilitative care
Rehabilitative care Rehabilitative care settings are the most suitable for a case manager to perform tasks as a delegatee. Hospice care settings are generally delegated to the registered nurse (RN). In extended care and long-term care settings, tasks are delegated to unlicensed assistive personnel (UAP).
What are the elements integrated into delegacy? Select all that apply. 1 Stability 2 Leadership 3 Clinical practice 4 Critical thinking 5 Communication
Stability Critical thinking The four elements that foster effective delegation decisions are safety, critical thinking, stability, and time. Leadership, critical thinking, communication, and clinical practice are the competency skills of a charge nurse.
Which of the following nursing interventions promotes perfusion and healing of the surgical wound for an older adult? 1 The nurse should minimize the use of tape on the skin. 2 The nurse should keep the client adequately hydrated. 3 The nurse should change the dressings as soon as they get wet. 4 The nurse should provide rest for the client throughout the day.
The nurse should keep the client adequately hydrated. The best practice of the nurse to improve perfusion of the wound to promote healing for an older client after surgery is to keep the client adequately hydrated. The nurse should minimize the use of tape on the skin to protect the fragile skin of the client. The nurse should also change the dressing as soon as they get wet during the protection of fragile skin. The nurse should provide rest to the client throughout the day to conserve the energy required for healing. Topics
The nurse manager is reviewing the hospital disaster plan with other members of the committee. Which is the minimum number of disaster drills the committee must plan and implement each year? 1 Two 2 Three 3 Four 4 Five
Two While it is appropriate to have more than the minimum number of disaster drill each year, the minimum that must be implemented per The Joint Commission (TJC) requirements is twice per calendar year.
The registered nurse is assigned on a shift with four nursing professionals. Organize the nursing professionals according to their span of control from least to most span of control. 1. Nurse manager 2. Registered nurse 3. Licensed vocational nurse 4. Unlicensed nursing personnel
Unlicensed nursing personnel Licensed vocational nurse Registered nurse Nurse manager Span of control increases as the number of individuals under a person's control increases. A nurse manager is responsible for the execution of duties delegated to registered nurses (RNs), licensed vocational nurses (LVNs)/licensed practical nurses (LPNs), and unlicensed nursing personnel (UNP). RNs are responsible for the work of LVNs, LPNs, and UNP. UNP have the smallest span of control.
Which actions can the mentor take to develop effective leadership qualities in the aspiring leader? Select all that apply. 1 Avoiding criticism 2 Modeling behavior 3 Noting the mistakes 4 Giving timely feedback 5 Providing appropriate advice
Modeling behavior Giving timely feedback Providing appropriate advice The mentor should model professional and desired behavior and give timely feedback and appropriate advice to make the aspiring leader an effective leader. The mentor should not criticize, but rather coach the new aspiring leader to develop a personal leadership style. Noting the mistakes without feedback does not help an aspiring leader become an effective leader. Topic
The registered nurse (RN) is caring for a client who underwent ileostomy. Which activity performed by the nurse indicates following the principle of right circumstance of delegation? Select all that apply. 1 Assessing the willingness of the delegatee 2 Assessing the equipment to determine vital signs 3 Providing supervision of the delegatee during the task 4 Teaching institutional policies about caring for a client with ileostomy 5 Communicating with the delegatee about care management of the client
Assessing the equipment to determine vital signs Providing supervision of the delegatee during the task Assessing the equipment and resources available to perform the task determines right circumstance of delegation. Supervising the delegatee during the task indicates right circumstance of delegation. Assessing the willingness of the delegatee determines the principle of right person of delegation. Determining if the task can be performed based on institutional policies indicates principle of right task of delegation. Communicating with the delegatee falls under right communication of delegation.
An obese client leads a sedentary lifestyle and complains of leg pain when walking long distances. A nurse leader is teaching the client different exercises that can relieve the pain and can be performed while working in an office or doing daily activities. Which of Gardner's leadership tasks is the leader nurse following? 1 Managing 2 Explaining 3 Motivating 4 Affirming values
Explaining The nurse leader is performing the explaining element of Gardner's leadership tasks. Explaining includes teaching and interpreting information to promote client functioning and well-being. Managing involves assisting the client with planning, priority setting, and decision making while ensuring the organizational systems work on the client's behalf. Motivating is inspiring clients to achieve their vision. Assisting clients in sorting out and articulating personal values in relation to health problems falls under the affirming values task.
