Management and Leadership/Ethical and Legal nursing Nclex questions
The nurse working in an acute care environment would utilize which strategies to reduce the risk of malpractice litigation? Select all that apply. 1. discuss any errors with the client and family in detail 2. keep incident reports on file 3. maintain expertise in practice 4. offer opinions to clients when the situation warrants 5. report unsafe staffing levels to supervisor
3, 5
The HCP orders a med in a dose that is considered toxic. The nurse administers the med to the client, who later suffers a cardiac arrest and dies. What consequence can the nurse expect from this situation. Select all that apply. 1. the HCP can be chrgd w/ negligence, being the person who ordered the dose 2. as the employing agency, only the hospital can be charged w/ negligence 3. the nurse and the physician may be terminated from employment to prevent a charge of negligence to the hospital 4. negligence will not be charged, as this event could have happened to any reasonable person 5. The nurse can be charged with negligence for administering the toxic dose
1, 5
An individual has a seizure while walking down the street. During the seizure, a nurse from a physician's office is noticed driving past without stopping to assist. The individual sues the nurse for negligence but fails to win a judgement for which reason? 1. The nurse had no duty to the individual 2. The nurse did what most nurse's do in the same circumstance 3. the nurse did not cause the client's injuries 4. The nurse was off duty
1.
The nurse on the hospital quality improvement team has been asked to evaluate nursing care on the nurse's assigned unit. After deciding to ask the nursing staff for assistance in this effort, what would be most appropriate for the nurse to initially ask the staff to do? 1. track the number of supplies used by the clients on the unit 2. document the time spent on direct client care 3. administer a client and family satisfaction survey 4. assess clients and report acuity daily
3.
A registered nurse is observing a nursing student auscultate the breath sounds of a client. The registered nurse intervenes if the nursing student performs which incorrect action? a) use the bell of the stethoscope b) asks the client to sit straight up c) places the stethoscope directly on the client's skin d) has the client breathe slowly and deeply through the mouth
A - The bell of the stethoscope is not used to auscultate breath sounds. The client ideally should sit up and breathe slowly and deeply through the mouth. The diaphragm of the stethoscope, which is warmed before use, is placed directly on the client's skin, not over a gown or clothing.
A client with active tuberculosis (TB) is to be admitted to a medical-surgical unit. When planning a bed assignment, the nurse: a) plans to transfer the client to the intensive care unit b) places the client in a private, well-ventilated room c) assigns the client to a double room because intravenous antibiotics will be administered d) assigns the client to a double room and places a "strict handwashing" sign outside the door
B - According to category-specific (respiratory) isolation precautions, a client with TB requires a private room. The room needs to be well-ventilated and should have at least six exchanges of fresh air per hour and should be ventilated to the outside if possible. Therefore, option 2 is the only correct option.
A nurse manager is planning to implement a change in the method of the documentation system for the nursing unit. Many problems have occurred as a result of the present documentation system, and the nurse manager determines that a change is required. The initial step in the process of change for the nurse manager is which of the following? a) plan strategies to implement the change b) set goals and priorities regarding the change process c) identify the inefficiency that needs improvement or correction d) identify potential solutions and strategies for the change process
C - When beginning the change process, the nurse should identify and define the problem that needs improvement or correction. This important first step can prevent many future problems, because, if the problem is not correctly identified, a plan for change may be aimed at the wrong problem. This is followed by goal setting, prioritizing, and identifying potential solutions and strategies to implement the change.
The charge nurse on the night shift reports that the narcotic count is incorrect. The nurse has spoken to the responsible staff nurse and believes that substance abuse by the nurse is the cause. If substance abuse proves to be the cause of the incorrect count, what is the most appropriate next step?
