leadership midterm

The most common source of legal liability for nurse managers is a(n): A.medical malpractice suit. B.organizational nursing issue. C.tort. D.vicarious liability.

C In nursing, harm related to clinical practice commonly arises from negligent acts or omissions (unintentional torts) and a variety of intentional acts (intentional torts), such as invasion of privacy or assault and battery.

Which ethical principle is violated when the RN tells the hospital accountant that the patient is HIV-positive? (Select all that apply) A.Beneficence B.Veracity C.Confidentiality D.Autonomy E.Fidelity

A,C

A patient who is not fully informed about his or her health status is an example of a violation of which ethical principle? A.Autonomy B.Justice C.Utilitarianism D.Confidentiality

A. Rationale: Autonomy refers to the client's right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision.

The process in which information, perception, and understanding are transmitted from person to person is: A.articulation. B.communication. C.evaluation. D.pronunciation.

Answer: B Communication is the process in which information, perception, and understanding are transmitted from person to person.

Which of the following is true of management activities: A.Inspiring a vision is a management function. B.Management is focused on task accomplishment. C.Management is more focused on human relationships. D.Management is more important than leadership.

B

Which of the following are examples of intentional torts that may occur in the health care field? (Select all that apply) A.Slip and fall in the hospital cafeteria B.Patient restrained by the neck utilizing the nurse's arm C.Ovary removal against the patient's signed consent D.Restraining a patient without a physician's order E.Hospital-acquired pressure ulcer

B, C, D Rationale: Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment.

A clearly recognizable process of providing care that has an evidence base demonstrating that it reduces the likelihood of harm is: A.risk adjustment. B.a sentinel event. C.a patient safety practice. D.a performance measure.

C Patient safety practices are discrete and clearly recognizable processes or manners of providing care that have an evidence base demonstrating that they reduce the likelihood of harm due to the systems, processes, or environments of care (National Quality Forum [NQF], 2009, p. 3).

For a nurse caring for a patient with a pulmonary embolism, which intervention within the patient's care plan can the RN delegate to the LPN? A.Evaluate the patient's complaint of chest pain B.Interpreting the patient's ABG values to assess oxygenation C.Assess the patient for respiratory distress D.Auscultate the patient's lungs for crackles while the nurse prepares medications in the room

D.Auscultate the patient's lungs for crackles The LPN can be trained to listen to lungs sounds and carry out this task with supervision by the RN

Although a large-scale disaster may require burn patients to be stabilized in nonburn hospitals, definitive care for serious burns should take place at facilities: a)with trauma centers b)with intensive care units c)with burn centers d)with urgent care centers

C

The best initial strategy for large burn wounds in a mass casualty incident is: a) to prevent hypothermia b) to cool the wounds c) to provide antibiotic cream and gauze d) to administer prophylactic IV antibiotic

A

A client admitted to a medical surgical unit is experiencing confusion. The nurse leaves the client alone With all four side rails down while the bed is in a high position.The client eventually falls and breaks a hip. What law has been broken by the nurse? A.Negligence B.Civil Tort C.Battery D.Assault

A.Negligence

One mechanism that ensures autonomy in the nursing profession is the: A.American Nurses Association (ANA). B.Department of Health Professionals. C.Nursing Code of Ethics. D.Professional Regulatory Board.

A

An employee satisfaction survey is conducted annually and shows that nurses in a particular unit are committed to their jobs and feel that they make positive contributions. These nurses are: A.Engaged B.Disengaged C.Unproductive D.At retirement age

A Rationale: An ongoing challenge among U.S. employers, including health care systems, is to keep employees engaged. A Gallup poll (2014) indicated that only 31.5% of employees in the United States report they are "engaged at work," meaning they are committed to their job and making positive contributions. Fifty-one percent reported they are "not engaged at work," meaning they are not likely to put effort into organizational goals. Seventeen and a half percent are "actively disengaged," described as unhappy, unproductive, and likely to spread negativity. Shared governance is the gold standard for engaging nurses in solving problems at the point of care.

Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more __ philosophy. A.Centralized B.Decentralized C.Autocratic D.Democratic

A Centralization and decentralization are organizational philosophies about power distribution that pertain to the hierarchical level of decision-making authority in the institution. Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization.

In organizations that practice shared governance, the responsibility for unit outcomes rests with the: A.Nursing team B.Nurse Manager C.Individual nurse D.Chief nursing officer (CNO).

A In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager.

Participative leadership was first introduced in the late 1970s. It was adapted by health care organizations to form the basis of shared governance and has evolved to define the roles of nurses and resolve issues related to: A.patient care. B.nursing liability C.nursing salaries. D.nursing turnover.

A Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care (Gray, 2013).

Decentralization occurs when: A.equipment is being purchased from approved vendors. B.hiring decisions are made at the executive level. C.power is distributed to those closest to the work of caregiving. D.supplies are distributed from one central supply area in the hospital.

C Decision-making authority rests at lower levels in the organizational framework, closer to the point of care, rather than being passed up through the chain of command to an executive.

A staff nurse is facing a dilemma between meeting clinical ethical standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to focus on: A.doing the right thing and taking the right action. B.meeting clinical standards before organizational goals. C.meeting organizational goals before clinical standards. D.referring indecisive staff members for additional training.

A Rationale: Although the domain of clinical ethics is the care of clients, the domain of organizational ethics is a facility's business-related activities. Together, clinical and organizational ethics reflect a health care facility's concern that, whether related to the continuum of care or the continuum of services related to that care, ethical dilemmas should be resolved based on values-centered principles that focus on doing the right thing and taking the right action.

The primary purpose of unit practice committees in a health care organization is to improve: Select all that apply A.practice. B.processes. C.outcomes. D.reimbursement. E.turnover

A, B, C Rationale: The purpose of the unit practice council is described as being "part of the shared governance structure to promote shared decision making at the unit/clinic/program of care level. To make and implement recommendations to improve practice, processes, and outcomes" (Jordan, 2016, p. 16).

Which of the following statements best describes an organizational chart? A.All job positions are displayed clearly in a two-dimensional drawing. B.All outside organizations with relationships to the hospital are depicted. C.Informal and formal structures within the organization are outlined. D.It shows organizational positions and relationships in a visual representation.

D Rationale: The organizational chart is a diagrammatic representation that displays "the flow of authority, chain of command, titles, and functions.

Organizational benefits of a culture of shared governance include: (Select all that apply) A.improved financial outcomes. B.Interdependence among staff nurses. C.increased commitment of staff to the organization. D.more senior leadership involvement at the point of service. E.a more efficient model for point-of-service decision making.

A, C, E Rationale: Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes.

These activities are included in the care plan for a 78-year-old patient admitted to the hospital with anemia caused by possible gastrointestinal bleeding. Which activity can you delegate to an experienced UAP?A.Obtaining stool specimens for fecal blood test (Hemoccult) slides B.Having the patient sign a colonoscopy consent form C.Giving the prescribed polyethylene glycol electrolyte solution (GoLYTELY) D.Checking for allergies to contrast dye or shellfish

A.Obtaining stool specimens for fecal blood test (Hemoccult) slides -An experienced UAP will have been taught how to obtain a stool specimen for the Hemoccult slide test, because this is a common screening test for hospitalized patients. Having the patient sign an informed consent form should be done by the physician who will be performing the colonoscopy. Administering medications and checking for allergies are within the scope of practice of licensed nursing staff.

Which ethical principle is violated when there are insufficient community resources to meet the needs of low-income families? A. Nonmaleficence B. Autonomy C. Beneficence D. Justice

D Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served.

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? A.Patient who is taking carvedilol (Coreg) and has a heart rate of 64 B.Patient who is taking digoxin and has a potassium level of 3.1 mEq/L C.Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache D.Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

B

The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse would take which best action? A.Refuse to float to the ICU based on lack of unit orientation. B.Clarify with the team leader to make a safe ICU client assignment. C.Ask the nursing supervisor to review the hospital policy on floating. D.Submit a written protest to nursing administration, and then call the hospital lawyer.

