N4320 Collaboration
How can the nurse evaluate the effectiveness of communication with a client? 1 Client feedback 2 Medical assessments 3 Health care team conferences 4 Client's physiological responses
1 RATIONALE: Feedback permits the client to ask questions and express feelings and allows the nurse to verify client understanding. Medical assessments do not always include nurse-client relationships. Team conferences are subject to all members' evaluations of a client's status. Nurse-client communication should be evaluated by the client's verbal and behavioral responses.
The nurse realizes that a double dose of insulin was administered to the client by mistake and informs the primary health care provider. Which element of the decision-making process is reflected in the nurse's action? 1 Authority 2 Autonomy 3 Accountability 4 Responsibility
3 RATIONALE: Accountability means being answerable for one's actions. The nurse's action of admitting the mistake and seeking instructions to correct it indicates accountability. Authority is the legitimate power to give instructions and make final decisions in a situation. Autonomy is freedom of choice and responsibility for the choices. Responsibility indicates the duties and activities that an individual is employed to perform.
Which is an example of an independent nursing intervention? 1 Preparing a client for endoscopy 2 Coordinating with an x-ray technician for imaging 3 Starting an intravenous line for a blood transfusion 4 Keeping edematous lower extremities elevated on pillows
4 RATIONALE: Independent nursing interventions do not require a prescription from another health care professional. Keeping edematous lower extremities elevated on pillows can be initiated by the nurse and does not need a prescription. Preparing a client for endoscopy, coordinating with an x-ray technician for imaging, and starting an intravenous line for a blood transfusion are dependent nursing interventions.
Which component of delegation is the ability to perform duties in a specific role? 1 Authority 2 Responsibility 3 Accountability 4 Legal authority
1 RATIONALE: Authority is the ability to perform duties in a specific role. Responsibility refers to 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 is the ability to transfer selected nursing activities in a given situation to a competent individual.
Which failure is consistent with an improper follow-through on the part of a delegatee? 1 Failure to report results and findings 2 Failure to understand the skills and abilities 3 Failure to provide clear and concise directions 4 Failure to cooperate with the other team members
1 RATIONALE: Improper follow-through on the part of a delegatee is failure to report results and findings. Improper follow-through occurs when the delegator does not understand the skills and abilities of the delegatee and does not provide clear and concise directions to the delegatee. The lack of cooperation with team members may be improved by educating, guiding, and monitoring the delegatee.
Which strategy of the nurse leader regarding the quality improvement (QI) process requires revising? 1 The focus is on correcting errors. 2 The task includes staff development. 3 The leader involves the interprofessional team. 4 Outcomes are set with input from clients and staff.
1 RATIONALE: The QI process focuses mainly on preventing errors rather than correcting them. The task of the QI process includes staff development. The team of the QI process involves the interprofessional team and the outcomes are set with the input of clients and the staff.
The registered nurse (RN) delegates a task to the licensed practical nurse (LPN). Which action would the RN take if the LPN executes the task improperly? 1 Provide constructive feedback. 2 Engage in a verbal attack on the delegatee. 3 Express satisfaction with the LPN's execution of the task. 4 Ignore the problem for now but stop considering the LPN for further delegation.
1 RATIONALE: The delegator should provide constructive, positive, but honest feedback about the work of the delegatee. A verbal attack will destroy the relationship between the delegatee and delegator. The RN would lose credibility by conveying satisfaction with the delegatee's work. Ignoring the problem and not giving feedback will not promote a healthy relationship.
Which quality is the most important tool the nurse brings to the therapeutic nurse-client relationship? 1 The self and a desire to help 2 Knowledge of psychopathology 3 Advanced communication skills 4 Years of experience in psychiatric nursing
1 RATIONALE: The nurse brings an understanding of self and basic principles of therapeutic communication; this is the unique aspect of the helping relationship. Knowledge of psychopathology, advanced communication skills, and years of experience in the field all support the psychotherapeutic management model and contribute to quality of care, but these are secondary to the offering of self and the fundamentals of good communication.
