Management of Care

How many levels of critical thinking exist for nursing judgement?

3 1- basic critical thinking (the nurse has faith that the expert has the right answer to each problem) 2- complex critical thinking (the nurse examines and analyzes information provided by the expert. may discover that another option is available with which to solve an issue) 3- commitment (nurse can make choices without help from others. nurse takes full responsibility for every action in which he or she engages)

Which variable is an internal variable?

Emotional factors

which statement describes a fundamental function of the clinical nurse leader (CNL)?

Evaluates care for evidence based approaches

Which professional standard is important for critical thinking?

Evaluation criterion

Which legal complication might the nurse face for using a restraint without a legal warrant on a client?

False Imprisonment Negligence: any conduct that falls below the standard of care Malpractice: type of negligence that is regarded as professional negligence

Which statement defines information gathered by the nurse?

It is the organization and interpretation of data (or pieces of reality)

Which statement accurately describes a healthcare policy as it related to health care economics?

It provides overarching goals and helps in setting priorities and values for the distribution of health resources

Which food would the nurse recommend to a client when instructing to increase potassium intake?

Orange

A child in respiratory distress is admitted to the hospital and diagnosed with acute spasmodic laryngitis (spasmodic croup). At the time of discharge, the mother asks how to handle another attack at home. Which would the nurse recommend?

Place him near a cool-mist humidifier - will decrease inflammation at home

In which type of room would the nurse tell the admissions clerk to place a client with Bipolar 1 disorder, manic phase?

Private the client who is manic needs a non-stimulating environment. the presence of another person in the room is considered stimulating and may interfere with the rest and sleep of both clients

Which test is used to confirm cephalopelvic disproportion?

Ultrasound A sonogram of the pelvis is an accurate and safe test for CD. Digital pelvimetry is an external measurement obtained by the PCP (it is an estimate, not an accurate assessment, less common than U/S)

What is exploratory research?

a study designed to develop a hypothesis about the relationship among phenomena

Which entity is responsible for activating the disaster plan during a MCI?

Federal emergency management system the national incident management system is a section within the US Department of Homeland Security. They are responsible for coordinating federal, state, and local government effort to respond to and manage domestic MCIs

How many rights of delegation are there in the nursing practice?

5 right task right circumstances right person right direction/ communication right supervision/ evaluation

Which description is correct in identifying "accountability"?

Determination of appropriate actions and providing detailed explanations of the actions

Which of these clients can be provided care safely by unlicensed nursing personnel (UNP)?

A client who is stable A client who is recovering

Which entity outlines the principles of delegation for RN's?

A: American Nurses Association Nurse practice act: examines the value of unlicensed personnel in client care delivery and declares that the importance of delegation decisions is the safety and welfare of the public National council of state boards of nursing: regulate nursing assistive personnel across multiple settings

Which refers to the professional obligation of the nurse to assume responsibility for actions?

Accountability Individuality and responsibility are positive characteristics of the nurse but are not necessarily professional obligations

Which critical thinking skill will help a student nurse avoid making assumptions about clients?

Analysis - allows student nurse to be open-minded Inference skills focus on the meaning of the findings and its significance. When the data is collected about the client helps in solving an existing problem Evaluation: looks at all situations objectively and using criteria to determine the results of nursing actions. used when results of nursing actions are determined Interpretation: involved in orderly collection of data. Explanation: when the nurse is using experience to care for clients

A client expresses a complete lack of interest in food. How would the nurse document this finding in the clients medical record?

Anorexia loss of appetite

Which is the most important action the nurse would take in preparation for a lumbar puncture for a child with a tentative diagnosis of bacterial meningitis?

Asking the parents what they were told about the test informed consent is required!

Which basic health care ethic does the nurse follow when signing the client's consent form as a witness?

Autonomy commitment to include clients decisions about all aspects of care as a way of acknowledging and protecting their independence

Which tort involves intentional touching without the clients consent?

Battery: this action may cause an injury or may be offensive to the client's personal dignity

Which organization assists in establishing policies related to Medicare and Medicaid payment for meaningful use of EHRs?

Center for Medicare and Medicaid Services

The nurse plans to delegate some of the tasks for the discharge of a PP client to an unlicensed health care worker. Which activity must be performed by the nurse?

Comparing the ID bands of mother and infant (one last time before discharge)

An older adult seems to make up stories to fill in for memory lapses. Which behavior is the client displaying?

Confabulating - filling in memory gaps as a protective mechanism

Which important consideration of the delegator is applicable to the "selling" in Hersey's model?