B.Clarify with the team leader to make a safe ICU client assignment.

A 50-car pileup occurs on a major freeway in California's Central Valley as a result of heavy fog. There are major injuries, and victims are expected to be transported to local emergency departments. Which type of disaster is this classified as: A.Mass casualty event B.Conventional disaster C.Biological disaster D.Radiological disaster

Answer: A A mass casualty event is a natural or manmade event generating large numbers of patients requiring medical care and that overwhelms a health care facility and prevents it from delivering medical services that are consistent with accepted standards (Agency for Healthcare Research and Quality [AHRQ], 2012).

The postoperative patient with anterior cervical laminectomy is complaining of tightness in his throat. His voice is raspy. The staff nurse asks the unit secretary to page the healthcare provider stat. This is an example of _____ leadership. A.Authoritarian B.Democratic C.Laissez-faire D.Servant

Answer: A Authoritarian leadership uses directive and controlling behaviors in which the leader determines policies and makes decisions in isolation. The leader orders subordinates to carry out the tasks or work. This style is helpful in crisis situations.

A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the clinical setting. Which of the following would be the best strategy to accomplish this goal? A.Support nurses using practice-oriented research findings in decision making. B.Eliminate all protocols and standards that are not evidence based. C.Refer agency nurses to Internet sources of research findings. D.Encourage group reflection on the ideals and expectations of nursing care.

Answer: A EBP demands changes. It requires incorporating more practice-oriented research and more collaboration between clinicians and researchers. Emphasis should be on decision making using the varied sources of evidence. The environment and climate must be supportive in order to implement EBP. Rather than eliminating protocols and standards that are not evicence based, the nurse manager should make it a priority to begin to update these practices based on EBP. Self-reflection on one's own nursing practice and how EBP can be implemented would be more important than group reflection on the large ideals of nursing practice. Referring the nurses to the Internet for ideas is helpful only if evidence-based practice sites are accessed, and most Internet sites are not EBP sites.

A medical-surgical unit reports higher rates of patient satisfaction coupled with high rates of staff satisfaction and productivity. Which of the following is attributed to the data findings: A.Effective leadership B.Management involvement C.Mentoring D.Rewards and recognition

Answer: A Effective leadership is important in nursing because of the impact on nurses' work lives, it being a stabilizing influence during change, and for nurses' productivity and quality of care.

A young woman is brought to the emergency department as a victim of a mass casualty that caused injury. The woman is awake and alert. She has a fractured left tibia and several small lacerations to her face. How would categorize this client? A.Priority 1 (red tag) B.Priority 2 (yellow tag) C.Priority 3 (green tag) D.Priority 4 (black tag)

Answer: B The client is awake and alert. She does not have overt signs of cardiac or respiratory distress. The client can wait for treatment for 1 to 2 hours, indicating priority 2 - yellow tag. Clients with a black tag do not have priority rating

A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team, the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse's aide, conduct the interviewing process with key questions that were developed by the team. This is an example of: A.centralized power. B.shared governance. C.span of control. D.vertical authority.

B For shared governance to be effective, decision making must be shared by empowered staff at the point where patients receive care.

Thirty people are injured in a train derailment. Which client should be transported to the hospital first? A.A 20-year-old who is unresponsive and has a high injury to his spinal cord B.An 80-year-old who has a compound fracture of the arm C.A 10-year-old with a laceration on his leg D.A 25-year-old with a sucking chest wound

Answer: D During a disaster, the nurse must make difficult decisions about which person to treat first. The guidelines for triage offer general priorities for immediate, delayed, minimal and expectant care. The client with a sucking chest wound needs immediate attention and will likely survive; the 80-year-old is classified as delayed; emergency response personnel can immobilize the fracture and cover the wound. The 10-year-old has minimal injuries and can wait to be treated. The client with a spinal cord injury is not likely to survive and should not be among the first to be transported to the healthcare facility.

•Hospital leadership should consider which of the following ethical dilemmas prior to experiencing an actual disaster? (Select all that apply.) A.Which clinical leader will make the decision about distribution of scarce resources B.Criteria to determine which patients receive aggressive treatment and which will receive palliative care C.Which nursing staff will be the first to report to the hospital in the event of a disaster D.How prophylactic pharmaceuticals will be distributed to protect staff and their families E.Who will be primarily responsible for external communication

Answers: A, B and D An emerging issue that challenges care during a disaster is allocation of scarce resources when the system is overwhelmed. Implementing periodic tabletop discussions regarding how to allocate resources in a time of scarcity will prove to be a powerful tool in setting the stage for what to do if such an event occurs. Collaborative professional staff and hospital leadership discussions about scarce resource allocation will present ethical dilemmas that need to be thoughtfully considered in a planning time that is devoid of emotion. Questions to be discussed at the tabletop include which hospital and/or clinical leader will make the final decision about ventilator allocation and other scarce resource distribution; the criteria used to determine which patients receive aggressive treatment and which will receive palliative care, both imminently and long term, as other life-threatening complications ensue; and how prophylactic pharmaceutical dissemination plans are going to be activated to protect staff and their families.

A nurse forgets to administer a dose of a client's diuretic drug and the client experiences an episode of pulmonary edema. The nurse should consider that this error constitutes negligence because the situation contains which element? A.Purposeful failure to perform a healthcare procedure. B.Unintentional failure to perform a healthcare procedure C.Act of substituting a different medication for the one prescribed D.Failure to follow a healthcare provider's prescription

B Negligence is the unintentional failure of an individual to perform or not perform an act that a reasonable person would or would not do in the same or similar circumstances. A purposeful failure to perform a procedure would be the opposite of negligence, which is unintentional. Substituting a different medication does not fit the description of the situation in the question. Failure to follow a direct order does not fit the desperation in the situation in the questions. Cognitive level: Applying

Shared governance is a model of organizational structure in which staff nurses are: A.employed to establish mutual goals with clients. B.empowered through autonomy and accountability. C.engaged in problem-solving strategies and techniques. D.equipped with evaluative thinking methodologies.

B Rationale: Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

Nurses' involvement in shared governance is an important component of: A.Practice models. B.Magnet recognition. C.Increased reimbursement D.Physician satisfaction

B Rationale: Nurses' involvement in governance is an important component of the American Nurses Credentialing Center's Magnet Recognition Program

The local hospital has a new specialty unit for women and children. The nursing staff has created a family advisory council to assist in reviewing educational materials used at discharge. This shared governance structure is an example of: A.interprofessional education. B.whole-system integration. C.engagement. D.collaboration

B Some see the benefits of decentralization and the shared governance model extending beyond nurses and all care providers to all employees. "As for the future of Shared Governance, Susan Allen PhD, RN (assistant vice president, Cincinnati Children's Hospital) says it would be ideal to see whole-system integration involving all hospital staff. Clearly, the next steps in this vision are to include patients and the community more deliberatively into the shared governance model. Allen says Cincinnati Children's Hospital has a family advisory council and a teen council that get involved in projects, including reviewing potential educational materials and designing a new learning center (Gray, 2013).

The nurse manager should use which of the following behaviors when implementing a shared governance structure? A.Autocratic decision making of the manager B.Coaching the staff to be successful C.Harboring the vision within the team D.Reimbursing the staff for overtime

B To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

The nurse is preparing to admit a client with a seizure disorder. Which action can be assigned to an LPN? A.Completing the admission assessment B.Setting up oxygen and suction equipment C.Placing a padded tongue blade at the bedside D.Padding the side rails before the client arrives

B •The LPN scope of practice includes setting up the equipment for oxygen and suctioning. The RN should perform the complete initial assessment. Controversy exists as to whether padded side rails provide safety, and their use may embarrass the client and family. Tongue blades should not be at the bedside and should never be inserted into the client's mouth after a seizure begins.

