NU370 Week 7 PrepU: Leadership and Management
A staff nurse is talking with a clinical nurse leader and asks, "What exactly do you do?" Which statement by the clinical nurse leader would be appropriate? "I'm an administrator involved with client care." "My position is one of management." "I collaborate with health care teams to promote client care." "I'm an advanced practice nurse with a specific specialty area."
"I collaborate with health care teams to promote client care." · A clinical nurse leader is a master's-prepared nurse who has earned the certified CNL credential and works collaboratively with the health care team to facilitate, coordinate, and oversee care provided to clients. This role is not considered an administrative or management role, but rather one of leadership in all health care settings. Clinical nurse specialists are advanced practice nurses with specialist education in a defined area of practice.
A nurse has been asked to chair an action team tasked with prioritizing a list of possible new equipment purchases. Which statements, made by this nurse, will help the team be most effective? Select all that apply. "Our goal is to prioritize this list of potential equipment purchases, offering rationale for our choices." "Once we have completed the list and rationale, I will compile our recommendations for us all to sign before submission." "I am willing to prioritize the list if someone else will write the rationale." "Before our next meeting, each of us will ask the nurses on the unit what their priority purchase would be." "When I got this assignment, they said something about deciding what equipment to purchase next year."
"Our goal is to prioritize this list of potential equipment purchases, offering rationale for our choices." "Once we have completed the list and rationale, I will compile our recommendations for us all to sign before submission." "Before our next meeting, each of us will ask the nurses on the unit what their priority purchase would be." o The most important component of team structure is to have a common goal. The goal of this group is to list potential equipment purchases with rationale. The second-most important component of team structure is to have clear roles and responsibilities. The direction by the nurse for the members to query nurses on each unit is an example of establishing clear roles and responsibilities. Teams also should hold themselves mutually accountable for achieving the goal, such as by having all the team members sign the recommendation. The work should be done by the team, not by just one or two members, as in the option about one nurse prioritizing the list and another writing rationale. Clarity and specificity are important in communicating the purpose of the team, both of which are lacking in the statement, "they said something about deciding what equipment to purchase next year."
A nurse caring for a group of clients on the neurological floor is working with a nursing assistant and a licensed practical nurse (LPN). Their client care assignment consists of a client with new-onset seizure activity, a client with Alzheimer's disease, and a client who experienced a stroke. While administering medications, the registered nurse receives a call from the intensive care unit (ICU), saying a client who underwent a craniotomy 24 hours ago must be transferred to make room for a new admission. The ancillary staff is providing morning care and assisting clients with breakfast. How should the nurse direct the staff to facilitate a timely transfer? Notify the supervisor that the client care assignment is unsafe with the addition of the new client, and insist the supervisor assist with the assignment. Administer the medications quickly and ask the nursing assistant and LPN to finish providing care for the clients. Ask the nursing assistant to finish providing care to the clients and the LPN to administer the remaining medications so the registered nurse can accept the client from the ICU. Tell the ICU they have to wait to transfer the client because everyone is too busy to accept the client.
Ask the nursing assistant to finish providing care to the clients and the LPN to administer the remaining medications so the registered nurse can accept the client from the ICU. o The registered nurse should use the ancillary staff to help effectively manage the group of clients. While the registered nurse accepts the client from the ICU, the nursing assistant can provide care for the clients, and the LPN can administer the remaining medications. Telling the ICU to wait or notifying the supervisor that they must assist are incorrect options because the nurse should assess the situation and use the ancillary staff appropriately. The nurse has adequate staff to safely provide care for this group of clients. The nurse shouldn't administer medications quickly because haste is an unsafe practice that could lead to a medication error. Instead of rushing, the nurse should delegate the responsibility to the LPN.
A nurse manager on a pediatric unit is making assignments for the day. The nurse's goals are atraumatic care for pediatric clients and minimizing parent-child separation. What method of care delivery should the nurse implement? Assign a medication nurse and a primary nurse. Assign unlicensed assistive personnel to care for the child to give the parents a break. Assign a core primary nurse. Assign a team of nurses and unlicensed assistive personnel.
