hurst leadership questions

The Emergency Department triage nurse encounters a client who says that he has received exposure to a liquid hazardous chemical at work. He reports that he is only 1 of about 20 people. What should the nurse do? 1. Call the supervisor and inform of the possibility of contamination in the surrounding space. 2. Obtain vital signs immediately. 3. Call personnel trained in containment and decontamination immediately. 4. Direct the individual to a bed space immediately. 5. Instruct the client to remove clothing and put on disposable hospital gown.

1. & 3. Correct: The nurse should report this to the supervisor who can determine the next action to take regarding isolation, decontamination, and use of the current space. Those who are trained in hazardous exposures should be informed immediately so that appropriate action is taken. These actions are priority for minimizing the exposure of clients and staff to the hazardous chemical. 2. Incorrect: The nurse should avoid contact with the client until personnel trained for handling hazardous exposures are present. 4. Incorrect: Containment is necessary to prevent further contamination of the space and individuals in the area. Directing the client to a bed space would not be containment. 5. Incorrect. The client may need to be directed to a decontamination area to prevent further contamination of the area, so removing clothing before going to this area would put others at risk for exposure to the hazardous chemical.

The nurse walks into a client's room and finds the client exposed while the unlicensed assistive personnel (UAP) is giving the bath. After covering the client with a sheet, what should the nurse do first? 1. Tell the UAP to keep the client covered at all times. 2. Talk with the UAP about providing appropriate care for all clients. 3. Provide teaching to the UAP about privacy for clients. 4. Use the call light to ask for additional assistance in the room.

1. Correct: A comment should be made about keeping the client covered. This instruction is the first action after covering the client. 2. Incorrect: The nurse should talk with the UAP but the discussion should focus specifically about providing privacy for clients. 3. Incorrect: The nurse may want to provide teaching, but this is not first action. Teaching would require allowing enough time to give instructions and then arranging time for return demonstration. 4. Incorrect: The UAP should be allowed to finish the bath. Additional assistance is not needed.

Which nurse would be the most appropriate for the charge nurse to assign to a 5 year old admitted in sickle cell crisis? 1. The nurse who is taking care of a 4 year old who had a routine appendectomy, a 3 year old who had bowel surgery, and a 10 year old with developmental delays. 2. The nurse who is taking care of a 6 month old with Respiratory Syncytial Virus (RSV), a 3 year old with exacerbation of asthma, and a 6 year old with a urinary tract infection for 2 weeks. 3. The nurse taking care of a 9 year old newly diagnosed with diabetes, a 6 year old with end stage renal disease, and a 2 year old with contact dermatitis. 4. The nurse taking care of a 8 year old with skeletal traction, a 5 year old with cerebral palsy, and a 12 year old with cystic fibrosis.

1. Correct: The nurse taking care of the appendectomy, bowel surgery, and developmentally delayed child has the set of clients that is less busy and has fewer client care needs. Routine appendectomy and bowel surgery will need observation and assessment but should be stable. The child with developmental delays will need assistance but no life threatening concerns with any of these clients. 2. Incorrect: This set of clients are not appropriate primarily, because of the RSV client. The client with sickle cell already has an oxygen problem and does not need RSV too. RSV is very contagious. 3. Incorrect: This set of clients are very labor intensive. The newly diagnosed diabetic requires constant assessment and interventions to prevent complications. The 6 year old with end stage renal disease also will require a great deal of nursing assessment. 4. Incorrect: Assignment requires much care for clients. This set of clients are inappropriate because of the labor intensive needs. Skeletal traction will require pin care, skin care and prevention of immobility. The cerebral palsy client will require assistance with hygiene and self care and the cystic fibrosis client requires respiratory and GI care including assessment fro complications.

normal pulmonary artery pressure

8-20 mmHg

what is magnesium citrate?

a laxative

What actions should the nurse take when administering fentanyl? 1. Remove old fentanyl patch prior to applying new patch. 2. Cleanse area of old fentanyl patch. 3. Shave hair where fentanyl patch will be applied. 4. Place fentanyl patch over dry skin. 5. Apply adhesive dressing over the fentanyl patch. 6. Dispose of fentanyl patch in trash.