In organizations that practice shared governance, the nurse manager's role is to, select all that apply: A.hire new employees. B.mentor the nursing staff. C.train new nurses in patient care. D.support the decisions of the nursing team. E.enable the staff to become effective leaders.

B, D, E Rationale: The nurse manager is primarily responsible for mentoring, facilitating, enabling, and supporting the staff personnel. Sustainable change can occur at the unit and organizational level if the nurse manager works within the framework of transformational leadership, shared governance, and action processes.

The nurse is floated form the emergency department to the neurologic floor. Which action should the nurse delegate to the unlicensed assistive personnel (UAP) when providing nursing care for a client with a spinal cord injury? A.Assessing the client's respiratory status every 4 hours B.Checking and recording the client's vital signs every 4 hours C.Monitoring the client's nutritional status, including calorie counts D.Instructing the client how to turn, cough, and breathe deeply every 2 hours.

B. The UAPs training and education covers measuring and recording vital signs. The UAP may help with turning and repositioning the client and may remind the client to cough and deep breathe, but he or she does not teach the client how to perform these actions. Assessing and monitoring clients require additional education and are appropriate to the scope of practice of professional nurses

Which postoperative client is manifesting the most serious negative effect of inadequate pain management? A.Demonstrates continuous use of call bell related to unsatisfied needs and discomfort B.Develops venous thromboembolism related to immobility caused by pain and discomfort C.Refuses to participate in physical therapy because of fear of pain caused by exercises D.Feels depressed about loss of function and hopeless about getting relief from pain

B. •Inadequate pain management for postsurgical clients can affect quality of life, function, recovery, and postsurgical complication; thus, all the manifestations are examples of negative results. However, venous thromboembolism can lead to pulmonary embolism, and this is an immediate life-threatening concern. The nurse also needs to implement interventions to resolve unsatisfied needs, fear of pain, and hopelessness related to pain and function.

A client with Parkinson disease has a problem with decreased mobility related to neuromuscular impairment. The nurse observes the unlicensed assistive personnel. (UAP) performing all these actions. For which action must the nurse intervene? A.Helping the client ambulate to the bathroom and back to bed B.Reminding the cline not to look at his feet when he is walking C.Performing the client's compete bathing and oral care D.Setting up the client's tray and encouraging the client to feed himself

C. Although all these actions fall within the scope of practice for a UAP, the UAP should help the client with morning care as needed, but the goal is to keep the client as independent and mobile as possible. The client should be encouraged to perform as much morning care as possible. Assisting the client in ambulating, reminding the client not to look at his fee (to prevent falls), and encouraging the client to feed himself are all appropriate

Family members are encouraging the client to "tough out the pain" rather than risk drug addiction to opioids. The client is stoically abiding. The nurse recognizes that the sociocultural dimension of pain is the current priority to the client. Which question will the nurse ask? A."Where is the pain located, and does it radiate to other parts of your body?" B."How would you describe the pain, and dhow is it affecting you?" C."What do you believe about pain medication and drug addiction?" D."How is the pain affecting your activity level and your ability to function?"

C. Beliefs, attitudes, and familiar influence are part of the sociocultural dimension of pain. Location and radiation of pain address the sensory dimension. Describing pain and its effects address the affective dimension. Activity level and function address the behavioral dimension. Asking about knowledge address the cognitive dimension.

Which client is most likely to receive opioids for extended periods of time? A.A client with fibromyalgia B.A client with phantom limb pain in the leg C.A client with progressive pancreatic cancer D.A client with trigeminal neuralgia

C. Cancer pain generally worsens with disease progression, and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with antiseizure medications such as carbamazepine. Phantom limb pain usually subsides after ambulation begins.

After a client has a seizure, which action can the nurse delegate to the unlicensed assistive personnel (UAP) A.Documenting the seizure B.Performing neurologic checks C.Checking the client's vital signs D.Restraining the client for protection

C. Measurement of vital signs is within the education and scope of practice of UAPs. The nurse should perform neurologic checks and document the seizure. Clients with seizures should not be restrained; however, the nurse may guide the client's movements if necessary, to prevent injury

Which client should the charge nurse assign to a new graduate RN who is orientating to the neurologic unit? A.A 28-year-old newly admitted client with a spinal cord injury B.A 54-year-old client with Parkinson disease who needs assistance with bathing C.A 67-year-old client who had a stroke 3 days ago and has left-sided weakness D.An 85-year-old client with dementia who is to be transferred to long-term care today

C.The new graduate RN who is on orientation to the unit should be assigned to care for clients with stable, noncomplex conditions, such as the client with stroke. The task of helping the client with Parkinson disease to bathe is best delegated to the UAP. The client being transferred to the nursing home, and the newly admitted client with spinal cord injury should be assigned to experienced nurses

The following clients present to the ED with signs and symptoms of heat-related illness. Which of them needs to be attended to first? A. A relatively healthy homemaker who reports that the air conditioner has been broken for days and who manifest fatigue, hypotension, tachypnea, and profuse sweating. B.An elderly person who complains of dizziness and syncope after standing in the sun for several hours to view a parade. C.A homeless person who is a poor historian; has altered mental status, poor muscle coordination, and hot, dry ashen skin; and whose duration of heat exposure is unknown. D.A marathon runner who complains of severe leg cramps and nausea, and manifests weakness, pallor, diaphoresis, and tachycardia.

C: The signs and symptoms manifested by the homeless person indicate that a heat stroke is happening,which is a medical emergency and can lead to brain damage. Patients who present with heat stroke typically have vital sign abnormalities to include an elevated core body temperature, sinus tachycardia, tachypnea, a widened pulse pressure, and a quarter of patients will be hypotensive.

The ABA recommends that ideally, burn patients in a mass casualty incident should be triaged to a burn center: a) within the first 12 hours of an incident b) within the first 24 hours of an incident c) within the first 36 hours of an incident d) within the first 72 hours of an incident

D

The nurse assesses clients in the postanesthesiacare unit (PACU). Which client does the nurse intervene for first? A.Client with a respiratory rate of 12 breaths/min B.Client with an oxygen saturation of 92% C.Client who is reporting pain (5 out of 10) D.Client with audible stridor

D

•Which of the following responses from the nurse manager is consistent with a culture that promotes patient safety? A.We make sure that we don't have any errors on this unit. B.We identify who made the error and take corrective action. C.We provide remedial training for all staff on the unit when there is an error. D.We report any medical error or near-miss to help us find the root cause of the problem.

D Health care organizations that embrace a fair and just culture identify and correct the systems or processes of care that contributed to the medical error or near-miss. Managers believe that more health care professionals will report more errors and near-misses when they are protected by a non-punitive culture of medical error reporting, and this will further improve patient safety through opportunities for improvement and lessons learned (CAPSAC, 2016). The American Nurses Association has endorsed just culture as a means of ensuring safe care (ANA, 2010).

In organizations that practice shared governance, staff, managers, and leaders are responsible for: A.technology. B.Budgeting C.Education D.Innovation

D Rationale: In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager. The manager is primarily responsible for mentoring, facilitating, enabling, and supporting.

Which client is at greatest risk for respiratory depression while receiving opioids for analgesia? A.Older adult client with chronic pain related to joint immobility B.Client with a heroin addiction and back pain C.Young female client with advance multiple myeloma D.Opioid-naïve adolescent with an arm fracture and cystic fibrosis.

D. At greatest risk are older adult clients, opiate-naïve clients, and those with underlying pulmonary disease. The adolescent has two of the three risk factors.