Complete and incidence report and report findings to the pharmacy and nursing administration. *if the staff nurse id founds to be using the substance, this finding must be reported to the state board of nursing*
A nurse forgets to administer a client's diuretic and the client experiences an episode of pulmonary edema. The charge nurse would consider the medication error to constitute negligence b/c the situation contains which element? 1. purposeful failure to perform a healthcare procedure 2. unintentional failure to perform a healthcare procedure 3. Act of substituting a different med for the one ordered 4. failure to follow a direct order by a physician
2.
The nurse-manager meets with a staff nurse to evaluate performance after a 6-month probationary period. As part of the evaluation process, the nurse-manager would ask the staff nurse to: 1. accept the nurse-manager's evaluation by signing in agreement 2. contribute a self-evaluation and suggested areas for future growth 3. have peers vouch for his or her performance 4. giver her perception of how the manager is performing
2.
A nurse and teacher are discussing legal issues r/t the practice of their professions. The teacher asks what the functions are of the Nurse Practice Act (NPA) in that state. The nurse would include which thoughts in response? Select all that apply. 1. accredit schools of nursing 2. enforce ethical standards of behavior 3. protect the public 4. define the scope of nursing practice 5. determine liability insurance rates
3, 4 The state's *NPA* serves to protect the public by setting minimum qualifications for nursing in relation to skills and competencies. One way it fulfills responsibility to protect the public is by defining the scope of practice in that state. The *state board of nursing* approves schools to operate but does not accredit them. The state board of nursing does not enforce ethical standards. A state NPA has no role in in setting liability insurance.
The nurse-manager implements new processes to decreased the incidence of central IV line infection. What is the best indicator that the measures have resulted in improved outcomes? 1. a survey of the unit's nurses indicates perceived improvement in results 2. a total decrease in the number of central line IV line infections on the unit has been identified 3. retrospective chart audits for infection rate show improvement in clients with central line IV lines 4. comparison of total number of IV ABX used b/w the two time periods has shown a decreased in ABX use
3.
The nurse-manager notes an unacceptable rate of falls on the unit. Hourly rounds by nursing staff are initiated. What is the best method to determine that the change has made a difference? 1. Scores on client satisfaction surveys 2. surveys on staff's perception of the effectiveness 3. comparing fall rates after the rounds are initiated 4. documentation that the rounds are completed as scheduled
3.
Which action can the nurse be legally liable for? 1. administering 2 mg hydromorphone (Dilaudid) when the client is prescribed 1 to 2 mg q 4hrs 2. withholding digoxin (Lanoxin) when the client's apical pulse is 56 bpm 3. withholding mononitrate (Imdur) when client's BP is 80/40 4. Administering cephalosporin when the client has an allergy to penicillin
4. (4)There is a cross-sensitivity b/w cephalosporin and penicillin, and the drug should not be given. (1)When a range is ordered, any dose in the range is acceptable. (2)Bradycardia is a sign of digoxin toxicity, and the drug should not ordinarily be given if the pulse is less than 60. (3)Nitrates cause vasodilation and should not be given when hypotension is present.
A staff nurse at the nurse's station answers the phone and is told there is a bomb in a client's room. What action should the nurse take? 1. put call on hold and obtain charge nurse 2. transfer call to security 3. ask caller for details about the bomb placement 4. signal to staff to close the clients door
3. with potential danger, it is important to determine as much information as possible
A new graduate nurse is completing the scheduled 4-week orientation to a med-surg unit. Which self-recognized need should prompt the new graduate nurse to request some additional time or training before ending orientation? 1. uncomfortable if had to manage a cardiac arrest independently 2. unclear on staffing assignments are made on the unit 3. frequently unable to establish new IV access on the first attempt 4. unable to manage more than two clients at a time
4.
Staff from two different dept. are disagreeing over the transfer process b/w there respective dept. Which is the best process to handle this disagreement? 1. ask director of nursing to establish a policy 2. allow the staff to handle the issue on their own without authoritative interference 3. Arrange managers from the dept. to determine a solution 4. set up a meeting of staff from the departments to identify key issues
4.