Assign a core primary nurse. o Family-centered care is the gold standard for pediatric nursing. It decreases anxiety for both the parent and the child, recovery times are shortened and pain management is enhanced. When a primary nurse is assigned to the child and family, they have an identifiable source to help meet their needs. Oftentimes when more than one person is providing care, effective communication is lost. The family is the primary source for the child and they should not be separated. Having a medication nurse and primary nurses tends to fragment care. The unlicensed assistive personnel can provide basic care for the child, but the parents to be offered to communicate how much involvement they wish in their child's care.
Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? Insertion of a urinary catheter in a client with benign prostatic hypertrophy Preparation of insulin for the diabetic client with an elevated blood glucose level Bed bath for the newly admitted client who has multiple skin lesions Ambulation of the client with a history of falls for the first time after surgery
Bed bath for the newly admitted client who has multiple skin lesions o The safest delegation is to have the UAP bathe the client with skin lesions and report any abnormal findings to the nurse. Preparing insulin is outside of the UAP's scope of practice. The UAP may have the skills to insert an indwelling catheter and ambulate clients, but the clients involved each have qualifiers that complicate the tasks.
The nurse is coordinating care for a client with continuous pulse oximetry who requires pharyngeal suctioning. To which staff member should the nurse avoid delegating the task of suctioning? Registered nurse Nursing assistant who is a nursing student Licensed practical nurse A senior nursing student present for clinical
Nursing assistant who is a nursing student o The nurse should avoid delegating this client to the nursing assistant who is a nursing student. Suctioning and the associated evaluation of the client would be within the scope of practice of the registered nurse, licensed practical nurse, and the senior nursing student present for clinical.
A registered nurse (RN) is caring for four clients on a medical-surgical unit. Which task is most appropriate for the nurse to delegate to the licensed practical nurse (LPN)? administering chemotherapy administering blood products administering intravenous push medication administering bedside blood glucose testing
administering bedside blood glucose testing o The LPN, under the nurse practice act (NPA), is permitted to administer testing for bedside blood glucose. The nurse must recognize the scope of practice of the delegate, and remember that client needs and activities delegated must be matched to skill level. The RN would not delegate administration of blood products, intravenous push medication, or chemotherapy to the LPN, as these tasks are not covered under the LPN's NPA.
Several day-shift nurses complain that the night-shift nurses aren't performing the daily calibration of the capillary glucose monitoring apparatus, which is their responsibility. It would be most prudent for a nurse-manager to review the capillary glucose monitoring calibration log book. counsel the night charge nurse about the discrepancy. immediately remind the night-shift nurses of the daily calibrations. arrange a meeting of the day-shift and night-shift nurses.
review the capillary glucose monitoring calibration log book. o When dealing with complaints, a nurse-manager should always gather data before acting. Therefore, the nurse-manager should review the calibration documentation, then address the findings. It would be inappropriate for the nurse-manager to remind the staff of a responsibility that they may be fulfilling, arrange a meeting that could become confrontational, or counsel the charge nurse before investigating and gathering data relative to the complaint.
A registered nurse is delegating activities to unlicensed assistive personnel (UAP) on a hospital unit. Which activities could this nurse normally delegate? Select all that apply. The determination of a nursing diagnosis for a client with breast cancer Taking routine vital signs Giving a bed bath to a client Transferring a client to another floor Administering medications to clients Planning education for a client with a colostomy
Taking routine vital signs Giving a bed bath to a client Transferring a client to another floor o The nurse should be familiar with guidelines for delegating nursing care. The nurse could delegate the following tasks to UAP: giving a bed bath to a client, taking routine vital signs, and transferring a client to another floor. The nurse could not delegate the administering of medications, planning client education for a client with a colostomy, or the determination of a nursing diagnosis.
A new graduate nurse demonstrates understanding that developing and maintaining competency is crucial to giving adequate and safe care to all psychiatric clients. To whom would the new graduate assign this responsibility for maintaining this standard of professional performance? The graduate nurse The facility where the graduate now works The American Nurses Association The nursing school from which the student graduated
The graduate nurse o Developing and maintaining competency is the responsibility of the professional psychiatric-mental health nurse.