1., 2., & 4. Correct: These are correct actions. Apply patch to dry, hairless area of subcutaneous tissue, preferably the chest, abdomen, or upper back. The old patch should be removed prior to applying a new patch so that too much medication is not given. This is also why the old site should be cleaned. The patch should be placed on dry skin. Do not place over emaciated skin, irritated or broken skin, or edematous skin. 3. Incorrect: Do not shave area where patch will be applied and do not apply over dense hair areas. If there is hair on the skin, clip the hair as close to the skin as possible, but do not shave. 5. Incorrect: Do not apply adhesive dressing over patch. It can interfere with absorption. If the patch comes loose, you may tape the edges and remove and apply a new patch. 6. Incorrect: Dispose of fentanyl patch in sharps container. Fentanyl patches that have been worn 3 days still contain enough medication to cause serious harm to adults and children.

A quality assurance (QA) manager plans to evaluate performance improvement regarding the implementation of fall precautions of at risk clients. What steps should the QA manager include? 1. Chart review for fall precaution documentation. 2. Direct observation of unit staff. 3. Ask staff what fall precautions are taken for at risk clients. 4. Identify at risk clients on unit. 5. Make unannounced visits to the unit for evaluating staff performance.

1., 2., 4 & 5. Correct: The QA manager can do chart reviews to see if staff are documenting fall precaution for a client. Direct observation of unit staff will let the QA manager know if staff are performing proper precautions while caring for clients. The first step is to identify what clients are at risk for falls and then see if the staff have identified these clients to be at risk as well. Monitoring should be at unpredictable intervals, so staff do not comply when it is time for an evaluation. 3. Incorrect: Ask the staff what they do to provide fall precautions for at risk clients does not ensure that they follow through. It will tell you if they know what should be done. The QA manager needs objective data and asking the staff is subjective data.

A child has been diagnosed with varicella in the clinic. What should the nurse tell the parents about home treatment of the child? 1. Apply calamine lotion to affected areas several times a day. 2. Provide cool baths with baking soda. 3. Administer aspirin for fever. 4. Do not allow visitors who have never had varicella. 5. Keep fingernails trimmed short.

1., 2., 4., & 5. Correct: Calamine lotion and cool baths with baking soda will relieve itching. Anyone not vaccinated for chickenpox or who has never had chickenpox should not be exposed. Pregnant women and anyone with a weakened immune system (persons with HIV/AIDS, cancer, had a transplant, receiving chemotherapy, immunosuppressive medications, or long-term use of steroids) should avoid exposure. Keeping fingernails trimmed short may help prevent skin infections caused by scratching blisters. 3. Incorrect: Do not use aspirin or aspirin-containing products to relieve fever from chickenpox. The use of aspirin in children with chickenpox has been associated with Reye's syndrome, a severe disease that affects the liver and brain and can cause death. Instead, use non-aspirin medications, such as acetaminophen, to relieve fever from chickenpox. The American Academy of Pediatrics recommends avoiding treatment with ibuprofen if possible because it has been associated with life-threatening bacterial skin infections.

Which client would be appropriate for the RN to assign to the LPN? 1. Client requiring enemas and antibiotics. 2. Newly admitted client with diagnosis of diabetic ketoacidosis (DKA). 3. Client returning from surgery post right upper lobectomy. 4. Client with frequent reports of nausea and vomiting following chemotherapy. 5. Client requiring frequent sterile dressing changes.

1., 4., & 5. Correct: Administering enemas and antibiotics to a client is within the scope of practice of the LPN. Nausea and vomiting are common side effects after a client receives chemotherapy. The LPN can administer antiemetics and monitor fluid status. It is within the scope of practice for the LPN to perform sterile dressing changes. 2. Incorrect: This client is a new admit who is in DKA and would be unstable. 3. Incorrect: This client will require frequent assessments and monitoring for postop complications.