A client asks why a dx test has been ordered and the nurse replies, "I'm unsure but I will find out for you." When the nurse later returns and provides an explanation, the nurse is acting under which principle? 1. Nonmaleficence 2. Veracity 3. Beneficence 4. Fidelity
4. *Fidelity* means being faithful to agreements and promises. This nurse is acting on the client's behalf to obtain needed information and report it back to the client. *Nonmaleficence* is the duty to do no harm. *Veracity* refers to telling the truth for example, not lying to a client about a serious prognosis. *Beneficence* means doing good, such as by implementing actions (e.g., keeping a salt shaker out of sight) that benefit a client (heart condition requiring sodium-restricted diet)
A registered nurse is mentoring a new nurse hired to work in the nursing unit. The registered nurse determines that the new nurse is competent to provide safe effective care for a client on a ventilator when the registered nurse notes that the new nurse: a) has the ventilator routinely assessed by the respiratory therapist b) realizes that the ventilator readings provide information without human error c) teaches family members how to reset controls during their visits if necessary d) establishes a rest pattern before morning care
A - Ventilators need to be assessed routinely by the respiratory therapist. Ventilators are machines, and machines can fail. Therefore, option B is not a reasonable option. Family members should not reset ventilator controls. Although option D is considered good nursing practice for the comfort of the client, it is not the priority option.
A new nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice? a) a task approach method is used to provide care to clients b) managed care concepts and tools are used in providing client care c) an RN leads nursing personnel in providing care to a group of clients d) a single RN is responsible for providing nursing care to a group of clients
C - In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A identifies functional nursing. Option B identifies a component of case management. Option D identifies primary nursing.
A registered nurse suspects that a colleague is substance impaired and notes signs of alcohol intoxication in the colleague. The Nurse Practice Act requires the registered nurse do which of the following? a) talk with the colleague b) call the impaired nurse organization c) report the information to a nursing supervisor d) ask the colleague to go to the nurse's lounge to sleep for a while
C - Nurse Practice Acts require reporting the suspicion of impaired nurses. The Board of Nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the Board of Nursing. Confronting the colleague may cause conflict. Asking the colleague to go to the nurses' lounge to sleep for awhile does not safeguard clients.
A charge nurse knows that drug and alcohol use by nurses is a reason for the increasing numbers of disciplinary cares by the Board of Nursing. The charge nurse understands that when dealing with a nurse with such an illness, it is most important to assess the impaired nurse to determine: a) the magnitude of drug diversion over time b) if falsification of clients records occurred c) the types of illegal activities related to the abuse d) the physiological impact of the illness on practice
D - A nurse must be able to function at a level that does not affect the ability to provide safe, quality care. The highest priority is to determine how the illness affects the nurse's ability to practice. The other options will be addressed if an investigation is carried out.
A client with cancer has decided to discontinue further tx. Although the nurse would like the client to continue tx, the nurse recognizes the client is competent and supports the client's decision using which ethical principle? 1. Justice 2. Fidelity 3. Autonomy 4. Confidentiality
3. *Autonomy* refers to the right to make one's own decisions, which is the principle supported in this situation. *Justice* refers to fairness. *Fidelity* refers to trust and loyalty. *Confidentiality* refers to privacy of personal health information
The nursing team consists of one RN, one LPN, and one UAP. What is the most appropriate assignment for the RN to delegate to the LPN? 1. pass the dinner trays 2. empty the Foley cath 3. administer morning PO daily meds 4.suction client who is one day postop after tracheostomy
3.
A client is referred to a surgeon by the general practitioner. After meeting the surgeon, the client decides to find a different surgeon to continue treatment. The nurse supports the client's action, utilizing which ethical principle? 1. beneficence 2. veracity 3. autonomy 4. privacy
3. *Autonomy* is the right of individuals to take action for themselves. *Beneficence* is an ethical principle to do good and applies when the nurse has a duty to help others by doing what is best for them. *Veracity* refers to truthfullness. *Privacy* is the nondisclosure of information by the health care team.
