Management of Care 2 (HESI)

How does the nurse leader, being in an executive position, perform Gardner's motivating task?

Inspiring the staff and community leaders to achieve desired levels of health and well-being The nurse leader can apply Gardner's motivating task by inspiring staff and community leaders to use clinical services appropriately. Inspiring the staff to achieve the mission of the organization indicates that the nurse leader is accomplishing the managing position of Gardner's task. The nurse leader fulfills Gardner's task of envisioning goals by assisting staff in formulating a vision of enhanced clinical and organizational performance. The nurse leader executes Gardner's task of explaining by teaching and interpreting organizational and community-based health information.

A nurse caring for a client prioritizes nursing actions on the basis of Maslow's hierarchy of needs. Which activities should the nurse perform to meet the client's safety and security needs? Select all that apply.

Positioning the bed in a low position and keeping the side rails up Monitoring vital signs, such as blood pressure to decrease the risk of falls Observing a client who has suicidal tendencies to prevent adverse incidents As per Maslow's hierarchy of needs, to meet the safety and security needs of the client, the nurse should position the bed in a low position and keep the side rails up to provide physical safety for the client. Monitoring vital signs, including blood pressure to prevent risk for falls is an example of a nursing activity that meets the client's safety and security needs. Observing a client who has suicidal tendencies to prevent adverse incidents is an example of a nursing activity that meets the client's safety and security needs. Providing a cold bath to the client to reduce body temperature is an example of a nursing activity that meets the client's physiological needs. Collaborating with family members to provide emotional support to the client post-surgery is an example of a nursing activity that meets the client's love and belonging needs.

The nurse manager appointed a registered nurse (RN) to provide hospice care for a client and explained the tasks to be performed. Which tasks has the nurse manager delegated to the RN? Select all that apply.

Providing total client care Teaching the client and family members Teaching the client about personal hygiene The registered nurse provides total client care, teaches the family about the client's care, and teaches the client about personal hygiene. The registered nurse may not perform all the hygienic tasks and daily activities. These tasks are delegated to the unlicensed assistive personnel.

The registered nurse delegates a task to a new team member for an ongoing process. Which style implemented by the delegator would be most appropriate in this situation?

Selling The delegator's style should be selling in this situation because there is an ongoing relationship. When the new team member has limited knowledge to perform a task and when there is no ongoing relationship, the leader's style is telling. When the new team has expertise, there is an established relationship, and there is need of only little guidance, then the delegator's style is delegating. When the new team has the willingness and ability to do a task and has a new relationship, then the delegator's style is participating.

During a recent tornado the emergency department mishandled several client situations. In which order should the manager perform actions to improve the quality of care in the future?

Assess client expectations for emergency room care Identify members of an interprofessional team to review client expectations Collect data regarding the current status of emergency room services Determine outcomes and quality indicators for emergency room services Chose an approach to meet the expected quality indicators Analyze data collected to determine achievement of expected quality indicators The steps in the quality improvement process begin with assessing the needs most important to the consumer, or in this situation, client expectations for emergency room care. The second step is to assemble an interprofessional team to review client needs and expectations. The third step is to collect data regarding the current status of emergency room services. The fourth step is to determine measurable outcomes and quality indicators for the emergency room services. The fifth step is to choose an approach to meet the expected outcomes or quality indicators. And the final step is to collect data to determine if the implemented plan achieved the expected quality indicators.

The condition of a child dying of leukemia deteriorates, and the child becomes comatose. The parents state that a relative told them that they should not allow the child to be resuscitated, but they are unsure. Which response by the nurse best demonstrates recognition of the ethical issues involved?

"The final decision must be made by you and your doctor, but it's important to talk about it." Telling the parents that they and the healthcare provider must make the final call but that it's important to discuss the issue is an ethically sound response that clearly defines who is involved in the decision making and allows parental expression of ideas and thoughts. Discussion of the implication of a do-not-resuscitate order should not take place until after the family has spoken with the practitioner. Although telling the parents to discuss the issue with the healthcare provider and offering to make the call promotes the practitioner-client relationship, it stops nurse-client interaction. Telling the parents to discuss the issue with the healthcare provider and religious adviser abdicates nursing responsibility, and the parents may have no desire to involve a religious adviser in the decision making process.