The nurse educator has provided education to newly hired emergency department nurses regarding mandatory reporting laws. Which suspected instances provided by the new nurses indicates to the nurse educator that education was effective? You answered this question Correctly 1. Financial abuse of an elder 2. Negligence of a colleague 3. Spousal abuse denied by the victim 4. Gunshot victim 5. Client diagnosed with Gonorrhea 6. Client diagnosed with West Nile virus

1., 4., 5., & 6. Correct: Federal and state laws require that certain individuals, particularly those who work in health care with the elderly, with children, and other vulnerable populations, have an affirmative duty to report to a specified state agency when violence occurs against those populations. This includes physical, mental, and financial abuse. Gunshots and knife injuries are reportable to law enforcement. Certain communicable diseases such as gonorrhea and West Nile virus are reportable to the CDC. 2. Incorrect: Suspected negligence of a colleague is not in the realm of mandatory reporting to authorities, but the nurse should discuss with the supervisor. 3. Incorrect: A spouse is not considered a vulnerable person so it is not required by law to report. You should encourage the spouse to report the abuse but you, as the nurse, are not bound by law to do so.

The nurse cares for a client who is scheduled for an upper GI series. The nurse teaches the client about the test. Which statement by the client indicates an understanding of the nurse's teaching? 1. I'll have to take a strong laxative the morning of the test. 2. I'll have to drink contrast while x-rays are taken. 3. I'll have a CT scan after I'm injected with a radiopaque contrast dye. 4. I'll have an instrument passed through my mouth to my stomach.

2. Correct: In an upper GI series (sometimes called a barium swallow test), the client swallows barium contrast while x-rays are taken. 1. Incorrect: Laxatives are taken the night before a colonoscopy to ensure stool is cleared from the colon. Waiting to take the laxative the morning of the test would be ineffective and uncomfortable for the client. 3. Incorrect: Radiopaque dye injected before a CT (computed tomography) scan is not part of a GI series. This would be a totally different diagnostic test from the upper GI. 4. Incorrect: In a gastroscopy (sometimes called a gastric endoscopy), a scope is passed through the mouth to the stomach to visualize the inner lining of the upper GI tract.

The charge nurse delegates a licensed practical nurse (LPN) to perform an intervention that is not within the scope of practice for the LPN. Which response by the LPN is appropriate in response to the inappropriate delegation? 1. Notify the primary healthcare provider. 2. Refuse the delegated intervention. 3. Discuss the assignment with another LPN. 4. Ask the charge nurse to evaluate the intervention.

2. Correct: The LPN has the right to refuse a delegated intervention that is not within the scope of practice for the LPN. The charge nurse should be informed that the delegated intervention is not appropriate according to the state's Nurse Practice Act. 1. Incorrect: There are situations in which the LPN must notify the primary healthcare provider. This is not a situation that requires the LPN to notify the primary healthcare provider. 3. Incorrect: Discussing the assignment with another LPN is delaying the client's needed intervention. The LPN should refuse the intervention. 4. Incorrect: The charge nurse cannot change the scope of practice for the LPN by evaluating the intervention. Only the state Board of Nursing can legally determine the LPN's scope of practice.

Which signs/symptoms noted by the nurse would support a client history of chronic emphysema? 1. Atelectasis. 2. Increased anteroposterior (AP) diameter. 3. Breathlessness. 4. Use of accessory muscles with respiration. 5. Leans backwards to breathe. 6. Clubbing of fingernails

2., 3., 4., & 6. Correct: Emphysema is described as a permanent hyperinflation of lung beyond the bronchioles with destruction of alveolar walls. Airway resistance is increased, especially on expiration. Inspection reveals dyspnea on exertion, barrel chest (anteroposterior diameter is equal to transverse diameter), tachypnea, and use of accessory muscles with respiration. Clubbing of fingernails is due to chronically decreased oxygen levels. 1. Incorrect: Atelectasis is collapse of alveolar lung tissue, and findings reflect presence of a small, airless lung. This condition is caused by complete obstruction of a draining bronchus by a tumor, thick secretions, or an aspirated foreign body, or by compression of lung. 5. Incorrect: Client tends to lean forward (orthopnea) and uses accessory muscles of respiration to breathe.

The nurse manager is developing a new yearly evaluation form for the staff. What statement(s) by the nurse manager would most likely improve staff outcomes? 1. "How often do you need help to finish assignments?" 2. "Are there any new skills you feel capable to learn?" 3. "Describe how you organize your daily assignments." 4. "Which tasks are most difficult for you to complete?" 5. "Explain any new goals you would like to achieve."