A client with chronic pain reports to the charge nurse that the other nurses have not been responding to requests for pain medication. What is the charge nurse's initial action? A.Check the medication administration records for the past several days B.Ask the nurse educator to provide in-service training about pain management C.Perform a complete pain assessment on the client and take pain history D.Have a conference with the staff nurses to assess their care of this client

D. The charge nurse must assess the performance and attitude of the staff in relation to this client. After data are gathered form the nurses, additional information can be obtained from the records and the client as necessary. The educator may be of assistance if a knowledge deficit or need for performance improvement is the problem.

A client arrives at the emergency department who suffered multiple injuries from a head-on car collision. Which of the following assessments made should take the highest priority? a.) unequal pupils b.) irregular pulse c.) ecchymosis in the flank area d.) a deviated trachea

d.) a deviated trachea - A deviated trachea is a symptom of tension pneumothorax, which will result in respiratory distress if left untreated.

A client with diabetic neuropathy reports a burning electrical-type pain in the lower extremities that is wor4s at night and nor responding to nonsteroidal anti-inflammatory drugs. Which medication will the nurse advocate for first? A.Gabapentin B.Corticosteroids C.Hydromorphone D.Lorazepam

•A Gabapentin is an antiepileptic drug, but it is also used to treat diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Hydromorphone is a stronger opioid and is not the first choice for chronic pain that be managed with other drugs. Lorazepam is an anxiolytic that may prescribes as an adjuvant medication.

A client with cervical spinal cord injury has been placed in fixed skeletal traction with a halo fixation device. When caring for this client, the nurse may assign which actions to the LPN? (Select all that apply) A.Checking the client's skin for pressure from the device B.Assessing the client's neurologic status for changes C.Observing the halo insertion sites for signs of infection D.Cleaning the halo insertion sites with hydrogen peroxide E.Developing the nursing plan of care for the client F.Administering oral medications as ordered

•A, C, D, F •Checking and observing for signs of pressure or infection is within the scope of practice of the LPN. The LPN also has the appropriate skills for cleaning the halo insertion sites with hydrogen peroxide. Administering oral drugs is within the scope of practice for an LPN. Neurologic exam and care plan development require additional education and skill appropriate for the professional RN

Which of the following is true about negotiation A.It commonly results in a win-lose situation B.It is aimed at solving problems, conflicts, or disputes. C.It is used only in contract and labor union disputes. D.It is the exchanging of favors or trading activity.

Answer: B Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes

When working with the community, recognizable nomenclature is important for: A.response. B.education. C.reporting. D.communication.

Answer: D When working with the community, using common language becomes especially important for promoting interagency communication in crisis situations. Therefore the National Incident Management System (NIMS) was created by the U.S. Department of Homeland Security (2016) Secretary to further standardize and integrate response practices nationally

On your unit there are two RNs: one is a new RN while the other is an experienced RN. In addition, there are three LPNs and two nursing assistants. Which tasks delegated to one of the nursing assistants by the newRN needs to be re-evaluated? A. Apply hydrocortisone cream to eczema on a patient's skin after giving thepatient a bath. B. Assist the patient with administering a Fleet Enema. C. Empty an ostomy bag. D. Assist a patient with ambulating. E. Collect and record patients' blood pressure, heart rate, temperature,oxygen saturation, respirations, and pain rating.

A & B Rationale:Answer A is a task for an LPN or RN.Hydrocortisone cream is amedication and the nursing assistantis not permitted to administermedications. Answer B is a task foran LPN or RN because it is aprocedure. Options C, D, and E areall delegated tasks a nursingassistant can perform.

A nurse is expected to triage incoming patients after a mass casualty in the community. Which patients are correctly classified? (select all that apply) A. A 35 year old female with severe chest pain: red tag B. A 88-year old man experiencing shortness of breath with visible chest bruises: green tag C. A 44-year old man with full thickness burns on his body: green tag D. A 55-year old female with a scalp laceration: black tag E. A 60-year old male with an open fracture with distal pulses: yellow tag

A & E Red tags: (immediate) severe life threatening injuries that need to be treated ASAP. Green tags: (walking wounded) minor injuries that do not need immediate care. Yellow tags: (delayed) serious injuries but not immediately life threatening. The patient needs to be treated promptly (around 30 min - 2 hours). Black tags: (deceased/expected) injuries that are not compatible with life and has no spontaneous respirations. Injuries are too severe to be expected to care for.

You're working as a triage nurse during a disaster situation. Based on the triage color code tags placed on each of the wounded, which tag color represents the wounded who have the highest priority of being treated first? A.Red B.Yellow C.Green D.Black

A. The red tag indicates the patient must be seen first because they have life-threatening injuries, but could survive if treated quickly. The patient is still alive but there is a severe alteration in their breathing, circulation, or mental status that requires immediate medical attention -yellow = treatment can be delayed -green = "walking wounded" -black = dead

A 64-year-old patient is receiving chemotherapy for breast cancer. After the morning report, the nurse finds the patient nauseated, vomiting light green emesis, and crying because her hair is falling out in clumps. The pulse is 115 beats/min and thready, and the blood pressure is 90/50 mmHg. Which intervention should the nurse make a priority for this patient? A. Obtaining an order for intravenous fluids at 100 mL/hr B. Teaching the patient some deep-breathing exercises to help her calm down C. Cleansing the skin and applying a clean hospital gown D. Premedicating for nausea before the next chemotherapy dose

A (obtain an order for intravenous fluids at 100 mL/hr) RATIONALE: The priority of care would be the patient's thready/tachy pulse and low blood pressure. Contacting the provider and obtaining an order to administer intravenous fluids to counter her fluid loss due to vomiting would be the priority. Providing premedication for nausea before the next chemotherapy dose will be helpful later but will not help restore her fluid balance now. Cleansing the skin and applying a clean hospital gown is not a priority. This comfort and hygiene intervention can be done once the nurse has intervened to restore the patient to homeostasis. Teaching deep-breathing exercises as a calming measure may help the patient through the course of her treatment, but this intervention to meet her psychological needs is of lesser priority than restoring her to physical homeostasis.

A client arrives at the emergency department with upper gastrointestinal (GI) bleeding and is in moderate distress. The priority nursing action is to: A. Obtain vital signs B. Ask the client about the precipitating events C. Complete an abdominal physical assessment D. Insert a nasogastric (NG) tube and Hematest the emesis

A (obtain vital signs) RATIONALE: The priority action is to obtain vital signs to determine whether the client is in shock from blood loss and to obtain a baseline by which to monitor the progress of treatment. The client may not be able to provide subjective data until the immediate physical needs are met. Insertion of an NG tube may be prescribed but is not the priority action. A complete abdominal physical assessment needs to be performed but is not the priority.

A staff nurse came in to work the 7 PM to 7 AM shift. She had met her friends for "happy hour" earlier in the evening. Her breath smells of alcohol. If this nurse is allowed to provide care for patients, she may be at risk for: A.maleficence. B.mélange. C.nonmaleficence. D.nonmanager.

A Rationale: maleficence is doing harm to the patient whether it is intentional or unintentional, such as an omission. If the nurse is intoxicated, she may fail to meet the standard of care.

To establish legal liability on the grounds of malpractice, the injured party must prove which of the following? (Select all that apply) A.A duty of care was owed to the injured party. B.An agreement was made to assume another party's liability. C.There was a breach of duty. D.Causation was present. E.Actual harm or damages were suffered by the plaintiff.

A, C, D, E

As the registered nurse, which tasks belowshould you NOT delegate to the LPN? A. Performing an assessment on a new admission. B. Collecting a urine sample from an indwelling Foley catheter. C. Developing a plan of care for a patient who is admitted with Guillain-Barré Syndrome. D. Educating a patient about how to monitor for side effects associatedwith Warfarin. E. Auscultating lung and bowel sounds. F. Starting a blood transfusion. G. Administering IV Morphine 2 mg for pain. H. Providing wound care to a stage 3 pressure injury.