The leader nurse noticed that a staff nurse is unable to meet the responsibilities assigned, though the staff nurse is aware of the working requirements. What is the staff nurse experiencing? 1 Role theory 2 Role conflict 3 Role ambiguity 4 Role acquisition
Role conflict Role conflict is easier to recognize because the employees know what is expected from them, but they are either unwilling or unable to meet the requirements. Role theory provides an appreciable framework for the development and evaluation of staff. Role ambiguity in the workplace creates an environment for misunderstanding and hinders effective communication. Individuals do not have a clear understanding of what is expected of their performance or how they are evaluated. Role acquisition is enhanced by the use of clear position descriptions and evaluation standards.
The blood lab work for a client with purpuric lesions on the skin shows a thrombocyte count of 100,000 cells per microliter. Which nursing intervention would be priority in this client to reduce the risk of bleeding? 1 Advising the client to drink plenty of fluids 2 Advising the client to perform bending exercises 3 Advising the client to use superabsorbent tampons 4 Advising the client to use alcohol-based mouthwashes
Advising the client to drink plenty of fluids A client with purpuric lesions and a thrombocyte count of 100,000 cells per microliter has thrombocytopenia. Drinking plenty of fluids helps to prevent constipation and straining while having a bowel movement, thereby preventing bleeding. Performing bending exercises may lead to bleeding from the nose, and it is contraindicated. Usage of superabsorbent tampons may increase the chance of toxic shock syndrome (TSS) and result in severe infection or death. Usage of alcohol-based mouthwashes can dry the gums and increase bleeding.
What is the proper order of events the nurse follows for performing critical analysis using the nursing process as a guide for delegation? 1. Planning an intervention 2. Implementing the plan including an observation of the delegation 3. Assessing the situation to determine what is legally appropriate to delegate 4. Evaluating whether the delegation process was completed safely and effectively 5. Determining whether the delegatee is competent to perform the task safely
Assessing the situation to determine what is legally appropriate to delegate Planning an intervention Determining whether the delegatee is competent to perform the task safely Implementing the plan including an observation of the delegation Evaluating whether the delegation process was completed safely and effectively To perform a critical analysis, the registered nurse uses the nursing process as a guide for delegation. The registered nurse in this situation determines what is legally appropriate to delegate. Then the registered nurse plans an intervention for it and determines whether the delegatee is competent to perform the task safely. The registered nurse implements the plan including an observation of the delegatee. Then the registered nurse evaluates whether the delegation process was completed safely and effectively.1
A direct care nurse performs exceedingly well on a cancer project. As a result, the managerial team decides to promote the nurse to a managerial position. Which actions by the nurse would justify the decision of the panel? Select all that apply. 1 Inspiring new ideas 2 Establishing short-term goals 3 Demonstrating positive feelings 4 Maximizing results from existing resources 5 Showing willingness to both lead and follow peers
Inspiring new ideas Establishing short-term goals Demonstrating positive feelings Maximizing results from existing resources The leader provides new ideas with a long-term effect on the progress of the organization. He or she should also provide a positive atmosphere by giving an equal importance to the followers. Providing short-term goals and maximizing results from existing resources are the job responsibilities of a manager. The willingness to lead and follow peers is the quality of a good follower.
Which actions in the delegation process represent accountability? Select all that apply. 1 Monitoring client care 2 Seeking the outcome report 3 Assessing the ability of the delegatee 4 Providing honest feedback to the delegatee 5 Assisting registered nurses with delegation decisions
Monitoring client care Seeking the outcome report Monitoring client care and seeking the outcome report represents accountability of the task in case of conflicts. Assessing the ability of the delegatee and educating about the task indicates responsibility. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions regarding safety issues, urgency to intervene, or potential negative client outcomes.
The nurse is caring for four clients who have survived burn injuries from a chemical plant explosion. Which client requires immediate surgical intervention based on priority? 1 Client with erythema 2 Client with fluid-filled vesicles 3 Client with mild to moderate edema 4 Client with visible thrombosed vessels
Client with visible thrombosed vessels The client with third to four degree burns suffer with dry, waxy white hard skin with visible thrombosed vessels. Therefore immediate surgical intervention is required in these clients. Conditions such as erythema, pain, and mild swelling are observed in clients with superficial burns, which may not require surgery. Clients with fluid-filled vesicles that are red and shiny or have mild to moderate edema is observed in clients with second degree burns. These clients may not require surgery.