3 & 5. Correct: Positive outcomes are more likely when staff feels appreciated, receiving constructive and encouraging feedback on a regular basis. Evaluations can be very stressful when staff are uncertain of expectations or are perceived in a negative framework. Seeking clarification on how staff organize assignments indicates awareness and may help in developing new protocols. Also, showing interest in individual goals will help develop learning opportunities for all staff. 1. Incorrect The tone of this question is derogatory, implying the individual is not able to complete daily assignments in a timely manner without assistance. 2. Incorrect: This inquiry is worded in a negative manner, implying the individual may not have the ability to learn new skills. 4. Incorrect: Although this might present information the nurse manager might use to develop more learning opportunities, the negative approach may intimidate staff, preventing complete honesty.

The RN, LPN, and unlicensed assistive personnel (UAP) are providing care for clients on the nursing unit. Which tasks could be completed only by the RN? 1. Administration of routine medications. 2. Dressing changes. 3. Assessment of newly admitted clients. 4. Calling the primary healthcare provider about lab results. 5. Teaching the diabetic client foot care.

3. & 5. Correct: Admission assessments and teaching must be performed by the RN. The nursing process, along with teaching are outside the scope of practice of the LPN. These are tasks that must be performed by the RN. The LPN can reinforce teaching. 1. Incorrect: Medication administration is within the LPN scope of practice and can be completed by the LPN. 2. Incorrect: Dressing changes may be delegated to the LPN as this is within the LPN scope of practice. 4. Incorrect: The LPN may call lab results to the primary healthcare provider because this is within the scope of practice for the LPN. If any additional prescriptions are required, the LPN can take these prescriptions over the phone.

The charge nurse at a long-term care facility is discussing restraint policies with new staff members. The nurse explains that the use of restraints are only appropriate for what reasons? 1. Reduce wandering throughout the night shift. 2. Prevent confused client from exiting the building. 3. Keep combative clients from injuring staff or clients. 4. Eliminate any falls when the client is sitting in a chair. 5. Decrease potential for pulling out I.V.'s or dressings.

3. & 5. Correct: Restraints are always considered a last resort when other methods have failed. The appropriate situations for using restraints are those in which the client may cause injury to self or others because of confusion or combativeness. Certain situations in which a client has an adverse reaction to drugs and medication, resulting in violent or combative behavior, would necessitate temporary use of restraints. Also, a confused, agitated client intubated on a ventilator, with invasive lines or dressings, might also need to be restrained to prevent injury from pulling out tubes, lines, or dressings. 1. Incorrect: Restraints may not be used for staff convenience or during low staffing periods, such as the night shift. Other methods should be utilized, such as moving the wandering client closer to the nursing station or perhaps using a Geri-chair for short periods of time. 2. Incorrect: Clients with dementia often experience greater confusion later in the day and evening, increasing the risk of wandering. Such clients should be checked on more frequently to verify safety and mental status. The nurse may employ other methods, such as encouraging family to visit, to deter client wandering. 4. Incorrect: Restraining a client while seated often increases agitation and enhances the potential for accidents. A client pulling against vest or wrist restraints could cause severe injuries while trying to resist those restrictions.

Which task would be appropriate for the Labor, Delivery, Recovery, Postpartum (LDRP) charge nurse to assign to an LPN/VN? 1. Administering IV pain medication to a client three days postopertive cesarean section. 2. Drawing a trough vancomycin level on a client 3 days postpartum with bilaterial mastitis. 3. Reinforce how to perform perineal care to a primipara who is four hours postpartum. 4. Drawing routine admission labs on a client admitted in final stages of labor.

3. Correct: Client teaching may be reinforced by an LPN/VN on a stable client. 1. Incorrect: Administering IV pain medications is out of the scope of practice of LPN/VN. 2. Incorrect: Drawing lab work on a client with severe infection and only 3 days postpartum is an unstable client and needs care from the RN. 4. Incorrect: Drawing routine admission labs on a client in final stages of labor would be inappropriate because the client is potentially unstable and needs experienced LDRP nursing care.