Delegatee requires explanation

Which is an appropriate action for the RN regarding assisted suicide?

Nurses' participation in assisted suicide violates the code of ethics

Which feature, according to Benner, is observed in the nurse at the "proficient" level?

Focuses on managing care rather than managing skills Proficient level: 2-3 years of experience in the same clinical position. focuses on managing care rather than managing and performing skills. novice nurse: learns by means of a set of riles, which are usually stepwise and linear. advanced beginner: has observational experience and is able to ID the principles of nursing care expert nurse: skilled at ID client-centered problems, health care system-related problems, and the needs of the novice nurse

Which type of continuing care would a client expect if discharged home with an infusion device to continue treatment for a leg wound?

Home care

Which would the nurse consider to be an example of a potential internal disaster?

Hospital fire

which strategy would the nurse use to minimize aggressive behaviors from the client with a neurocognitive disorder?

ID nursing staff members whom the client prefers the type of care required by the client requires trust in the caregiver, which develops more rapidly when there is a cooperative relationship and client input is accepted

Which of these refers to the accountability element of the decision making process?

Individuals being answerable for their actions

Which amount of time is appropriate for the nurse to spend triaging each client during a mass casualty incident?

Less than 15 seconds

Which type of relationship between the nurse delegator and delegatee causes the nurse delegator to use the leadership behavior of "telling"?

Limited when they are unlikely to work together again, the relationship is limited and the delegator uses the leadership behavior of telling. when the relationship is established, the delegator uses the leadership behavior of delegating. new or developing relationship: use participating developing or ongoing: use selling

The nurse is teaching an adolescent newly diagnosed with type 1 diabetes about self-care. Which is the primary long-term goal?

Maintaining normoglycemia -decreases the risk of complications such as neuropathy, retinopathy, and atherosclerosis a regimen of insulin, exercise, and diet will help the adolescent achieve this goal

Which outcome would indicate a client who was hospitalized with severe anxiety ready to be discharged?

Maintains anxiety at a manageable level

A client was admitted with full-thickness burns 2 weeks ago. Since admission, the client has lost an average of 1 lb (0.5 kg) of weight each day. Which dietary adjustment would the nurse recommend?

Provide high-protein food they have twice the calories per volume of other fluids and provide protein for wound healing

A client arrives in the ED with multiple crushing wounds of the chest, abdomen, and legs. What are the priority nursing assessments?

Quality of respirations and presence of pulses

Which parameters would the nurse consider for proper rapid baseline assessment using a disability mnemonic (AVPU) in a client with drug abuse?

Reaction to pain Response to voice provides rapid baseline assessment of neurological status -assess the responsiveness to pain and voice

A client with chronic asthma is being cared for in the inpatient care unit. Which health care team member would be delegated to assess the client on a regular basis?

Registered Nurse (RN) responsible for assessing the asthmatic symptoms of a client and providing care LPNs do not assess the clients condition, but are responsible for providing treatment prescribed by the health care provider and delegated by the RN

Which caring intervention helps provide comfort, dignity, respect, and peace to a client?

Relieving pain and suffering

Which behavior would the nurse consider suitable for an executive position according to Garner's tasks of leading/ managing?

To assist corporate leaders with planning and priority setting a behavior of the executive position is to assist corporate leaders with planning and priority setting

Which action would the nurse take to minimize ambiguity and confusion when entering a client's data in the EHR?

Using consistent, codified terminology

which component of delegation is suitable to all members of the health care team?

authority

Which aspect of total client care needs to be taken into consideration if used on a 24-bed care area?

cost of nurses because total client care is provided by RNs it can be very expensive and not realistic to use a highly skilled and extremely knowledgeable professional nurse to provide all the care required in a unit of 24 clients.

which health care team member is a first responder when an emergency or mass casualty incident (MCI) occurs?

critical care nurse

The nurse is developing a teaching plan for a client with lower extremity arterial disease (LEAD). Which directions will the nurse include in the teaching plan?

go to the hospital for cuts

which behavior of the nurse leader is characterized as "delegating" according to Hersey's model?

observing or monitoring

which guide would the associate nurse use to provide client care within the primary nursing delivery model?

plan of care the associate nurse provides care using the plan of care developed by the primary nurse

How are profits used in a for-profit health care organization?

profits are paid out to shareholders in for-profit, the profits are generated for the shareholders not-for profit, the profits are used to buy new equipment, build additional facilities, and improve healthcare services

which component of delegation is considered a two-way process?

responsibility

Which definition is involved in the caring process called knowing, according to Swanson's theory of caring?

striving to understand an event as it has meaning in the life of the other

Which strategy of the nurse leader regarding the quality improvement process (QI) requires revising?

the focus is on correcting errors the QI process focuses mainly on PREVENTING errors rather than correcting them

Which statement describes the goal of case management?