The registered nurse is caring for a client undergoing chemotherapy. Which statement made by the client shows a need for the registered nurse (RN) to delegate unlicensed assistive personnel (UAP) to help the client with activities of daily living (ADL)? Select all that apply. 1 "I have severe nausea." 2 "I developed rashes after therapy." 3 "I am unable to bear the pain of chemotherapy." 4 "I am unable to eat by myself due to the intravenous (IV) catheter." 5 "I am unable to get out of bed because I am so weak from the therapy."
"I am unable to eat by myself due to the intravenous (IV) catheter." "I am unable to get out of bed because I am so weak from the therapy." Unlicensed assistive personnel are members of the healthcare team whose scope of practice is limited to feeding, providing basic care, hygiene, and comfort. The client reporting an inability to eat due to the intravenous catheter and an inability to get out of bed due to weakness indicates that he or she can be assisted by the UAP. The RN will be required to report the client's severe nausea to the primary healthcare provider. The RN will be required to report the pain experienced by the client undergoing chemotherapy. The client who developed rashes after therapy will require the RN to report the side effects of the medication to the primary healthcare provider.
While caring for a client with asthma, the delegator assigns the client to a registered nurse (RN) and to a licensed practical nurse (LPN). Which component of delegation is transferable to the RN? Select all that apply. 1 Authority 2 Supervision 3 Responsibility 4 Accountability 5 Communication
Authority Responsibility Accountability Authority, a component of delegation, is transferred to the registered nurse (RN) by the delegator. Responsibility is the component of delegation that is transferable to the RN. Accountability is also a component of delegation that is transferable to the RN. Supervision and communication are rights of delegation.
Which are disadvantages to the functional system of care delivery? Select all that apply. 1 Poor communication 2 Fragmentation of care 3 Efficiency with specific tasks 4 Fixed number of registered nurses 5 Changes in client status go unnoticed
Poor communication Fragmentation of care Changes in client status go unnoticed The disadvantages associated with the functional system of care delivery include poor communication among the team, fragmentation of care, and changes in client status that may go unnoticed. Efficiency with specific tasks and a fixed number of registered nurses are both considered advantages to the functional system of care delivery.
What are the functions of the Hospital Incident Command System (HICS) in disaster management? Select all that apply. A To manage mass fatalities B To provide first aid stations C To standardize disaster operations D To establish emergency animal care E To establish an emergency operations center (EOC)
To standardize disaster operations To establish an emergency operations center (EOC) The Hospital Incident Command System (HICS) is the facility-level organizational model for disaster management. It functions to standardize disaster operations. HICS personnel establish an emergency operations center (EOC) or command center. Disaster Mortuary Operational Response Teams (DMORTs) manage mass facilities. A Disaster Medical Assistance Team (DMAT) is a medical relief team that provides first aid stations. A National Veterinary Response Team (NVRT) is a healthcare service that establishes emergency animal care.
Which of these clients is most appropriate for delegation to a cross-trained technician? 1 Client A respiratory therapy 2 Client B 3 Client C 4 Client D
Client A A cross-trained technician, when paired with a registered nurse (RN), may perform respiratory therapy, phlebotomy, and electrocardiography. Care of client A can be safely delegated to a cross-trained technician. Though the cross-trained technician can record the ECG, he or she may not monitor the continuous ECG. Monitoring of vital signs is also the role of the RN. Leg exercises may be taught by the RN or by a physician. The other licensed assistive personnel may be delegated the task of reinforcing the teaching, but this is not an appropriate role for the cross-trained technician.
The registered nurse is assigning work to four delegatees. Which delegatee most likely has a limited relationship with the delegator? 1 Delegatee A 2 Delegatee B 3 Delegatee C 4 Delegatee D
Delegatee B According to Hersey's model, if the relationship between the delegator and delegatee is limited, the behavior of the delegator is "telling." The delegator is telling Delegatee B to check the client's blood pressure every morning, which indicates a limited relationship between them. Participating in the delegatee's work by helping to complete the task early indicates a new relationship, which may be ongoing. Monitoring the delegatee by saying he or she is right indicates an established relationship between the delegator and delegatee. Recommending that the delegatee use a digital sphygmomanometer for ease and accuracy indicates selling behavior; this is done when the relationship between the delegator and delegatee is ongoing.