The registered nurse is caring for a client in the medical unit. The registered nurse wants to transfer the responsibilities and accountability to another individual. Whom would the registered nurse use to accomplish this task? 1 Charge nurse 2 Nursing assistant 3 Licensed vocational nurse (LVN) 4 Unlicensed assistive personnel (UAP)
1 RATIONALE: The registered nurse caring for an elderly client in the medical unit may transfer the responsibilities and accountability to a charge nurse. A charge nurse may serve as the delegatee who has the appropriate level of competency skills such as critical thinking, clinical practice, organization, leadership, communication, and time management. Nursing assistants would follow organization policies. The registered nurse may transfer responsibilities to the licensed vocational nurse (LVN) and unlicensed assistive personnel (UAP), although accountability for elderly client care is not transferred and remains with the registered nurse.
Which factor supports task delegation to nursing assistive personnel (NAP) according to the National Council of State Boards of Nursing (NCSBN) Decision Tree? Select all that apply. One, some, or all responses may be correct. 1 The task is within the nurse's scope of practice. 2 The task may be performed with a predictable outcome. 3 Agency policies and protocols are available for the task or activity. 4 The task is performed according to an established sequence of steps. 5 NAP have the appropriate knowledge, skills, and abilities required to complete the task.
1,2,3,4,5 RATIONALE: According to the NCSBN Decision Tree, for a task to be delegated it must be within the nurse's scope of practice and have a predictable outcome. Agency policies and procedures must be available for the task, and it must have an established sequence of steps. The NAP to whom the task is assigned must have the appropriate knowledge, skills, and abilities to perform the task.
Which questions would the delegator assess to determine the right task? Select all that apply. One, some, or all responses may be correct. 1 "Is the task legally appropriate to delegate?" 2 "Is the environment conducive to completing the task safely?" 3 "Does the delegator provide clear and concise directions for the task?" 4 "Is the task appropriate to delegate based on institutional policies and procedures?" 5 "Does the delegatee have the knowledge and experience to perform the specific task safely?"
1,4 RATIONALE: The delegator has to determine right task by assessing whether the task is legally appropriate to delegate. The delegator must also check that the task is appropriate to delegate based on institutional policies and procedures. The right circumstance can be assessed by asking, "Is the environment conducive to completing the task safely?" The right direction and communication is assessed by asking, "Does the delegator provide clear and concise directions for the task?" The right person eligible to accomplish the task is assessed by asking, "Does the delegatee have the knowledge and experience to perform the specific task safely?"
Which psychophysiological factors influence communication between the nurse and a client? Select all that apply. One, some, or all responses may be correct. 1 Privacy level 2 Emotional status 3 Information exchange 4 Level of caring expressed 5 Growth and development
1,5 RATIONALE: Growth and development and emotional status are two psychophysiological factors that influence communication between the nurse and a client. Privacy level is an environmental factor. Information exchange is a situational factor. Level of caring expressed is a relational factor.
Which is the role of a case manager in a health care organization? 1 To delegate work on the unit suitably 2 To follow up with the client after discharge 3 To provide direct care for the client at the bedside 4 To unite the strategic direction of the organization
2 RATIONALE: A case manager is an advanced practice nurse who coordinates a client's acute care in the hospital and follows up with the client after discharge. The nurse manager delegates work appropriately to the nursing staff on the unit. A registered nurse provides direct care to the client at the bedside. The nurse executive is often the vice president or strategic director of nursing in a health care organization.
To minimize error during intravenous (IV) administration of antibiotics, the legal authority advises the delegatee to wear a colored vest that says, "Do not disturb! Medication administration in process." Which delegatee is appropriate to follow the advice of the legal authority? 1 Nursing aide 2 Registered nurse (RN) 3 Patient care associate (PCA) 4 Licensed vocational nurse (LVN)
2 RATIONALE: Administration of IV medications is under the scope of practice of the RN. The nursing aide is unlicensed and his or her scope of practice does not permit the administration of IV medications. The PCA is also a member of unlicensed assistive personnel whose scope of practice does not permit the administration of IV medications. An LVN only can administer intramuscular and oral medications to the client.