The team leader/charge nurse notices at the beginning of the shift that all of the IV ABX for a client are still in the medication room. Which action should the team leader take first? 1. ask client if client received the meds on previous shift 2. return meds to pharmacy so client does not get billed 3. ask nurse who cared for the client about the medications 4. notify the nurse-manager of the unit
3. team leader should attempt to clarify with the involved staff first
Based upon a request made by the client's spouse and children, a physician asks a nurse to discontinue the feeding tube in a client who is in chronic debilitated and comatose state. The nurse understands the legal basis for carrying out the order and first checks the client's record for documentation of: a) a court approval to discontinue the treatment b) approval by the institutional Ethics Committee c) a written order by the physician to remove the tube d) authorization by the family to discontinue the treatment
D - The family or a legal guardian can make treatment decisions for the client who is unable to do so. Once the decision is made, the physician writes the order. Generally, the family makes decisions in collaboration with physicians, other health care workers, and other trusted advisors. Although a written order by the physician is necessary, the nurse first checks for documentation of the family's request. Unless special circumstances exist, a court order is not necessary. Although some health care agencies may require reviewing such requests via the Ethics Committee, this is not the nurse's first action.
A nursing student is developing a plan of care for a client with a chest tube that is attached to a Pleur-Evac drainage system. The nurse intervenes if the student writes which incorrect intervention in the plan? a) position the client in semi-fowler's position b) add water to the suction chamber as it evaporates c) tape the connection sites between the chest tube and the drainage system d) instruct the client to avoid coughing and deep breathing
D - It is important to encourage the client to cough and deep breathe when a chest tube drainage system is in place. This will assist in facilitating appropriate lung re-expansion. Water is added to the suction chamber as it evaporates to maintain the full suction level prescribed. Connections between the chest tube and the drainage system are taped to prevent accidental disconnection. The client is positioned in semi-Fowler's to facilitate ease in breathing.
A registered nurse has instructed a new nursing graduate about the procedure for weaning a client from a ventilator by using a T-piece. The registered nurse determines that the new nursing graduate nurse states which of the following to be part of the procedure? a) removing the client from the mechanical ventilator for a short period b) connecting the T-piece to the client's artificial airway c) providing supplemental oxygen through the T-piece at an Flo2 that is 10% higher than the ventilator setting d) gradually decreasing the respiratory rate on the ventilator until the client takes over all of the work of breathing
D - The T-piece or Briggs device requires that the client is removed from the mechanical ventilation for a short time, usually beginning with a 5-minute period. The ventilator is disconnected and the T-piece is connected to the client's artificial airway. Supplemental oxygen is provided through the device, often at a FIo2 that is 10% higher than the ventilator setting. Option 4 describes the process of weaning via synchronized intermittent mandatory ventilation.
The nurse has recently been assigned to manage a pulmonary progressive unit at a large urban hospital. The nurse's leadership style is participative, with the belief that all staff members assist in decision making and the development of the unit's goals. The nurse is implementing which leadership style? a) democratic b) laissez faire c) auticratic d) situational
A - Democratic leadership is defined as participative with a focus on the belief that all members of the group have input into the decision making process. This leader acts as a resource person and facilitator. Laissez faire leaders assume a passive approach, with the decision making left to the group. Autocratic leadership dominates the group, with maintenance of strong control over the group. Situational leadership is based on the current events of the day.
A registered nurse is preceptor for a new nursing graduate and is observing the new nursing graduate organize the client assignment and daily tasks. The registered nurse intervenes if the new nursing graduate does which of the following? a) provide time for unexpected tasks b) lists the supplies needed for a task c) prioritizes client needs and daily tasks d) plans to document task completion at the end of the day
D - The nurse should document task completion continuously throughout the day. Options A, B, and C identify accurate components of time management.