The registered nurse raises a concern about preparedness after the community healthcare provider explains the disaster plan schedule. Which statement made by the provider is the registered nurse concerned about?

"We should improvise the plan structure for handling the risks associated with the disaster." The registered nurse is concerned that improvising the plan indicates an issue with preparedness. Drills are utilized as part of training for the response phase in order to identify aspects of the plan that may need improvement. Mitigation is the phase of the disaster management continuum that includes attempts to limit the disaster's impact on the human and community function. Stabilization following a disaster would indicate the recovery phase of the disaster management continuum.

A nurse on the psychiatric unit of the hospital has been assigned four clients for the shift. The assignment includes an 84-year-old client who is severely depressed, a 73-year-old client who is being discharged, a 53-year-old client who was admitted for lithium toxicity, and a 48-year-old client who has panic attacks. Which client should the nurse assess first after receiving report?

53-year-old client The 53-year-old client should be assessed first because of the severity of adaptations associated with lithium toxicity. A severely depressed client has a low energy level and is not at the greatest risk at this time. A client who is stable enough to be discharged does not need immediate attention. Clients with panic attacks usually seek immediate attention when it is needed.

How can a nurse manager reduce moral distress in the nursing staff? Select all that apply.

By providing additional staff whenever needed By providing additional counselors for solving client's family issues By facilitating education for better communication among all levels of healthcare practitioners The reason for moral distress in nurses may be lack of professionals needed for the task, or lack of communication among all the levels of healthcare professionals. Disagreements between nurses and the client and family members regarding the care may also lead to moral distress. Providing additional staff whenever needed helps reduce work stress and errors in client care. Providing additional counselors for solving client's family issues helps the families to understand the role of nurses in client care, thus promoting their cooperation. Facilitating education for better communication among all levels of healthcare practitioners helps prevent communication gaps and promotes effective nursing care. Limiting the affected nurses' interaction with the client may not help reduce moral distress. Providing short breaks from work may not be a practical approach, and may not help in reducing moral distress.

The nurse is learning about the rules of leaders. Which actions of the nurse indicate effective implementation of these rules in the profession? Select all that apply.

Communicating in a simple language with followers Giving a chance to the followers to express their views Ensuring proper eye contact while communicating with followers An effective leader should use the simplest and fastest method to communicate with followers. An effective leader should give a chance to the followers to express their views, as followers have many questions to ask. Proper eye contact ensures effective communication; therefore an effective leader should maintain proper eye contact while communicating with followers. An effective leader should use critical thinking to decide the actions to be performed but should not instruct the followers. An effective leader should communicate the clear boundaries with followers.

The nurse is instructing the student nurse how to administer percutaneous enterostomal gastrostomy (PEG) tube feeding to a client. What should the nurse tell the student? Select all that apply.

Connect tube feeding bag to client and feeding pump. Flush with warm water before beginning feeding. Check prescription for correct client formula. Set correct rate and initiate pump. Check for diarrhea. Connect the feeding bag to the client and pump and check for any residual feeding before initiating the feeding. Always check the most recent tube feeding prescription before initiating feeding. Flush the PEG tube with 30 mL of warm water and set correct rate on pump and begin feeding. Diarrhea is a complication of tube feedings and should be assessed. The client's head of bed needs to be elevated at least 30 degrees.

A client is prescribed apomorphine. Which concern would be a priority while addressing client needs?

Operating heavy machinery or driving Apomorphine is a dopamine agonist, which has side effects of orthostatic hypotension, drowsiness, and hallucinations. The priority nursing instruction for a client prescribed apomorphine is to instruct the client to avoid operating heavy machinery or driving. Entacapone is a monoamine oxidase inhibitor, which causes life-threatening complications when it interacts with foods containing tyramine. Therefore the clients who are on entacapone therapy must be advised to avoid foods containing tyramine. Verapamil is a calcium channel blocker, which may cause bradycardia, so clients who are on verapamil therapy must be instructed to report fatigue and shortness of breath. Sumatriptan is a triptan, which may cause cardiac damage. Therefore clients who are on sumatriptan must be instructed to report chest discomfort and chest pain.