A, C, D, F, & G These are all out of the scope of practice for an LPN.Anything that deals with assessments, educating,evaluating, developing a plan of care, IV medications,unstable patients, or invasive/complex procedureswhere there is unpredictability the RN is responsiblefor doing it, and these tasks cannot be delegated. AnLPN can perform a focused assessment by listeningto lung or bowel sounds and report the findings tothe RN but a comprehensive assessment is done byan RN. In addition, the LPN can perform standardprocedures that are predictable on stable patientslike wound care for a pressure injury, Foley catheterinsertion, obtaining an EKG, and obtaining bloodglucose levels.

The nurse is working with one LPN and two assistantpersonnel (APs) on a 20-bed unit. Which are theappropriate tasks to delegate to the appropriateperson? (Select all that apply) A. Feeding an elderly and confused client to the aide. B. Toileting the client for the first time after surgery to the LPN. C. Placing the bathroom supplies in the room of the new admission to the LPN. D. Reinforcing the discharge teaching instructions to the LPN. E. Administering a PO pain medication to the LPN. F. Performing the routine dressing change 5 days after surgery to the LPN.

A, D, E, & F There are 5 rights of delegation: the right task, circumstances, person, direction, and supervision. The aide can perform routinetasks, the LPN can deliver skilled care, andthe RN performs assessments and doesthe teaching. Toileting the client for thefirst time requires the assessment of theRN. The bathroom supplies can bedelegated to the aide. The remainingselections are appropriate. The LPN canreinforce teaching, but the initial teachingmust be done by the RN.

You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP? A.Assisting the patient with oral hygiene B.Observing the patient's response to feedings C.Facilitating expression of grief or anxiety D.Initiating daily weighings

A. Assisting the patient with oral hygiene-Oral hygiene is within the scope of duties of the UAP.

The nurse calls the primary health care provider (PHCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the PHCP, and the medication is due to be administered. Which action would the nurse take? A. Contact the nursing supervisor. B. Administer the dose prescribed. C. Hold the medication until the PHCP can be contacted. D. Administer the recommended dose until the PHCP can be located.

A. If there is no resolution regarding the prescription because the PHCP cannot be located, the nurse would contact the nurse manager or nursing supervisor for further clarification as to what the next step needs to be.

While eating lunch in the hospital cafeteria, a nursing student overhears two nurses taking about a client. Which is the important information for the nurses to remember when talking about the client? A. Talking about a client in a public place is a violation of the client's confidentiality B. The client's rights to confidentiality do not apply to the break time of employees C. It is acceptable for the nurses to talk about a client because they are on the same treatment team D. The nurse taking care of the client would not share information with each other that the client has told them separately

A. Talking about a client in a public place is a violation of the client's confidentiality.

There are four clients with infections in the ED and only one private room is available. Which among the clients is the most appropriate to occupy the private room? A. A client with a cough who may have tuberculosis B. A client with toxic shock syndrome and a temperature of 102.4°F (39.1°C) C.A client with diarrhea caused by C. diff D.A client with a wound infected with Vancomycin-resistant enterococci (VRE)

A. A client with a cough who may have tuberculosis -Private rooms should be occupied mainly for clients with infections that require airborne precautions such as TB

The court has found that a registered nurse (RN) harmed a patient by violating his rights. The nurse is ordered to pay the patient a large sum of money. The court has determined that the nurse has committed a: A.civil act. B.criminal act. C.critical wrong. D.quality breach.

A. Rationale: By definition, civil acts are wrongs that violate the rights of individuals by tort or breach of contract.

A family in the emergency department is overwhelmed at the loss of several family members due to a shooting incident in the community. Which intervention should the nurse complete first? A. Provide a calm location for the family to cope and discuss needs B. Call the hospital chaplain to stay with the family and pray for the deceased C. Do not allow visiting of the victims until the bodies are prepared D. Provide privacy for law enforcement to interview the family

A. The nurse should first provide emotional support by encouraging relaxation, listening to the family's needs, and oering choices when appropriate and possible to give some personal control back to individuals.

The registered nurse (RN) directs the licensed practical nurse (LPN) to assist with the care of a client who has a sacral pressure injury. Which is the most appropriate activity for the RN to delegate to the LPN? A.Place the client in a side-lying position. B.Initiate wound care protocol for standardized ulcer care. C.Meet with the wound specialist to identify measures to improve healing. D.Determine which treatments would best meet the healing needs of the client.

A.Place the client in a side-lying position.-The best task for the LPN is to place the client in the side-lying position. Proper positioning requires nursing skills and is within the LPN's abilities and scope of practice. Initiating wound care protocol is outside the LPN's scope of practice. Meeting with the wound specialist is outside the LPN's scope of practice. Even though the LPN may assist the RN in determining the plan of care, this activity is the RN's responsibility

As the nurse manager in a public health department, you are implementing a plan to reduce the incidence of infection with human immunodeficiency virus (HIV) in the community. Which nursing action will you delegate to health assistants working for the agency? A.Supplying injection drug users with sterile injection equipment such as needles and syringes B.Interviewing patients about behaviors that indicate a need for annual HIV testing C.Teaching high-risk community members about the use of condoms in preventing HIV infection D.Assessing the community to determine which population groups to target for education

A.Supplying injection drug users with sterile injection equipment such as needles and syringes -Supplying sterile injection supplies to patients who are at risk for HIV infection can be done by staff members with health assistant education.

Effective communication is fostered through which of the following ingredients? (Select all that apply.) A.Trust B.Humility C.Respect D.Empathy E.Sympathy

Answer: A, C and D Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.

During a staff meeting, a group of RNs has complained that medications are not arriving to the unit in a timely manner. The nurse manager suggests that the group resolve this issue through the development and work of a multidisciplinary team led by one of these RNs. This scenario demonstrates: A.adaptation. B.empowerment. C.flexibility. D.relationship management.

Answer: B Empowerment is the giving of authority, responsibility, and the freedom to act. In this situation, the manager has given authority, responsibility, and the freedom to act in the investigation and resolution of this issue.

A health care system's ability to rapidly expand beyond normal capacity to meet an increased demand for qualified personnel, beds, and medical care services in the event of a large-scale emergency or disaster is known as: A.acuity. B.surge capacity. C.mass casualty. D.natural disaster.

Answer: B Surge capacity is a measurable representation of the ability to manage a sudden influx of patients (American College of Emergency Physicians [ACEP], 2011). In addition to the overall all-hazards preparedness plans, the hospital will need to define procedures regarding what will be done in any biological, chemical, nuclear/radiological, or conventional disaster, and the surge capacity needs related to any of the events

The number one cause of preventable medical errors is: A.hostile work environments. B.poor communication. C.ineffective leadership. D.staff competency.

Answer: B The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program (AHRQ, 2016).

Which communication format was developed to address the communication arm of the TeamSTEPPS model A.NVC (nonviolent communication) B.SBAR (situation, background, assessment, and recommendation) C.VERA (validation, emotion, reassurance, activity) D.MI (motivational interviewing)

Answer: B To address the 1ccommunication arm 1d of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.

•All-hazard preparedness plan drills should occur at least: A.annually. B.biannually. C.monthly. D.quarterly.

Answer: B The benefits of conducting biannual emergency drills, both announced and unannounced, include being able to test the EOP, the command center, and staff roles and responsibilities.

A nurse is caring for an elderly patient who was admitted after sustaining a fall at home. When creating a care plan for the patient, she requests that the doctor order a home health visit to assess for home safety and medication compliance. In addition, the nurse is concerned about the nutrition of the patient and requests a dietitian evaluation. The nurse is demonstrating which of the following leadership skills: A.Care provider B.Business principles C.Care coordination D.Change management

Answer: C Care coordination is the delivery of nursing services that involves the organization and coordination of complex activities. The nurse uses managerial and leadership skills to facilitate delivery of quality care.