A nurse is told that the nursing model used in the nursing facility is a functional nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice? a) a task approach methods is used to provide care to clients b) a single registered nurse (RN) is responsible for providing nursing care to a group of clients c) managed care concepts and tools are used in providing client care d) nursing personnel are led by a RN in providing care to a group of clients
A - In functional nursing, a task approach method is used to provide care to clients. Option B exemplifies primary nursing. Option C exemplifies a component of case management. Option D exemplifies team nursing.
A registered nurse assigns a new nursing graduate to care for a client with a diagnosis of active tuberculosis, and the registered nurse explains the use of a particulate respirator to the graduate. Which observation indicates that the new nursing graduate understands how the particulate respirator operates? a) the nosepiece is readjusted if air is detected escaping around the nose b) another particulate respirator is obtained if air is escaping around the nose c) the new nursing graduate states that a fit check is not needed d) the new nursing graduate states that a fit check is necessary only when putting on the respirator for the first time
A - Personal protective equipment, called particulate respirators, is required for all health care workers entering a tuberculosis isolation room. When fitted and used properly, these respirators filter droplet nuclei. It is important that no air escapes around the nose while wearing the respirator. The strap needs to be adjusted if air is escaping. It is important to exhale forcefully while placing both hands over the apparatus. It is necessary to perform a fit check each time the nurse uses the mask.
When a nurse manager makes a decisions regarding the management of the nursing unit without input from the staff, the type of leadership style that the nurse manager is demonstrating is: a) autocratic b) situational c) democratic d) laissez-faire
A - The autocratic style of leadership is task oriented and directive. The leader uses his or her power and position in an authoritarian manner to set and implement organizational goals. Decisions are made without input from the staff. Democratic styles best empower staff toward excellence because this style of leadership allows nurses to provide input regarding the decision-making process and an opportunity to grow professionally. The situational leadership style utilizes a style depending on the situation and events. The laissez-faire style allows staff to work without assistance, direction, or supervision
A hospitalized client with a diagnosis of anorexia nervosa and in a state of starvation is in two-bed hospital room. A newly admitted client will be assigned to this client's room. Which client would be inappropriate to assign to this two-bed room? a) a client with pneumonia b) a client who can perform self-care c) a client with a fractured leg that is casted d) a client who is scheduled for a MRI and possible biopsy of the liver
A - The client in a state of starvation has a compromised immune system. Having a roommate with pneumonia would place the client at risk for infection. Options B, C, and D are appropriate roommates.
The nurse manager is planning to implement a change in the nursing unit from team nursing to primary nursing. The nurse anticipates that there will be resistance to the change during the change process. The primary technique that the nurse would use in implementing this change is which of the following? a) introduce the change gradually b) confront the individuals involved in the change process c) use coercion to implement the change d) manipulate the participants in the change process
A - The primary technique that can used to handle resistance to change during the change process is to introduce the change gradually. Confrontation is an important strategy used to meet resistance when it occurs. Coercion is another strategy that can be used to decrease resistance to change but is not always a successful technique for managing resistance. Manipulation usually involves a covert action, such as leaving out pieces of vital information that the participants might receive negatively. It is not the best method of implementing a change.
A client is scheduled for bronchoscopy, and the registered nurse reviews the plan of care written by a nursing student. The registered nurse discusses revision of the plan with the nursing student if which incorrect intervention was documented? a) removing any dentures b) removing contact lenses c) letting the client eat or drink d) obtaining a signed informed consent
C - The client is not allowed to eat or drink for usually 6 to 8 hours (or as specified by the physician) before the procedure. The client must sign an informed consent, because the procedure is invasive. If the client has any contact lenses, dentures, or other prostheses, they are removed before sedation is administered to the client.
