Lesson 1 Management of Care Questions

The triage nurse in an emergency room identifies that a 16-year-old client, who is legally married, has signed the consent form for medical treatment. Which action should the nurse take? a. Refer the client to a pediatric hospital's emergency department. b. Accept the consent form and proceed with the triage process. c. Obtain consent for treatment over the phone from the client's spouse. d. Ask the client to wait until a parent or legal guardian can be contacted.

b. Accept the consent form and proceed with the triage process. Under the Statutory Guidelines for Legal Consent for Medical Treatment, a minor may gain the legal status of an "emancipated minor" through marriage. Therefore, this married client has the legal capacity of an adult. The triage nurse should allow the client to sign the consent form for treatment and proceed with the triage process. This client legally can consent to medical treatment independently, as an emancipated minor.

An 85-year-old client is admitted to a home health care agency following a hospitalization. The client needs assistance with activities of daily living (ADLs). During the admission process, the nurse develops a plan of care for this client. Place the steps in the case management process in the correct order by dragging and dropping the options below. -12345 Identification of nursing problems -12345 Evaluation of progress towards the client's home care goals -12345 Assessment of biophysical and sociocultural considerations -12345 Reassessment of health status and ADL ability -12345 Complete referrals for assistance with ADLs

-Assessment of biophysical and sociocultural considerations -Identification of nursing problems -Complete referrals for assistance with ADLs -Reassessment of health status and ADL ability -Evaluation of progress towards the client's home care goals Case management is a collaborative process that follows the nursing process and assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual's health needs. When a client is admitted to a home health care agency, an assessment is conducted to ensure continuity of care between the hospital and the home health agency. The nurse should follow the nursing process and first asses the biophysical (i.e., physiologic) and sociocultural (i.e., interpersonal) considerations. Then the nurse can use this information to identify nursing problems. Once the problems are identified the nurse can make referrals as appropriate. After these referrals have been implemented, the nurse should reassess the client's health status and ADL abilities. Finally, the nurse should evaluate the client's progress toward their home care goals.

The nurse in a family practice office is teaching a client about establishing advance directives for health care. Which statement by the client indicates that further teaching is needed? a. "It will describe how my things should be divided between my family members." b. "My wishes for end-of-life treatment are stated in writing." c. "It is a legal document that becomes a part of my health care record." d. "I will need to identify someone to be my health care proxy."

a. "It will describe how my things should be divided between my family members." An advance health care directive is also known as a living will. It is a legal document in which a person specifies their wishes concerning medical treatments at the end-of-life, when they are unable to make those decisions. Advance care planning involves sharing personal values and wishes with loved ones and selecting someone (called a medical power of attorney or health care proxy) who will eventually make medical decisions on the client's behalf. A living will does not expire; it remains in effect unless it is changed. A living will does not include information regarding assets or a person's estate.

The nurse manager suspects a staff nurse may be suffering from substance use disorder (SUD). Which initial action by the nurse manager would be best? a. Consult with human resources staff and follow their recommendations. b. Schedule a meeting with other staff members to collect information. c. Meet with the nurse about the suspicions in a private meeting. d. Counsel the nurse about substance abuse and suggest treatment options.

a. Consult with human resources staff and follow their recommendations. The best initial action is to consult with the human resources department to determine a plan of action regarding this situation. The nurse manager should follow the proper procedures for objectively documenting and reporting the nurse's behavior. The nurse manager could also consult the Employee Assistance Program (EAP) if one is available. Attempts should be made to help the nurse with SUD by providing resources for counseling and treatment for this disease but those interventions would come later.

A client is being prepped for a surgical procedure and the nurse is reviewing the consent form with the client. The client asks, "Is there any other way to take care of this without having surgery?" What should the nurse do next? a. Notify the surgeon that the client has additional questions about the surgery. b. Tell the client if they don't want the surgery, they don't have to have it. c. Notify the operating room and cancel the surgery. d. Reassure the client that the surgery is the best treatment option.

a. Notify the surgeon that the client has additional questions about the surgery. The client should only sign the consent form after all their questions are answered. Notify the appropriate health care provider if the client needs additional information about the surgery. Once the client has all the necessary information, they can then decide not to sign the informed consent form and the surgery can be cancelled. Offering false reassurance violates the client's right to autonomy. Cancelling the surgery is premature at this time.