Which prescription should the nurse question for a client diagnosed with heart failure who has a Swan-Ganz mean pulmonary artery pressure of 20 mm Hg? 1. Oxygen 2 liters/nasal cannula 2. Furosemide 40 mg IV push stat 3. Normal saline infusion at 100 mL/hr 4. Pulse oximetry monitoring

3. Correct: Normal mean pulmonary artery pressure is 10-20 mmHg. An elevation is an indication of right side heart failure or cor pulmonale. This value is high normal and we worry about fluid volume excess. The nurse should question the IV prescription of normal saline at 100 mL/hr. Normal saline is an isotonic fluid that will keep fluid in the vascular space which will increase fluid volume. Sodium should be restricted as well, and the IV rate is too high. 1. Incorrect: This client needs oxygen and should be started at the lowest effective dose. 2. Incorrect: Furosemide is a diuretic which is needed to pull off excess fluid. 4. Incorrect: The heart is not functioning properly, and the client is exhibiting fluid volume excess. The nurse should monitor the client's oxygenation.

A client is scheduled for a colonoscopy with biopsy of a large tumor that is completely blocking the large intestine in the morning. Which preoperative prescription should the nurse question? 1. Administer tap water enemas until clear at 6 AM. 2. Nothing by mouth (NPO). 3. IV of D5 ½ NS at 75 mL/hour with a 20 gauge catheter. 4. Give magnesium citrate 296 mL at 3 PM today.

4. Correct: Did you notice the hint? Complete blockage of the large intestine. If you give the magnesium citrate, which is a laxative, what will happen? Nothing will get passed the complete blockage. The client would develop severe cramping. This could cause a medical emergency. 1. Incorrect: The client does need to be cleaned out below the tumor so that the primary care provider can see the area of concern and complete the biopsy. Since the enema would clean below the obstruction, the client would be able to expel the enema and any feces in this part of the colon. 2. Incorrect: Since this client has an obstruction, anything the client eats will not be able to come out. This is an appropriate prescription. 3. Incorrect: The client will need IV access for sedation during the procedure and will need the fluid for hydration since the client is NPO.

Which action by an unlicensed nursing assistant would require the nurse to intervene? 1. Collecting I & O totals for unit clients at the end of shift. 2. Elevating the head of the bed 30°- 40° for the client post thoracotomy 3. Ambulating a client who is 2 days post vaginal hysterectomy 4. Turning off continuous tube feeding to reposition a client, then turning the feeding back on

4. Correct: The unlicensed nursing assistant should not turn tube feedings off or on. The nurse should do this when repositioning is needed. Prior to turning feeding back on, tube placement needs to be verified. 1. Incorrect: Obtaining the urinary output of a client at the end of the shift is appropriate for the nursing assistant and should be documented and reported to the RN. 2. Incorrect: This is appropriate because this position will improve gas exchange and breathing for a client after thoracic surgery. 3. Incorrect: The hysterectomy client needs to be ambulated to avoid post op complications. This is an appropriate and safe action for the unlicensed nursing assistant to do.

The night nurse on a step down unit suspects another nurse may be intoxicated. What initial action should the nurse take? 1. Ask another nurse to confirm suspicions. 2. Call supervisor to report the intoxication. 3. Confront the nurse privately in person. 4. Discuss suspicions with unit nurse manager.

4. Correct:The greatest concern at this time is the safety of the clients to whom the intoxicated nurse is providing care. The nurses Code of Ethics dictates safe, effective care for the public with protection from incompetent or unethical practice. The chain of command for this floor nurse is to report directly to the unit nurse manager. 1. Incorrect: When dealing with ethical or legal issues, the chain of command starts with the nurse manager of the unit in question. Asking another staff nurse for a personal opinion would not provide any pertinent data and instead amounts to gossip. 2. Incorrect: In order to avoid undue conflict, the nurse needs to immediately alert the unit nurse manager and not the facility supervisor. The nurse manager must then manage any conflict that may result and bears the responsibility to control possible disruption resulting from re-assigning the impaired nurse's clients. 3. Incorrect: Direct confrontation of the allegedly impaired nurse would most likely result in denial or defensive behaviors which could place the clients at further risk. The chain of command for this staff nurse starts with the unit nurse manager who would be more qualified to deal with conflict resolution in this matter.