The registered nurse assigned a task to unlicensed nursing personnel (UNP). The UNP observed a change when measuring a client's blood pressure. What is the responsibility of the UNP in this situation? 1 Administer medication. 2 Inform the licensed practical nurse. 3 Inform the registered nurse immediately. 4 Discuss with other UNP about the problem.
Inform the registered nurse immediately. The UNP should inform the registered nurse about the condition of the client immediately, as the RN is accountable and responsible for the client. The UNP is not eligible to administer medication to the client. Informing the licensed practical nurse (LPN) is not beneficial because the LPN is not directly responsible for client care. The LPN can give client care only under the supervision of the RN. Discussing with other UPN is not appropriate.
Which personnel are responsible for identifying the need for and calling in specialty trained providers in emergencies? 1 Triage officer 2 Public information officer 3 Medical command physician 4 Hospital incident commander
Medical command physician The medical command physician is responsible for identifying the resource needs of the clients. Therefore the medical command physician identifies the need for and calls in the specialty trained providers in emergencies. Triage officers are responsible for rapidly evaluating each client to determine priorities for treatment. The public information officer serves as a liaison between the healthcare facility and the media. The hospital incident commander is the one who assumes overall leadership for implementing the emergency plan.
Which healthcare professional would the nurse know is held accountable for the tasks performed by the patient care associate (PCA)? 1 Registered nurse (RN) 2 Licensed vocational nurse (LVN) 3 Unlicensed assistive personnel (UAP) 4 Unlicensed nursing practitioner (UNP)
Registered nurse (RN) The delegator is held accountable for tasks performed by the delegatee. In this situation, the delegator is the RN; therefore, the RN is held accountable for the tasks performed by the PCAs. The RN is also accountable for delegation to LVNs, UAPs, and UNPs as delegatees.
The nurse is caring for the survivors of a disaster. Which tag would be assigned to a client who has an open fracture with a distal pulse? 1 Red 2 Black 3 Green 4 Yellow
yellow A yellow tag is assigned to clients with open fractures that require treatment within 30 minutes to 2 hours. A red tag is assigned to clients with life-threatening conditions such as severe hemorrhage or airway obstruction that require immediate treatment. A black tag is assigned to clients who are dead or expected to die. A green tag is assigned to clients with minor injuries.
Which statements indicate that the nurse leader is adapting to changes in leadership practices to adjust to complex changes in healthcare systems? Select all that apply. 1 "I will stop tracking progress." 2 "I will be clear about purpose and process." 3 "I will involve stakeholders and listen to them." 4 "I will stop utilizing and providing older resources." 5 "I will align systems and processes to support the change."
"I will be clear about purpose and process." "I will involve stakeholders and listen to them." "I will align systems and processes to support the change." The nurse leader should be clear about the purpose and processes in order to adjust to complex changes. This clarity will help the nurse leader implement the desired changes efficiently and effectively. Listening to the stakeholders and involving them helps the nurse leader understand the changes properly. Aligning systems and processes to support the change is an effective way to implement the change. Tracking progress helps the nurse analyze whether the change is being implemented properly. Utilization of both new and older resources is required to implement the changes effectively.
Which task followed by the executive nurse is a leadership development task? 1 Maintaining balance 2 Having a clear vision 3 Listening to constituents 4 Maintaining a positive attitude
Having a clear vision Having a clear vision and seeing beyond where one is and where one is going is a leadership development task. Maintaining balance, listening to constituents, and maintaining a positive attitude are rules for a leader.
Which activity performed by the registered nurse in a healthcare organization is considered active delegation? 1 A pharmacist giving medications upon prescription 2 A primary healthcare provider assessing and prescribing medication 3 A registered nurse administering medication and fluids upon prescription 4 A registered nurse directing an unlicensed nursing professional to perform certain task
A registered nurse directing an unlicensed nursing professional to perform certain task Active delegation by a registered nurse is the process of assessing a situation and determining what is appropriate for client care such as directing an unlicensed nursing professional to perform certain tasks and holding the individual accountable. Passive delegation contains functions that are normally performed or are an essential part of the practice of a licensed individual. A pharmacist giving medications upon prescription is passive delegation since it is a part of practice. A primary healthcare provider assessing and prescribing medication is passive delegation since it is a part of practice for a primary healthcare provider. A registered nurse administering medication and fluids upon prescription is passive delegation since it is a part of practice for a registered nurse.