Where can the nurse find the most reliable guidelines regarding the appropriate delegation of tasks to unlicensed assistive personnel (UAP)? a. That state's nurse practice act (NPA) b. The American Nurses Association (ANA) c. The National Council of State Boards of Nursing (NCSBN) d. The American Nurses Credentialing Center (ANCC)

a. That state's nurse practice act (NPA) When questions arise regarding who can delegate what activities to which unlicensed provider groups, it is the nurse practice acts (NPAs) of individual states that establish the legal definitions of appropriate delegation practices. Because regulations differ among states, each nurse must identify and understand the regulations for the state in which they practice.

The nurse on a post-surgical unit observes an unlicensed assistive person (UAP) caring for a client who had a transurethral resection of the prostate (TURP). Which action by the UAP requires immediate intervention by the nurse? a. The UAP adjusts the rate of the irrigation bag for the client's continuous bladder irrigation. b. The UAP applies a moisture barrier cream to the client's excoriated perianal area. c. The UAP empties the indwelling catheter bag and records the amount of output. d. The UAP assists the client to the bathroom to shave his face with an electric razor.

a. The UAP adjusts the rate of the irrigation bag for the client's continuous bladder irrigation. Unlicensed assistive personnel (UAP) can perform a number of delegated nursing tasks, such as emptying an indwelling urinary catheter bag, applying moisture barrier cream after peri-care, assisting a client to the bathroom and helping a client shave with an electric razor. The UAP should not complete tasks that require nursing assessment. Since adjusting the irrigation rate requires nursing assessment, it should only be done by the nurse.

The nurse observes another nurse walking away from their computer with a client's electronic medical record (EMR) still visible on the screen. What should the nurse do first? a. Notify the nurse manager of the incident. b. Walk over to the computer and close the client's medical record. c. Speak with the nurse about always closing the EMR. d. Complete an incident report about the potential client privacy violation.

b. Walk over to the computer and close the client's medical record. All of the nurse's actions are appropriate, but in order to prevent unauthorized personnel from seeing any of the client's protected health information, the nurse should first close the client's EMR, which is still visible on the screen.

The nurse is handing-off the care of a client admitted with pneumonia to the nurse for the next shift. What client information should the nurse include in the hand-off report, using the S.B.A.R. method? a. Pain, oxygen requirements, insurance information and vital signs b. IV access, admitting diagnosis, allergies and antibiotics given c. Admitting diagnosis, vital signs, room number and insurance information d. Marital status, vital signs, religious affiliation and admitting diagnosis

b. IV access, admitting diagnosis, allergies and antibiotics given S.B.A.R. stands for situation, background, assessment and recommendation. Situation in the model refers to the client's main problem. Background refers to the client's basic information, such as admitting diagnosis, allergies, etc. Assessment refers to objective and subjective data the nurse collects that helps to define the client's problem. Recommendation is the nurse's suggested solution(s) to the problem. Insurance information, marital status and religious affiliation are not shared when using the S.B.A.R. model of communication.

The new graduate nurse interviews for a nursing position on a hospital unit that uses a shared governance model. Which description best illustrates this concept? a. The manager of the nursing unit develops and implements changes on the unit. b. Nurses work together to implement changes and share responsibility for client outcomes. c. The hospital's executive team determines the standards of nursing care. d. Nurses and physicians collaborate to discuss client care standards.

b. Nurses work together to implement changes and share responsibility for client outcomes. Shared governance or self-governance is a method of organizational design. It promotes the empowerment of nurses and gives them responsibility for client care issues and outcomes. Chaired by senior clinical nursing staff, these groups are empowered to establish and maintain standards of nursing care and practice on their unit. The committees review and establish standards of care, develop policy and procedures, resolve client satisfaction issue, and/or develop new documentation tools. It is important to focus on client outcomes to ensure high-quality care is delivered on the nursing unit.