Leadership is best defined as: A.an interpersonal process of participating by encouraging fellowship. B.delegation of authority and responsibility and the coordination of activities. C.inspiring people to accomplish goals through support and confidence building. D.the integration of resources through planning, organizing, and directing.

Answer: C Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers.

Unspoken affective or expressive behaviors best describe which type of communication A.Effective communication B.Ineffective communication C.Non-verbal communication D.Verbal communication

Answer: C Non-verbal communication is unspoken. It is composed of affective or expressive behaviors.

Which combination of leadership is recommended for chairing an emergency management committee? A.Chief executive officer and internal medicine physician B.Chief financial officer and emergency care nurse liaison C.Representative chief nurse officer and emergency care physician D.Representative chief information technology officer and critical care physician

Answer: C In health care systems, system-wide executive administrators need to be part of the emergency management committee. Having a senior executive administrator of the health care system serve as the chairperson of the committee will provide the leadership needed to communicate the importance of emergency preparedness as a system priority. A representative CNO and emergency medicine physician, serving as co-chairs with the senior executive administrator, can create a dynamic team that is uniquely prepared to tackle any issues that arise.

In a disaster, it is most important that the: A.clients are sent home quickly. B.All medications are moved to the pharmacy C.Nurses and their families feel safe. D.security department increases its workforce.

Answer: C It is most important that the staff members feel safe. In a disaster, the paradigm of keeping the patient safe first needs to change its focus so that staff members and their families feel as safe as possible. This way, staff members are best able to meet their patients' needs.

•Which communication technique would be most effective when handling a patient complaint? A.Persuasion B.Bargaining C.Negotiation D.Non-verbal cues

Answer: C Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue.

An example of a cyber disaster is a catastrophic event caused by: A.the use of military weapons. B.an exposure to toxic materials. C.an outbreak of a pathogen. D.an attack initiated from one computer against another.

Answer: D A cyber disaster is a catastrophic event that results from an attack initiated from one computer against another computer with the purpose of compromising the information stored on it.

Over lunch in the cafeteria, student nurses are sharing information about the patients for whom they are caring. This is a(n): A.breach of beneficence. B.example of maleficence. C.potential assault and battery charge. D.violation of the Health Insurance Portability and Accountability Act (HIPAA). .

Answer: D HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality

•Interpersonal communication is defined as: A.the conscious intent by one individual to modify the thoughts or behaviors of others. B.a combination of written and spoken communication. C.a theory used to describe a manner of communicating. D.communication between two or more individuals involving face-to-face interaction.

Answer: D Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.

Which of the following traits describe a transactional leader? (Select all that apply.) A.Functions in a caregiver role. B.Surveys their followers' needs and sets goals for them. C.Uses charisma to produce greater effort in followers. D.Focuses on the maintenance and management of ongoing and routine work. E.Motivates followers to perform to their full potential.

Answers: A, B and D A transactional leader is a leader or manager who functions in a caregiver role and is focused on day-to-day operations. Such leaders survey their followers' needs and set goals for them based on expectations. They are also leaders who are focused on maintenance and management of ongoing and routine work. Transformational leaders use charisma to produce greater effort and are able to motivate followers to perform to their full potential over time.

The hospital plays an important role in the community in the case of a disaster. What are some of the expected roles of the hospital? (Select all that apply.) A.Stockpiling emergency equipment B.Purchasing personal protective equipment (PPE) C.Providing additional security for the community D.Educating staff on all-hazards preparedness E.Providing emergency shelter to community members

Answers: A, B and D The hospital will play an important role in the community in the case of a disaster. The materials, equipment, and training required for hospitals to prepare adequately for their role in responding to disasters are very expensive. Capital expenditures will be required to create decontamination facilities; purchase PPE; train and educate staff on effective all-hazards preparedness; stockpile emergency equipment, supplies, and pharmaceuticals; ensure adequate isolation rooms; and outfit a hospital command center. Hospitals need financial assistance to do this well, and the AHPTF members can be advocates for federal and state funding.

Which of the following behaviors build trust between leaders and employees in an? (Select all that apply.) A.Sharing relevant information B.Encouraging competition via winners and losers C.Reducing controls D.Meeting expectations E.Avoiding discussion of sensitive issues

Answers: A, C and D Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition

Which of the following definitions apply to management? (Select all that apply.) A.It is a process of inspiring people to accomplish goals through support and confidence building. B.It is the process of coordination and integration of resources to accomplish specific goals. C.It includes the activities of planning, organizing, coordinating, directing, and controlling. D.It is a process of planning and directing human effort to achieve established objectives. E.It is the directing of the organizations' money, facilities, and supplies to achieve results

Answers: B, C, D and E Management is defined as the process of coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific goals. Management is a process of planning and directing human effort to achieve established objectives while ensuring that the organizations' money, facilities, and supplies are directed in a manner that achieves the best results.

The registered nurse (RN) is planning assignments forthe clients on a nursing unit. The RN needs to assignfour clients and has one RN, one LPN, and two assistivepersonnel (APs) on a nursing team. Which client would the nurse most appropriately assign to the LPN? A. The client who requires a 24-hour urine collection. B. The client with an abdominal wound requiring frequent wound irrigations. C. The older client requiring assistance with a bed bath and frequentambulation. D. The client on a mechanical ventilator requiring frequent assessment andsuctioning

B When delegating nursing assignments, thenurse must consider the skills and educationallevel of the nursing staff. The LPN is skilled inwound irrigation and dressing changes, so thisclient would be assigned to this staff member.Collecting 24-hour urine and helping with abed bath and frequent ambulation can mostappropriately be assigned to the APs. Theclient on the mechanical ventilator requiringfrequent assessment and suctioning wouldmost appropriately be cared for by the RN.

A nursing quality improvement supervisor is proposing to enhance the current quality improvement program. One of the most important themes that a nursing quality improvement supervisor should consider is: A.budgetary considerations. B.collaboration between health care teams. C.regular staff training programs. D.suggestions from patients.

B Collaborative partnerships are part of this imperative and shape the way professional nurses act clinically and how they participate in performance and quality improvement efforts. As the complexity of care increases, multidisciplinary and inter-professional teamwork is used to solve complex problems in practice

Which patients below are best assigned tothe LPN? Select all that apply: A. A 30-year-old male patient with active GI bleeding that requires multipleblood transfusion. B. A 78-year-old female with osteoporosis who needs assistanceperforming range of motion exercises and ambulating with a walker. C. A 29-year-old male patient who is post-op day 6 from a colostomyplacement that is on a clear liquid diet. D. A 55-year-old male patient who reports chest pain and has an STsegment elevation on the EKG.

B & C Rationale: LPNs should be assigned to stable patients with predictable outcomes and cases that do not require critical thinking or complex analysis. The patients in options A and D are unstable and require constant care with decisions based on interpreting patient findings.

A client with multiple injuries is rushed to the ED after a head-on car collision. Which assessment takes first priority? A. Irregular apical pulse B. Deviated trachea C. Unequal pulses D. Ecchymosis in flank area

B (deviated trachea) RATIONALE: A deviated trachea is a symptom of a tension pneumothorax, which will result in respiratory arrest if not treated. This patient does not have a patent airway, which is always the first priority in assessment and treatment. All the other answer options are also alarming, but do not take priority over the airway.

The major responsibility for upholding patient care standards belongs to the: A.chief executive officer of the facility B.nurse manager. C.on-call physician. D.staff nurse providing patient care.

B Rationale: Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.

Which of the following patient-related events may be considered as examples of common negligence allegations in a nursing malpractice suit? (Select all that apply) A.Staffing levels in the medical unit B.Patient fall with injury C.Heparin error D.Failure to utilize rapid response team with change in vital signs E.Failure to ensure telemetry monitor is on the correct patient

B, C, D, E Rationale: Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians' orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment.