Integrate care with cost-effective approaches

which term describes the expected outcomes for a client who is admitted for a recurrent mental health problem?

Measurable objectives expected outcomes are measurable and realistic and reflect desirable projected responses to therapeutic interventions that consider the client's present and potential capabilities

Which primary task is achieved by a delegator when delegating a task to a delegatee for an effective outcome?

Motivation inspiring the delegatee by motivation is the primary task to be achieved by the delegator to reach an effective outcome

Which action by the nurse would be priority for a male client with a history of schizophrenia who comes to the ED accompanied by his spouse?

Observing and evaluating his behavior The client and his needs are the priority, and assessment is the first step of the nursing process.

Which statement describes a client in the stage of contemplation in the stages of change?

A: Considers change within the next 6 months pre-contemplation: the client does not intend to make changes within the next 6 months action: the client actively engages in strategies to change behavior. this stage lasts up to 6 months when sustained change is noticed over time, beginning 6 months after action has started and continuing indefinitely, the client has reached the maintenance stage.

Clients with which tag are referred to as "walking wounded" clients while managing a disaster?

A: Green - clients who sustained minor injuries during a disaster and can evacuate themselves are referred to as "walking wounded". Red: immediate threats to their life and should be treated immediately Black: given to clients who are not expected to live or are dead Yellow: given to clients who sustained major injuries and need treatment within 30 minutes to 2 hours.

Which component of delegation is the ability to perform duties in a specific role?

ANSWER: Authority Authority is the ability to perform duties in a specific role Responsibility: reliability, dependability, and obligation to accomplish work Accountability: determines whether a person's actions are appropriate and provides a detailed explanation of what occurred Legal authority: ability to transfer selected nursing activities in a given situation to a competent individual

Which inpatient admission orders for a child with viral pneumonia would the nurse question?

Aspirin 325 mg every 4 hours prn for fever higher than 101.4 F (38.6 C) Salicylates should not be given to children younger than 16 years with viral infections because of the relationship of aspirin to the development of Reye syndrome

A friend transports an adult client to the ED and states, "All of us were partying at a club, and all of a sudden my friend collapsed." The clients vital signs are temperature 99.2 F (37.3 C), pulse 152 bpm, respirations 32 breaths per minute, BP 163/92 mmHg. Which action would the nurse implement next, after completing the physical assessment and health history from the client?

Relay the client's status to the health care provider; insert the prescribed IV line. explanation: Ecstacy is an abused drug that has both stimulant and hallucinogenic properties. Stimulants have the ability to cause dehydration by increasing activity and diaphoresis; the nurse would inform the health care provider and insert the prescribed IV line.

A client is admitted to the hospital with a diagnosis of acute Guillain-Barre syndrome. Which assessment is priority?

Respiratory Exchange - Ascending paralysis can reach the diaphragm, leading to death from respiratory failure. More on GB: Motor manifestations affecting mobility - ascending symmetric muscle weakness--> flaccid paralysis without muscle atrophy - decreased or absent DTRs - Respiratory compromise (dyspnea, diminished breath sounds, decreased tidal volume, reduced peripheral oxygenation and vital capacity, and respiratory failure - loss of bowel and bladder control (less common) - Ataxia Sensory Perception manifestations: Paresthesias and pain (cramping) CN manifestations: Facial weakness, dysphagia, diplopia, difficulty speaking Autonomic manifestations: Labile BP, cardiac dysrhythmias, tachycardia

A client at 36 weeks' gestation has a BP of 140/90. Which additional sign of preeclampsia would the nurse assess for?

Urine dipstick positive for protein PE: increased BP and proteinuria. Mild ankle edema is known as physiological edema, is commonly seen in the 3rd trimester. No longer diagnostic criterion for preeclampsia, edema evidenced by excessive weight gain or edema of the hands and face may support the diagnosis. Episodes of dizziness on arising may occur in the 3rd trimester because the enlarged uterus impedes venous return, causing supine hypotension. Weight gain of 2 lb in 2 week is expected during the 3rd trimester

Which nursing action has the highest priority when preparing to transfer an unconscious client who sustained a head injury from the emergency department to a neurological trauma unit?

Validating availability of a BVM during transfer is vital in case respiratory distress, increased ICP compressed the brainstem, which contains the medulla, the respiratory center (Respiratory status is priority)