The nurse in an emergency room is planning care for an unconscious client who arrived by ambulance from a long-term care facility. The paramedics have given the nurse copies of paperwork from the client's facility. Which is the best way for the nurse to determine who should make health care decisions for this client? a. Ask the primary health care provider in the emergency room. b. Review a notarized original copy of the client's advance directives. c. Contact the client's primary care physician by phone. d. Call the emergency contact person listed in the client's paperwork.

b. Review a notarized original copy of the client's advance directives. The client's advance directives specify the client's wishes about what actions are to be taken should the client become unable to make health care decisions. This client is unconscious, thus unable to make decisions. Typically, clients from long-term care facilities have advance directives in place, and the facility sends this document with them if they leave the facility for any reason. The advance directive often includes a living will and the power of attorney to whom will make the health care decisions for the client. The nurse should seek out this document when planning care for this client to ensure the client's wishes are followed.

A client with Parkinson's disease is prescribed benztropine (Cogentin). For which of the following should the nurse call the health care provider immediately? a. The client is exhibiting bradykinesia and slurred speech. b. The client has a history of primary angle-closure glaucoma. c. The client's heart rate increased from 80 to 95 beats per minute. d. The client is complaining of dizziness when standing up.

b. The client has a history of primary angle-closure glaucoma. The nurse must be able to recognize adverse drug effects and contraindications of medications commonly prescribed for the client with Parkinson's disease. Common clinical manifestations of Parkinson's disease include bradykinesia (slow movement), dysarthria (slurred speech) and orthostatic hypotension, caused by the loss of the neurotransmitter dopamine. The goal of pharmacotherapy is to restore the functional balance of dopamine and acetylcholine. This is achieved by giving dopaminergic drugs and cholinergic blockers. Benztropine is an anticholinergic medication used in the treatment of Parkinson's disease that blocks excess cholinergic stimulation in the brain and reduces muscular tremors and rigidity. Tachycardia is a potential adverse drug event, but a heart rate increase of 15 bpm is within acceptable limits. Due to their blocking actions of the parasympathetic nervous system, anticholinergics are contraindicated with glaucoma, where they can cause an increase in intraocular pressure (IOP), which can lead to vision loss and blindness.

The nurse is assigned to care for four clients in the emergency department. Which client should the nurse see first? a. A 45-year-old with spontaneous pneumothorax and a respiratory rate of 28 b. A 22-year-old with acute asthma with episodes of bronchospasms c. A 34-year-old with a tension pneumothorax and tracheal deviation d. A 59-year-old with suspected viral pneumonia and atelectasis

c. A 34-year-old with a tension pneumothorax and tracheal deviation Tension pneumothorax occurs when there is an accumulation of air under pressure in the pleural space. This causes compression of the lungs and decreases venous return to the heart. Tracheal deviation indicates a significant volume of air is trapped in the chest cavity, causing a mediastinal shift. This is a medical emergency. In tension pneumothorax, the tracheal deviation is away from the affected side. This situation also results in sudden air hunger, agitation, hypotension, pain in the affected side and cyanosis with a high risk of cardiac tamponade and cardiac arrest. This patient is the most critical and should be seen first.

A client's family member calls for an update on the client's condition. What should the nurse do first before providing information to the caller? a. Call the physician to verify the client's condition before updating the caller. b. Decline the caller's request and notify the nurse supervisor of a potential HIPAA violation. c. Check with the client and obtain permission to provide the caller with the requested information. d. Ask the family member who is currently visiting the client if it is okay to release the information.

c. Check with the client and obtain permission to provide the caller with the requested information. The nurse must have permission from the client to release information to the caller. If the client is unable to give permission and has a power of attorney for health care (POAH), then information shall only be given to the POAH. Family members can obtain updates from that person. Remember, it is difficult to know who is calling over the phone. The nurse should also be familiar with the organization's policy on requests for information over the phone.