A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply). A.Justice B.Autonomy C.Veracity D.Confidentiality E.Maleficence

B,C Rationale: Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case.

Professional safeguards that protect the nurse from being wrongfully accused of malpractice include which of the following? (Select all that apply). A.Code of Ethics B.Statute of Limitations C.Affidavit of Merit D.Standard of Proof E.Sources of Law

B,C,E

The nurse arrives at work and is told to report (float) to the ICU for the day because the ICU is understaffed and needs additional nurses to care for the patients. The nurse has never worked in an ICU. Which is the best action for the nurse to take? A.Refuse to float to the ICU based on lack of unit orientation. B.Clarify the ICU patient assignment with the team leader to ensure that it is a safe assignment. C.Ask the nursing supervisor to review the hospital policy on floating. D.Submit a written protest to nursing administration, and then call the hospital lawyer.

B. Floating is an acceptable way hospitals solve staffing issues. Since this nurse does not have ICU experience, the nurse should clarify the assignment with a team leader to ensure patients' safety and the nurse has the knowledge and skills to accomplish the tasks expected by them for this shift.

You have a patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant? A.Instructing the patient on how to cough effectively B.Assisting the patient to sit up on the side of the bed C.Teaching the patient to use incentive spirometry. D.Auscultation of breath sounds every 4 hours.

B. Assisting the patient to sit up on the side of the bed. Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant.

The registered nurse (RN) is planning assignments for the clients in a nursing unit. The RN needs to assign four clients and has one RN, one licensed practical nurse, and two assistive personnel (APs) on a nursing team. Which client would the nurse most appropriately assigned to the licensed practical nurse? A.The client who requires a 24-hour urine collection B.The client with an abdominal wound requiring frequent wound irrigations C.The older client requiring assistance with a bed bath and frequent ambulation D. The client on a mechanical ventilator requiring frequent assessment and suctioning

B. The client with an abdominal wound requiring frequent wound irrigations LPNs are skilled in wound irrigations, so this patient would be assigned to the LPN.

The nurse is the first responder at the scene of a multivehicle accident on the highway. Which victim would the nurse attend to first? A.) A victim with a deep head wound who is unresponsive B.) A victim experiencing severe dyspnea C.) A victim with a fractured tibia and several small lacerations D.) A victim with tachycardia

B.) A victim experiencing severe dyspnea - Needs related to maintaining a patent airway are always a priority, therefore the victim experiencing dyspnea is priority.

During a class discussion, a 50 year old teacher suddenly feels left-sided chest pain, dizziness, and shortness of breath. What is the priority action when he arrives to the ED? A.Place an IV B.Supply oxygen via nasal cannula C.Put the patient on the monitor D.Notify the Ed physician

B.Supply oxygen via nasal cannula -Increasing myocardial oxygenation is the priority goal

Which comment by the nurse manager would indicate that the hospital places a high value on patient safety A.We have safety posters throughout the hospital that encourage people to report problems. B.We have monthly safety in-services. C.We encourage patients and families to participate in their care. D.All employees are required to update their knowledge of safety practices each year.

C Nurse leaders will continue to play an important role in designing care delivery systems that promote patient and family engagement (Pelletier & Stichler, 2014a). Various toolkits have been developed to assist staff nurses and managers who desire to engage patients and their families in hospitals (AHRQ, 2013c; Pelletier & Stichler, 2014b) and ambulatory and primary care (Caplan et al., 2014; Robert Wood Johnson Foundation, 2014).

An hour after admission to the nursery, the nurse observes a newborn baby having spontaneous jerky movements of the limbs. The infant's mother had gestational diabetes mellitus (GDM) during pregnancy. Which of the following actions should the nurse take FIRST? A. Give dextrose water. B. Call the physician immediately. C. Determine the blood glucose level. D. Observe closely for other symptoms.

C (determine the blood glucose) RATIONALE: As a skilled nursing professional, you should notice that the baby's jerky motions are likely due to hypoglycemia. While observation, calling the physician and giving dextrose water seem like great ideas, determining the baby's blood glucose level is most important. Calling the physician immediately would not be correct because they would ask what you did, and if you didn't get the blood glucose level first you would have no information besides stating the baby is having jerky movements.

A new RN is observed breaking sterile technique by the perioperative nurse. This is an example of a violation of which ethical principle? A.Autonomy B.Justice C.Nonmaleficence D.Confidentiality

C Rationale: Nonmaleficence means doing no harm to clients. A break in sterile technique could cause significant harm to a patient by causing an infection

Nurse managers can create an environment that is devoted to health care safety by doing which of the following? (Select all that apply.) A.Adopting and embracing the concept of disciplining staff who commit errors B.Learning the concepts and tools related to quality improvement and quality assurance C.Becoming a role model for staff and peers in practicing health care safety concepts D.Encouraging staff to be constantly vigilant in identifying potential risks in the care environment E.Creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks

C,D,E Nurse managers can personally create an environment that is devoted to health care safety by doing the following: learning the concepts and tools related to risk identification, analysis, and error reduction; adopting and embracing the concept of non-punitive error reporting; advocating for the establishment of a non-punitive culture if it is not currently a strong ideal within the organization; encouraging staff to be constantly vigilant in identifying potential risks in the care environment; creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks; and becoming a role model for staff and peers in practicing health care safety concepts.

The role of the _____ is to provide leadership and direction for all aspects of nursing services with a focus on integrating the system and building a culture. A.nurse manager B.care provider C.nurse executive D.senior leader

C. The nurse executive's role and functions concentrate on the long-term administration of an institution or program that delivers nursing services, focusing on integrating the system and building a culture

A primary care provider's orders indicated that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement "best" illustrates the nurse fulfilling the client advocate role? A. "The doctor has asked that you sign the consent form." B. "Do you have any questions about the procedure?" C. "What were you told about the procedure you are going to have?" D. "Remember that you can change your mind and cancel the procedure."

C. "What were you told about the procedure you are going to have?" This is the best answer because the nurse is assessing the client's level of knowledge as a result of the discussion with the primary care provider. Based on this assessment, the nurse may initiate other actions (call the primary care provider if the client has any questions)

The nurse learns that patients from a motor vehicle accident are being transferred to the Emergency Department (ED). The nurse performs triage in the ED. Which of the following patients should the nurse see FIRST? A.A patient with ecchymosis and lacerations to the facial area B.A patient complaining of shortness of breath and pressure in the chest C.A patient with a blood pressure of 90/60 and an apical pulse of 120 bpm D.A patient complains of dizziness and nervousness

C. A patient with a blood pressure of 90/60 and an apical pulse of 120 bpm This is the correct answer because the vital signs indicate shock. They are the most unstable patient and require immediate intervention

The nurse is the first responder at the scene of a train accident. Which victim should the nurse attend to first? A. A middle-aged man with 1 foot trapped under the wreckage B. A screaming middle-aged woman looking frantically for her husband C. A young woman who appears dazed and confused and is shivering D. A crying teenager who is holding pressure on an arm laceration

C. A young woman who appears dazed and confused and is shiveringa. This victim is showing signs of shock (hypothermia, confusion) , therefore takes the number one priority. Assessment of airway, breathing, and circulation need to be done immediately followed by oxygenation and intravenous fluids to maintain tissue perfusion.

A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the: A.ANA. B.current federal defense attorney. C.state nurse practice act. D.policy and procedure manual of the unit.

C. •Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision.

The community health nurse is working with disaster relief after a tornado. The nurse assists in finding safe housing for survivors, providing support to families, organizing counseling, and securing physical care when needed. Which level of prevention does the nurse exercise? A.) Primary level of prevention B.) Secondary level of prevention C.) Tertiary level of prevention D.) Quaternary level of prevention

C.) Tertiary level of prevention - Tertiary prevention involves reduction of the amount and degree of disability, injury, and damage after a crisis.