The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task? 1 Time 2 Safety 3 Stability 4 Critical thinking
Critical thinking Critical thinking is of utmost importance for selecting a suitable nursing assistant for delegation of a task in a situation where a client requires more attention, as the delegatee should be able to perform the task effectively. Time, safety, and stability are also the elements for effective delegation, but these are suitable depending on the situation for assigning a task and delegation.
According to chaos theory, what is the most important factor contributing to a successful organization? 1 Self-organizing structure 2 Managers who can take risks 3 Readiness to accept change 4 Leaders who are committed to lifelong learning
Readiness to accept change The most important characteristic of an organization according to chaos theory is the ability to adapt to change, which is important for survival in the face of instability and provides stability. Establishing a self-organizing structure, hiring managers who can take risks, and developing leaders who are committed to lifelong learning will help ensure that an organization is able to adapt to change.
Which statement of the chief executive officer of another healthcare facility does the nurse recognize as related to diffusion theory? Select all that apply. 1 "Our hospital culture communicates changes quickly by using Twitter." 2 "Our leaders believe in the rapid adaptability to change in order to survive." 3 "Our leaders are engaged in a change to infuse the energy from early adopters." 4 "Our team produces a model that explains the process of healthcare organization evolution." 5 "Our team believes that the greatest outcome is achieved from the sum of small acts or parts."
"Our hospital culture communicates changes quickly by using Twitter." "Our leaders are engaged in a change to infuse the energy from early adopters." Diffusion theory focuses on the quick communication of changes; therefore using Twitter in the hospital culture would be suitable in this regard. Diffusion theory also involves engaging the leaders in a change to infuse the energy from early adopters. Chaos theory believes the organization to be self-organizing. It requires the organization to be rapidly adaptable to change for survival. System theory explains the process of healthcare evolution as a model. Quantum theory focuses on the achievement of the greatest outcome through the sum of small acts.
A staff nurse is next in line to be assigned a primary client; however, the nurse is scheduled to be off for the next four work days. What should the nurse manager do? 1 Assign the client to a nurse who volunteers to take the primary client. 2 Assign the client to the next two staff nurses who can work in tandem. 3 Assign the client to the staff nurse regardless of the scheduled time off. 4 Assign the client to the nurse who comes after the one leaving for a long weekend.
Assign the client to the nurse who comes after the one leaving for a long weekend. The manager should assign the client to the nurse that comes after the one with scheduled days off because it defeats the purpose of primary nursing if the primary nurse is not available to coordinate all of the client's care. The nurse who volunteers for the primary client may not be the best choice based on the client's needs and the nurse's abilities. Primary nursing does not use a team approach. Assigning a primary client to two nurses would not be an appropriate implementation of the model. Assigning the client to the nurse regardless of having scheduled time off places a tremendous amount of responsibility on the associate nurses and does not support the intention of the delivery model.
Which client is most appropriate to be delegated to unlicensed assistive personnel (UAP) based on the given data? 1 Client A 14 months, severe diarrhea, acute 2 Client B 12 years, hand fracture, extended 3 Client C 30 years, bronchitis, acute 4 Client D 50 years, dementia, long-term
Client D The unlicensed assistive personnel (UAP) is delegated to work in long-term care settings and extended-care settings as the clients are more stable. The UAP may not be delegated to work in acute care, emergency care, and intensive care settings. In dementia, the client experiences confusion, so long-term care is essential for this client. Since UAPs generally work in long-term care, client D is most appropriate to be delegated to a UAP. As severe diarrhea needs acute care, client A may not be delegated to a UAP. Though a hand fracture may require extended care, the client can do work on his or her own when compared to the client with dementia. Therefore, client B may not be delegated to a UAP. Clients with bronchitis need acute care as they may experience breathing difficulties. Therefore, client C is not delegated to a UAP.
A delegator is providing feedback to four delegatees. Which feedback is constructive feedback that can help the delegatee to improve quality of care? 1 A Well done, nice job 2 B What is wrong with you today 3 C How did the client respond after you did the task? 4 D Your work was good, but let me demonstrate a more effective way to perform the task.