The new nurse understands that patient-centered care, according to QSEN, should include which nursing actions? Select all that apply. a. Participating in designing systems that support effective teamwork. b. Adhering to Institutional Review Board (IRB) guidelines. c. Respecting and encouraging individual expression of client values. d. Communicating what care was provided and is needed at each transition in care. e. Recognizing the boundaries of therapeutic relationships.

c. Respecting and encouraging individual expression of client values. d. Communicating what care was provided and is needed at each transition in care. e. Recognizing the boundaries of therapeutic relationships. The QSEN project defines the knowledge, skills and attitudes (KSAs) for six key areas or required competencies for new nurses. KSAs required for patient-centered care include for the nurse to: Elicit patient values, preferences and expressed needs as part of the clinical interview, implementation of care plan and evaluation of care; communicate patient values, preferences and expressed needs to other members of the health care team; and provide patient-centered care with sensitivity and respect for the diversity of human experience. Designing systems that support effective teamwork fits under the Teamwork and Collaboration QSEN category. Adherence to IRB guidelines is found under the Evidence-based Practice (EBP) QSEN competency.

The nurse is precepting a new nurse employee, and explains the standards of nursing documentation. Which statement by the new nurse employee indicates teaching was effective? a. "It is best to use general statements such as 'status unchanged' when writing client care notes." b. "I will summarize client comments in my own words to keep documentation concise." c. "I will leave blank spaces in the written notes section so staff can add notes later if needed." d. "I will document objective assessments and interventions at the time of client care."

d. "I will document objective assessments and interventions at the time of client care." The medical record is a legal document. Documentation should include all steps of the nursing process. It must be complete, accurate, concise and in chronological order. Inaccurate or incomplete documentation will raise red flags in a court of law and may indicate the nurse failed to meet the standards of care. The nurse should emphasize complete and accurate documentation at all times in the medical record. Nurses should avoid generalized statements. Specific information about the client should be included, along with complete descriptions of care provided. Nurses should not leave blank spaces in written notes sections. This leaves a place where someone could add incorrect information at a later time. Notes should be chronological. Client comments should be quoted, verbatim and placed in quotation marks when appropriate. Nurses should only enter objective information and objective descriptions of client behavior.

Which of these activities can the nurse assign to an unlicensed assistive person (UAP)? a. Care for a stable client. b. Reinforce teaching to the client. c. Create a plan of care for the client. d. Provide basic care to the client.

d. Provide basic care to the client. UAPs' limited scope includes (but may not be limited to) assisting with ADLs such as bathing, feeding, toileting, obtaining vital signs, input and output (I/O), performing point of care (POC) tests, such as a blood sugar check or 12-lead electrocardiogram, and recording height and weight. UAPs cannot reinforce teaching, create a plan of care or assume nursing care for a client - even if the client is stable.

After a stressful shift at the hospital, the nurse writes the following post on their personal social media account: "Today was a rough day. One of my clients was in a terrible car crash and hemorrhaged. I felt so bad for the family." Which consequence could result from the nurse posting this information online? a. The nurse could be reprimanded for not first clearing the post with the hospital's administration team. b. The information was posted without mention of personal identifiers, so legally no consequences can follow. c. The nurse could be asked to post a disclaimer that they do not represent the hospital on this social media account. d. The nurse could be terminated from employment at the hospital for breach of client confidentiality.

d. The nurse could be terminated from employment at the hospital for breach of client confidentiality. Many health care facilities have adopted a social media policy. It is important to understand that nurses can be terminated (i.e., fired) for posting personal information about clients online, because this is an invasion of privacy. In addition to being a Health Insurance Portability and Accountability Act (HIPAA) violation, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) gives state's attorneys the right to pursue violations of client privacy. Maintaining confidentiality is an important aspect of professional behavior. Sharing personal information or gossiping about others violates nursing ethical codes and practice standards.