A nurse manager has implemented a change in the method of documenting nursing care. A licensed practical nurse (LPN) is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following would be the best approach in dealing with the LPN? a) ignore the resistance b) tell the LPN that the registered nurse will do all of the documentation c) confront the LPN, and encourage verbalization of feelings regarding the change d) tell the LPN that she must comply with the change
C - Confrontation is an important strategy to meet resistance head-on. Face-to-face meetings to confront the subject at hand will allow verbalization of feelings, identification of problems and subjects, and development of strategies to solve the problem. Option A will not address the problem. Option B might provide a temporary solution to the resistance but will not specifically address the concern. Option D might produce additional resistance.
A nurse notes that a postoperative client has not been obtaining relief from pain with the prescribed opioid analgesics when a particular licensed practical nurse (LPN) is assigned to the client. The appropriate action for the nurse to take is to: a) reassign the LPN to the care of clients not receiving opioids b) notify the physician that the client needs an increase in opioid dosage c) review the client's medication administration record immediately and discuss the observations with the nursing supervisor d) confront the LPN with the information about the client having pain control problems and ask if the LPN is using the opioids personally
C - In this situation, the nurse has noted an unusual occurrence, but before deciding what action to take next, the nurse needs more data than just suspicion. This can be obtained by reviewing the client's record. State and federal labor and opioid regulations, as well as institutional policies and procedures, must be followed. It is therefore most appropriate that the nurse discuss the situation with the nursing supervisor before taking further action. The client does not need an increase in opioids. To reassign the LPN to clients not receiving opioids ignores the issue. A confrontation is not the most advisable action because it could result in an argumentative situation.
A nurse manager has identified a problem on the nursing unit and holds unit meetings for all shifts. The nurse manager presents an analysis of the problem and proposals for actions to team members and invites the team members to comment and provide input. Which style of leadership is the nurse manager specifically employing? a) situational b) laissez-faire c) participative d) authoritarian
C - Participative leadership demonstrates an "in-between" style, neither authoritarian nor democratic style. In participative leadership, the manager presents an analysis of problems and proposals for actions to team members, inviting critique and comments. The participative leader then analyzes the comments and makes the final decision. A laissez-faire leader abdicates leadership and responsibilities, allowing staff to work without assistance, direction, or supervision. The autocratic style of leadership is task oriented and directive. The situational leadership style utilizes a style depending on the situation and events.
A charge nurse observes that a staff nurse is not able to meet client needs in a reasonable time frame, does not problem-solve situations, and does not prioritize nursing care. The charge nurse has the responsibility to: a) supervise the staff nurse more closely so that tasks are completed b) ask other staff members to help the staff nurse get the work done c) provide support and identify the underlying cause of the staff nurse's problem d) report the staff nurse to the supervisor so that something is done to resolve the problem
C Option C empowers the charge nurse to assist the staff nurse while trying to identify and reduce the behaviors that make it difficult for the staff nurse to function. Options A, B, and D are punitive actions, shift the burden to other workers, and do not solve the problem.
A clinical nurse manager conducts an inservice educational session for the staff nurses about case management. The clinical nurse manager determines that a review of the material needs to be done if a staff nurse stated that case management: a) manages client care by managing the client care environment b) maximizes hospital revenues while providing for optimal client care c) is designed to promote appropriate use of hospital personnel and material resources d) represents a primary health prevention focus managed by a single case manager
D - Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal client care. It manages client care by managing the client care environment.
The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A nursing assistant is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following is the best approach in dealing with the nursing assistant? a) ignore the resistance b) exert coercion with the nursing assistant c) provide a positive reward system for the nursing assistant d) confront the nursing assistant to encourage verbalization of feelings regarding the change
D - Confrontation is an important strategy to meet resistance head on. Face-to-face meetings to confront the issue at hand will allow verbalization of feelings, identification of problems and issues, and development of strategies to solve the problem. Option A will not address the problem. Option B may produce additional resistance. Option C may provide a temporary solution to the resistance but will not address the concern