D Providing feedback to delegatee D that the procedure properly performed followed by demonstrating a more effective way to perform the task improves quality of client care. Therefore, the feedback given to delegatee D is constructive feedback. Saying to delegatee A that the work was nice is vague feedback, which does not specify the behavior of the delegatee and is not constructive feedback. Providing feedback to delegatee B asking what had gone wrong with him or her today is a verbal attack that does not produce effective change and potentially may undermine a long-term working relationship. Asking delegatee C how the client responded after the task was done is an open-ended question that allows the delegator to gain pertinent information from the delegate.
Which task can be delegated to a cross-trained technician when paired with a registered nurse? 1 Monitoring vital signs 2 Drawing blood samples 3 Teaching clients directly 4 Administering intravenous medication
Drawing blood samples Drawing the blood samples, or phlebotomy, can be delegated to cross-trained technicians when paired with the registered nurse. The cross-trained technician can only record the vital signs, monitoring the vital signs is outside the scope of practice for a cross trained technician. Intravenous medication can only be administered by the registered nurse. The cross trained technician is an assistive personnel who can reinforce the teaching but he or she cannot teach the client directly.
Which behavioral manifestations in the nursing staff should alert the nurse manager of moral distress? Select all that apply. 1 Failing to act as a client advocate 2 Withdrawing from client care situations 3 Failing to complete the assigned tasks on time 4 Involving the family members in client care 5 Educating the family members about nurse's role in client care
Failing to act as a client advocate Withdrawing from client care situations Moral distress may manifest as behavioral changes in nurses. The nurse may fail to act as a client advocate resulting in client discomfort. The nurse may withdraw from a client care situation resulting in ineffective care. Failing to complete the assigned task on time may not indicate moral distress; it can be due to many other reasons. Involving family members in client care and educating them about the nurse's role in client care may help reduce moral distress. These behaviors are not manifestations of moral distress.
The nurse leader actively participates in the quality improvement process. Arrange the steps in a sequence that the nurse leader will follow while implementing the quality improvement process? 1. Select a plan to meet the outcomes. 2. Collect the data for evaluating the plan. 3. Establish the outcomes and quality indicators. 4. Identify the important needs of the consumer. 5. Collect the data on the current status of the service. 6. Collaborate with the interprofessional team to review needs.
Identify the important needs of the consumer. Collaborate with the interprofessional team to review needs. Collect the data on the current status of the service. Establish the outcomes and quality indicators. Select a plan to meet the outcomes. Collect the data for evaluating the plan. The first step of the quality improvement process involves identifying the needs that are important to the consumer of healthcare services. Collaborating with the interprofessional team to review the needs that are identified is done to avoid bias. The next step is confirming the needs and collecting the data on the current position of the service that helps in the improvised plan. This is followed by implementing the process and establishing the outcomes for which quality indicators are required. Then the next step is to select and implement the plan to meet the outcomes and objectives of quality improvement. Evaluating the plan is the last step and is necessary for quality improvement.
The delegatee is performing a task and in the process loses confidence in what he or she is doing. Which delegator's action may have contributed to the delegatee's loss of confidence? 1 Intervening when the delegatee is performing the task 2 Providing feedback about the work performed 3 Communicating with the delegatee about the work being performed 4 Stating that the task should be completed by a specified time
Intervening when the delegatee is performing the task The delegatee may lose confidence and get frustrated if the delegator intervenes. Therefore intervening in tasks is not encouraged. The delegator can instead provide feedback about the task being performed to help improve the effectiveness of the delegation. Communication generally opens lines between the delegator and delegatee and will be helpful in effective delegation. The delegator should brief the delegatee about the specified time the task should be completed; this would not make the delegatee lose confidence.
Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply. 1 Is the prospective delegatee a willing and able employee? 2 Does the delegatee understand the directions and expected results of the task? 3 Does the delegatee understand how, what, and when to report to the delegator? 4 Is it clear that the delegatee will provide feedback related to the task when appropriate? 5 Does the delegatee have the knowledge and experience to perform the specific task safely?
Is the prospective delegatee a willing and able employee? Does the delegatee have the knowledge and experience to perform the specific task safely? The right delegatee is chosen on the basis of the person's willingness and ability. The nurse should assess the knowledge and experience of the prospective delegatee to perform the specific task safely and fulfill the expected outcomes. Right direction and documentation are assessed by the delegatee's ability to understand the directions and expected results of the task. It can also be assessed on the basis of the delegatee's understanding of how, what, and when to report to the delegator. The right supervision is providing feedback to the delegatee, related to the task, when appropriate.