The nurse is preparing to teach a client about self-injection of insulin. Which action by the nurse will increase the effectiveness of the teaching session? 1 Wait until a family member is also present. 2 Assess the client's barriers to learning self-injection techniques. 3 Begin with simple written instructions describing the technique. 4 Wait until the client has accepted the new diagnosis of type 1 diabetes mellitus.
2 RATIONALE: Before a teaching plan can be developed, the factors that interfere with learning must be identified. Although family members can be helpful, client involvement in care is most important for promoting independence and self-esteem. Assessment comes before intervention; written instructions may not be the most appropriate teaching modality. The client may never accept the change but must learn to manage care; this may be an unrealistic expectation.
The delegator explains the procedure of the task to the delegatee and asks the delegatee to provide feedback after the task has been completed. Which delegation "right" is the delegator referring to in this situation? 1 The right person 2 The right supervision 3 The right circumstances 4 The right communication
2 RATIONALE: The delegator is supervising the task by asking the delegatee to provide regular feedback on the events of the specific assigned task. The delegator has to understand and assess the abilities and skills of the delegatee to determine that the right person is selected to perform the specified task. The right circumstance may be assessed by checking the environment, equipment, and resources to perform the task. The delegator has to develop and maintain open lines of communication to promote a positive work environment.
Which statement(s) are true regarding delegation? Select all that apply. One, some, or all responses may be correct. 1 The delegatees are accountable for effective client care. 2 Open lines of communication must occur between delegator and delegatee. 3 Delegation occurs only when at least two people are involved in a mutual work situation. 4 The delegation potentials are significantly lower when caregivers such as unlicensed nursing personnel (UNP) are partnered. 5 Delegation involves sharing activities with other health team members who have the authority to accomplish the work.
2,3,5 RATIONALE: Open lines of communication between delegator and delegatee help eliminate any misunderstanding regarding delegated tasks. Delegation occurs only when at least two people are involved in a mutual work situation; one who has the authority to perform specific tasks and the other who holds accountability for the task being performed. Delegation involves sharing activities with others who have appropriate authority to accomplish the work. When delegating a task to delegatee, the delegator retains accountability for effective client care by ensuring that the task is completed by the right person and that the person is supervised appropriately. The delegation potentials are significantly higher when caregivers such as UNPs are partnered.
Which steps listed by the nursing student are accurate regarding discharge planning? Select all that apply. One, some, or all responses may be correct. 1 "Plan the client's discharge at the time of leaving the hospital." 2 "Teach the client the safe and effective use of medications and medical equipment." 3 "Remember that discharge planning is a centralized, coordinated, interdisciplinary process." 4 "Coordinate with the primary health care provider only when preparing discharge planning." 5 "Develop a care plan that moves the client from the hospital to another level of health care."
2,3,5 RATIONALE: The nurse would teach the client the safe and effective use of medications and medical equipment before he or she leaves the health care facilities. The nurse would remember that discharge planning is a centralized, coordinated, interdisciplinary process that ensures that the client has a plan for continuing care after leaving a health care facility. The nurse would develop a care plan that moves the client from the hospital to another level of health care such as the client's home or a nursing home. The nurse would start discharge planning the moment a client is admitted to a health care facility. The nurse would coordinate with all members of the interdisciplinary health care team to identify and anticipate the client's need when preparing discharge planning.
Which is the most effective professional leadership and management strategy nurses implement to improve safety and quality of patient-centered care? 1 Autonomy 2 Guidance 3 Delegation 4 Accountability
3 RATIONALE: Delegation is the most effective strategy for nurse leaders and managers to implement to improve safety and quality of patient-centered care. Delegation requires knowing the level of competence of the individual delegatee and understanding the concepts of responsibility, authority, and accountability. Autonomy for the nurse is the ability to control one's practice. "Guidance" is a general term meaning providing direction or instruction. Accountability is assuming personal responsibility for actions.