A client with breast cancer is receiving IV morphine sulfate for pain. When writing the plan of care for this client, the nurse would include which choice as the priority action? A.Monitor temperature B.Monitor urine output C.Monitor respiratory status D.Encourage increased fluids

C..Monitor respiratory status -Morphine sulfate depresses respirations. The nurse monitors the client's respiratory status closely. The correct choice identifies the priority nursing action. (Think ABCs- airway, breathing, and circulation)

You are caring for a client who just had a squamous cell carcinoma removed from the face. Which activity can you delegate to an experienced LPN? A.Teaching the client about risk factors for squamous cell carcinoma B.Showing the client how to care for the surgical site at home C.Monitoring the surgical site for swelling, bleeding, or pain D.Discussing reasons for avoiding aspirin use for a week after surgery

C.Monitoring the surgical site for swelling, bleeding, or pain An LPN can monitor the site for swelling, bleeding, or pain, and will notify the supervising RN.

You are supervising a student nurse who is performing tracheostomy care for a patient. Which action by the student would cause you to intervene? A.Suctioning the tracheostomy tube before performing tracheostomy care B.Removing old dressings and cleaning off excess secretions C.Removing the inner cannula and cleaning using standard precautions D.Replacing the inner cannula and cleaning the stoma site

C.Removing the inner cannula and cleaning using standard precautions -When tracheostomy care is performed, a sterile field is set up and sterile technique is used. Standard precautions such as washing hands must also be maintained, but are not enough when performing tracheostomy care. The presence of a tracheostomy tube provides direct access to the lungs for organisms, so sterile technique is used to prevent infection. All of the other steps are correct and appropriate.

A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and Multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? A. Obtain a court order for the surgical procedure B. Ask the EMS team to sign the informed consent C. Transport the victim to the operating room for surgery D. Call the police to identify the client and locate the family.

C.Transport the victim to the operating room for surgery.

Nurse managers are able to respond better to ethical dilemmas when they have access to the organization's: A.mission and vision. B.patient safety plan. C.medical staff bylaws. D.ethics committee.

D Rationale: It is critical that nurses and administrators have access to and inclusion on the health care organization's ethics committee. Nursing professionals are ideal members because of their responsibilities and experiences associated with patient care

A hospitalized client tells the nurse that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance obtaining a witness to the will. Which is the most appropriate response to the client? A. "I will sign as a witness to your signature." B. "You will need to find a witness on your own.' C. "Whoever is available at the time will sign as a witness for you." D. "I will call the nursing supervisor to seek assistance regarding your request."

D. The nurse should provide her nurse manager with the details and have her nurse manager check.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations; it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse's actions, the admitting hospital may be found to be: A.a judicial risk. B.an ostensible authority. C.indemnified. D.vicariously liable.

D. Rationale:If a nurse negligently injured a client during and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable.

A primary health care provider (PHCP) asks the nurse to discontinue tube feeding in a client who has a terminal condition. The PHCP tells the nurse that the request was made by the client's spouse and children. What would the nurse check for first before carrying out the prescription? A.Court approval to discontinue the treatment B.Approval by the institutional ethics committee C.A written prescription by the PHCP to remove the tube D.Authorization by the family to discontinue the treatment

D. Authorization by the family to discontinue the treatment--- the family or a legal guardian can make treatment decisions for the client who is unable to do so.

The nurse is assigned to care for four clients. In planning client rounds, which client should the nurse assess first? A. A client scheduled for a chest x-ray B. A client requiring daily dressing changes C. A postoperative client preparing for discharge D. A client receiving nasal oxygen who had difficulty breathing during the previous shift.

D. (a client receiving nasal oxygen who had difficulty breathing) RATIONALE: Airway is always the highest priority (ABC's); thus, the nurse would attend to the patient that was having previous breathing difficulties for the other shift first. It is still important to assess the other patients, but client D is the most unstable and airway always takes priority.

After a change of shift, you are assigned to care for the following patients. Which patient should you assess first? A. A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab B. A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation C. A 70-year old with pneumonia who needs to be started on intravenous (IV) antibiotics D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.

D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.

An Emergency Department (ED) charge nurse prepares to receive clients from a mass casualty within the community. What is the role of this nurse during the event? a.Ask ED sta to discharge clients from the Medical-Surgical units to make room for critically injured victims. b.Call additional Medical-Surgical and Critical Care nursing sta to come to the hospital to assist when victims are brought in. c.Inform the incident commander at the mass casualty scene about how many victims may be handled by the ED. d.Direct Medical-Surgical and Critical Care nurses to assist with clients currently in the ED while emergency sta prepare to receive the mass casualty victims.

D. Direct Medical-Surgical and Critical Care nurses to assist with clients currently in the ED while emergency sta prepare to receive the mass casualty victims.

The nurse on a medical unit is caring for a 19-year-old with complications from a congenital heart defect. The client's mother is consistently at the bedside asking questions and attempting to direct the treatment plan. Which of the following shows how the nurse should communicate with the mother? A.Discuss personal information that the client shared with the nurse in confidence. B.Provide the mother with any information required for continuity of care. C.Explain that client confidentiality prevents the nurse from disclosing information. D.Ask the client if he gives permission for the nurse to share information with the mother.

D. Rationale: It is the nurse's legal and ethical duty to protect the adult "child's" autonomy and not simply accept a parent's intervention, without lawful authority, just because it may seem easier at the moment. The nurse must obtain permission from the client before sharing information with the mother

A nurse is field-triaging clients after an industrial accident. Which client condition should the nurse triage with a red tag? A.Dislocated right hip and an open fracture of the right lower leg B.Large contusion of the forehead and a bloody nose C. Closed fracture of the right clavicle and arm numbness D.Multiple fractured ribs and shortness of breath

D: Clients who are at an immediate threat to life are given highest priority and red tagged.The client with multiple rib fractures and shortness of breath most likely has developed a pneumothorax which may be fatal and classified as a class I.

The plan of care for a patient with dehydration is routine oral care. Which interventions are within the scope of practice of an LPN and can be delegated to them? (Select all that apply) a)Reminding the client to avoid mouthwashes containing alcohol b)Encouraging the client to rinse his/her mouth frequently c)Seeking a dietary consult to increase fluids on meal trays d)Observing the lips, tongue, and mucus membranes e)Providing mouth care every 2 hours while the client is awake

a, b, d, e

A nurse manager is planning the client assignments for the day. Which of the following clients would the nurse assign to the nursing assistant? a) A 2-day postoperative client who had a below-the-knee amputation b) A client on a 24-hour urine collection who is on strict bedrest c) A client scheduled to be discharged after coronary artery bypass surgery d) A client scheduled for a cardiac catheterization

b) A client on a 24-hour urine collection who is on strict bedrest The nursing assistant has been trained to care for a client on bedrest and on urine collections.

After an initial assessment the nurse determines the need to place a restraint on a client. The client Refuses application of the restraint. What is the best nursing action for this client? A Apply the restraint anyway, b.Contract the primary care provider (PCP). c.Compromise with the client and then apply the restraint. d.Medicate the client with a sedative and then apply the restraint.

b.Contract the primary care provider (PCP).

Nursing staff members are sitting in the lounge taking their morning break. An unlicensed assistive Personnel (UAP) tells the group that she thinks that the unit secretary has acquired AIDS and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. Which legal tort has the UAP violated? a.Libel b.Slander c.Assault d.Negligence

b.Slander

A hospitalized client tells the nurse that a living will is being prepared and that the lawyer is going to be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance obtaining a witness to the will. Which is the most appropriate response to the client? a."I will sign as a witness to your signature" b."You will need to find a witness on your own" c."Whoever is available at the time will sign as a witness for you" d."I will call the nursing supervisor to seek assistance regarding your request"

d."I will call the nursing supervisor to seek assistance regarding your request"