The nurse manager uses operant conditioning when managing the staff by providing positive reinforcement to motivate them to repeat constructive behavior. Which leadership theory is reflected in this practice? 1 Hierarchy of needs 2 Transformational theory 3 Situational contingency theory 4 Organizational behavior (OB) modification
Organizational behavior (OB) modification OB modification theory is applied by providing positive reinforcement to the staff to motivate them to repeat constructive behaviors in the workplace. Awareness of the hierarchy of needs can be used to understand what motivates staff; for example, the need for security will override social needs. Transformational theory does not utilize operant conditioning for motivation. Situational contingency theory is applied to consider the challenge of a situation and encourages an adaptive leadership style to complement the issue being faced.
The registered nurse (RN) delegates the tasks of caring for a client with pressure ulcers. The client suffers further tissue necrosis during treatment. What could be the reason for this condition? 1 Cleaning of the wound by the registered nurse (RN) 2 Performing irrigation of the wound by the patient care associate (PCA) 3 Administering of oral analgesics by the licensed practical nurse (LPN) 4 Repositioning the client every 1-2 hours by the licensed practical nurse (LPN)
Performing irrigation of the wound by the patient care associate (PCA) The patient care associate (PCA) is not authorized to irrigate the wound as improper technique can lead to tissue damage. The RN is qualified to perform wound care; therefore, cleaning the wound is not likely to lead to tissue necrosis. Pressure ulcers are associated with pain. The LPN administering oral analgesics may relieve the pain, but it will not cause tissue necrosis. Having the licensed practical nurse (LPN) reposition the client every 1 or 2 hours will minimize the risk of tissue necrosis due to pressure ulcers.
The nurse finds that a client with a spinal cord injury has developed sudden autonomic dysreflexia. What is the priority nursing action in this situation? 1 Place in a sitting position 2 Give nifedipine as prescribed 3 Examine for symptoms of pressure ulcers 4 Monitor blood pressure every 10 to 15 minutes
Place in a sitting position Clients with spinal cord injuries are at an increased risk for developing autonomic dysreflexia. Autonomic dysreflexia is a condition in which the client has very high blood pressure. The first step in this situation is to assist the client into a sitting position because it naturally reduces blood pressure. The nurse can give nifedipine as prescribed, but only after assisting the client into a sitting position. The nurse can examine the symptoms of pressure ulcers after stabilizing the client. The nurse should monitor client's blood pressure every 10 to 15 minutes after stabilizing the client.
A hospital management team has conducted a randomized controlled trial to decrease the occurrence of ventilator-associated pneumonia .The trial was successful and had positive outcomes. The nurse manager, in collaboration with other hospital management staff, conducted the same trial in another hospital, but the results were different. Which research strategy implementation would the nurse manager consider to be beneficial in preventing dramatic differences in trial results? 1 Evidence-based practice (EBP) 2 Practice-based evidence (PBE) 3 Client-centered outcomes research 4 Comparative effectiveness research (CER)
Practice-based evidence (PBE) PBE is a research methodology that helps inform practice. It uses an observational cohort study design that compares clinically relevant interventions, includes diverse study participants, uses heterogeneous practice settings, collects data on a broad range of health outcomes, and includes frontline clinicians in study development. EBP is the integration of the best research evidence with clinical expertise and the client's unique values and circumstances in making decisions about the care of individual clients. Client-centered outcomes researchers conduct research to provide information about the best available evidence to help clients and their providers make decisions that are more informed. CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods.
What is the main motto of the Hersey's 2006 model? 1 Information decay 2 Information salience 3 Situational leadership 4 Individual accountability
Situational leadership Hersey's 2006 model provides a solid foundation for delegation decisions. The main motto of this model is situational leadership. The core competencies of a situational leader are the ability to diagnose the performance, competence, and commitment of others; to be flexible; and to partner for performance. Anthony and Vidal describe characteristics of communication that interfere with the delegation process, such as information decay. They also describe information salience, or the quality, meaning, and clarity of the information. Ana mentioned individual accountability, the expectation of accountability and responsibility in 2011, specifically referencing delegation.