Which distinguishes evidence-based practice from quality improvement? 1 Evidence-based practice is a part of a regular clinical practice. 2 Evidence-based practice aims to improve client care and outcomes. 3 Evidence-based practice focuses on the implementation of evidence already known into practice. 4 Evidence-based practice consists of internal funding and can be conducted by practicing nurses.
3 RATIONALE: Evidence-based practice focuses on the implementation of evidence already known into practice whereas quality improvement measures the effect of changing practices on a specific population. Both evidence-based practice and quality improvement are a part of regular clinical practice. Both aim to improve client care and outcomes. Both evidence-based practice and quality improvement consist of internal funding and can be conducted by practicing nurses and other health care professionals.
Arrange the events of communication throughout the nursing process in chronological order. 1.Intrapersonal analysis of the assessment findings 2.Documenting expected outcomes 3.Assessing the medical records and diagnostic tests 4.Performing verbal, visual, auditory, and tactile health-teaching activities 5.Identifying the factors affecting the outcomes
3,1,2,4,5 RATIONALE: The first step of communication throughout the nursing process is assessment, which involves assessing medical records and diagnostic tests. The second step is nursing diagnosis, which involves the intrapersonal analysis of assessment findings. The third step is planning, which involves the documentation of expected outcomes. The fourth step is implementation, which involves performing verbal, visual, auditory, and tactile health-teaching activities. The final step is evaluation, which involves identifying the factors affecting the outcomes.
Arrange the order in which quality improvement takes place according to the plan, do, study, act (PDSA) cycle model. 1.Evaluate the outcomes. 2.Choose the appropriate intervention. 3.Review available data. 4.Incorporate new practices in daily performance
3,2,1,4 RATIONALE: According to the PDSA model of quality improvement (QI), the first step is to review all available data to understand current practice conditions and determine the need for change. The next step of QI is to "do." This step involves selecting and implementing an intervention on the basis of the reviewed data. The next step is to "study." At this stage, the outcomes of the change are evaluated by the health care facility. The final step is to "act." If the change in the process is successful and yields positive results, then the health care facility incorporates the new practices into its daily unit performance.
The registered nurse (RN) is teaching the newly hired nurse about active delegation. Which statement made by the newly hired nurse indicates the need for further teaching? 1 "I will evaluate the client's pain status." 2 "I will assess the client's laboratory findings." 3 "I will instruct unlicensed assistive personnel [UAP] to wash the client." 4 "I will instruct the licensed vocational nurse [LVN] to administer intravenous [IV] medications.
4 RATIONALE: In active delegation, the RN assesses the client's situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individuals accountable. Instructing the LVN to administer IV medications is beyond the practice scope for an LVN. Evaluating the client's pain status is a part of active delegation. Assessing the client's laboratory findings is active delegation. Instructing the UAP to wash the client is an active delegation, as the RN is directing a task to be performed by the UAP.
Which intervention related to restraint use is appropriate to delegate to nursing assistive personnel (NAP)? Select all that apply. One, some, or all responses may be correct. 1 Appropriate use of restraints 2 Determination of the need for restraints 3 Assessment of the client's behavior 4 Routine checks of the client while in restraints 5 Orientation of the client to the environment
4 RATIONALE: NAP can perform routine checks of the client in restraints. Determination of appropriate use of restraints and the need for restraints; assessment of a client's behavior; and orientation of the client to the environment are not tasks that can be delegated to NAP.
The registered nurse is evaluating the statements made by a student nurse after teaching ways to make appropriate delegation decisions. Which statement made by the student nurse indicates a need for correction? 1 "The delegatee would report the findings back to the delegator." 2 "The delegatee would understand the assigned task completely." 3 "The delegator would trust the delegatee to accomplish the task." 4 "The delegator would recheck and redo the work of the delegatee."
4 RATIONALE: Time management is an important part of an appropriate delegation process. If the delegator rechecks and redoes the work of the delegatee, it increases the time to accomplish the task and results in inappropriate delegation. Reporting the findings back to the delegator helps the delegator understand the progress of the task. The delegatee would understand the task completely to perform as desired by the delegator. Trusting the delegatee reduces time to do the task and builds a healthy working environment.