NSG 1650- EAQ 5: Healthcare Quality II & Healthcare Economics

The registered nurse is teaching the student nurse about the concepts of delegation. Which response given by the student nurse indicates the need for further teaching? A. "Delegation always involves two individuals." B. "Delegation is the transfer of accountability while retaining responsibility." C. "Delegation is an important strategy for client safety and quality of client care." D. "Delegation has five 'rights' that would be followed in the process of delegation."

B RAT: Delegation is the transfer of the responsibility for the task, while the final accountability is always retained with the delegator. Delegation involves the delegator and the delegatee. Delegation is an important strategy for ensuring client safety and quality of client care. Delegation has five "rights" that are to be followed throughout the delegation process: right task, right person, right circumstance, right direction/communication, and right supervision.

The registered nurse is teaching a group of nursing students about leadership principles. Which statement made by a nursing student indicates the need for further teaching? A. "A leader has a formal position." B. "A leader intervenes with courage." C. "A leader organizes a group of colleagues." D. "A leader is a specific management position after promotion."

A RAT: A leader does not necessarily have a formal position to indicate that she or he is a leader; rather, leadership refers to performance. Leaders are those medical professionals who can intervene with courage when needed. Leaders are also able to organize a group of colleagues to solve an organizational problem. A nursing medical professional becomes a leader after promotion.

Which laboratory value would the nurse assess when preparing a client for a renal biopsy? Select all that apply. One, some, or all responses may be correct. A. Hematocrit B. Hemoglobin C. Platelet count D. Prothrombin time (PT) with international normalized ratio (INR) E. Partial thromboplastin time (PTT)

A, B, C, D, E RAT: The nurse would assess the client's hematocrit and hemoglobin before and after the procedure to determine blood loss. The nurse would also check the client's platelets, PT/INR, and PTT to determine if the client is at risk for hemorrhage.

Which assessment would the nurse perform before administering a dose of vancomycin to a client? Select all that apply. One, some, or all responses may be correct. A. Creatinine B. Trough level C. Hearing ability D. Intravenous site E. Blood urea nitrogen

A, B, C, D, E RAT: Two major adverse effects of vancomycin are nephrotoxicity and ototoxicity. The nurse would assess the client's creatinine and blood urea nitrogen levels to determine renal function. The nurse would also assess the vancomycin trough levels to determine if the client's kidneys are clearing the medication. The nurse would assess for changes in hearing as a result of ototoxicity. Vancomycin can cause phlebitis, so the nurse would assess the intravenous site before initiating the infusion.

The nurse manager is teaching newly assigned delegators about the limitations of delegation. Which statements made by the delegators indicate effective teaching? Select all that apply. One, some, or all responses may be correct. A. "Personal hygiene activities can be delegated to unlicensed assistive personnel (UAP)." B. "Administration of oral medication can be delegated to the licensed practical nurse (LPN)." C. "Administration of intravenous medication can be delegated to the licensed practical nurse (LPN)." D. "Tasks related to caring for diabetic clients can be delegated to unlicensed assistive personnel (UAP)." E. "Tasks related to caring for clients in a hospice care setting can be delegated to licensed vocational nurses (LVNs)."

A, B, E RAT: Activities related to client hygiene can be delegated to UAP. Administration of oral medication can be done by the LPN. LVNs can care for the clients in a hospice care setting. Administration of intravenous medication cannot be done by LPNs, because it is outside the scope of practice of the LPN. Diabetic clients cannot be cared by UAPs, because this group does not have sufficient knowledge about how to care for clients with diabetes.

The nurse manager is planning to delegate tasks to the unlicensed assistive personnel (UAP). Which tasks can be delegated on a medical-surgical unit to a UAP? Select all that apply. One, some, or all responses may be correct. A. Performing a bed bath for a client on bed rest B. Evaluating the effectiveness of acetaminophen and codeine C. Obtaining an apical pulse rate before oral digoxin is administered D. Assisting a client who has patient-controlled analgesia (PCA) to the bathroom E. Assessing the wound of a client recovering from an abdominal laparotomy

A, D

The nurse manager is educating a group of nurses regarding older adults and the risk for suicide. Which factors would be included in this presentation? Select all that apply. One, some, or all responses may be correct. A. Spiritual beliefs B. Presence of family C. Loss of independence D. Chronic health conditions E. Access to many medications

C, D, E RAT: Older adults, especially men over the age of 65, are at increased risk for committing suicide. Risk factors include loss of independence, presence of chronic health conditions, and access to large amounts of medications. Positive factors that decrease the risk for self-harm include spiritual beliefs and presence of family in the life of the older adult.

After assigning a task, the delegator makes sure that the instructions are clear so that the delegatee can provide feedback related to the task. Which delegation right is referred to in this situation? A. Task B. Person C. Direction D. Supervision

D RAT: Ensuring that the delegatee has a clear understanding of how to provide feedback related to the task refers to the right supervision. Knowing whether the task is appropriate to the delegatee based on institutional policies and procedures refers to the right task. Knowing whether the delegatee has the knowledge and experience to perform the specific task safely refers to the right person. Knowing whether the delegatee understands the assignment and directions of the task refers to the delegation of right direction.

When the nurse manager is evaluating the care of a client receiving oxygen through a nasal cannula, which finding indicates a need for more staff education about oxygen therapy? A. Oxygen flow rate is set to 8 L/min. B. There is bubbling present in the humidifier. C. Pressure areas of tubing along the ears are padded. D. Smoking and open flame prohibited signs are clearly posted.

A RAT: Flow rates for nasal cannulas should be set no higher than 6 L/min, higher flows do not lead to an increase in FIO2, and high oxygen flow increases drying and irritation of mucous membranes. Bubbling of oxygen through the humidifier indicates that humidification of oxygen is occurring. Padding of pressure areas on the oxygen tubing decreases skin irritation and breakdown. Smoking and open flame prohibition signs are posted in places where oxygen is used to decrease the risk for fire.

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. A. Appropriate use of restraints B. Determination of the need for restraints C. Assessment of the client's behavior D. Routine checks of the client while in restraints E. Orientation of the client to the environment

D RAT: 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.