The nursing instructor is teaching a group of nursing students about the various responsibilities of the labor and delivery medical team. The instructor determines the session is successful when the students correctly choose which function as the primary role of the LPN/LVN members of the team? Assist the providers in the delivery room. Provide direct independent care to the client. Provide care under the supervision of an RN. Observatory to assist the RN.
Provide care under the supervision of an RN. o The LPN may provide care within the appropriate scope of practice under the direct supervision of an RN. The RN is responsible for providing direct independent care of the client. Both LPN/LVNs and RNs assist health care providers in the delivery room. The LPN/LVNs provide more than just observatory functions for the RN.
Following notification of two client falls on the unit, a nurse manager decides a formal investigation is necessary and informs the staff. Which statement indicates the primary reason the nurse manager would perform an investigation to determine the causes of the falls? "I want to determine exactly what happened and why the two clients fell." "I would like to know which staff members were on duty when the falls occurred." "I would like to establish the causes and trends related to client falls." "I want to identify the environmental factors that contributed to the falls."
"I would like to establish the causes and trends related to client falls." o The analysis will identify variations in performance that cause or could cause the clients to fall. It will identify the answer to the question of "How can we prevent this from happening again?" It does not place blame on individuals; rather, it looks at systems and processes. Limiting the focus of the inquiry to the specific clients or staff members does not meet the criteria for root cause analysis, because those foci are too narrow in scope. Similarly, limiting the inquiry to only environmental factors could result in missed data important to the contributing factors for the falls. The nurse examines all potential contributing factors to develop the most helpful investigation.
Nurses on the unit are discussing their interactions with parents of children with special needs. Which comment made by a nurse would immediately prompt the nursing supervisor to intervene? "It is tiring caring for special needs clients and their families day after day." "I have suggested that the parents of two of my clients talk with each other for support." "The parent will need a specially designed car seat to transport the child home safely." "That parent just does not appreciate how much nurses know about working with special needs kids."
"That parent just does not appreciate how much nurses know about working with special needs kids." o The comment about a parent's appreciation of nursing knowledge needs investigation by the supervisor first. Parents should be engaged as equal partners in the care of their children with special needs. They are experts and understand the full range of their child's care and have found effective ways to provide it. The nursing supervisor would then investigate the nurse's feeling of tiredness as this could lead to nurse burnout. The other comments are appropriate to the situation and involve giving information, checking for understanding, and encouraging a parent-to-parent connection.
A nurse from a surgical unit is asked to work on the pediatric unit during a staffing shortage. The surgical nurse has not worked in pediatrics for 10 years and is not familiar with the unit. The surgical nurse approaches the nurse manager and claims not to be competent to work on the pediatric unit. What should the nurse manager do? Find another nurse to cover the unit and send the nurse back to the surgery unit. Give the nurse the lightest workload on the unit. Tell the nurse that as an RN, the nurse should be competent to work in any area. Tell the nurse to buddy up with someone else and do the best that the nurse can do.
Find another nurse to cover the unit and send the nurse back to the surgery unit. o Nurses are accountable for their practice and must recognize the limitations of their own competency. To the extent possible, the nurse manager must ensure nurses working on their units have the required knowledge, skills, and competencies. The other options are incorrect because they do not ensure that the clients are receiving care from the most competent nurse.
The primary responsibility of the nurse manager is to: provide direct client care. direct discharge planning. create unit plans and budgets. evaluate nursing care plans.
create unit plans and budgets. o The primary responsibility of a nurse manager is to create plans and budgets for the unit as a whole. Staff nurses are responsible for direct patient care, discharge planning, and evaluating nursing care plans.
Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? "The continuous passive motion device can decrease the development of adhesions." "Bleeding is a complication associated with the continuous passive motion device." "Monitoring skin integrity is important while the continuous passive motion device is in place." "The client is receiving physical therapy twice per day, so they don't need a continuous passive motion device."
"The client is receiving physical therapy twice per day, so they don't need a continuous passive motion device." o Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.
When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager? "It would be great if you could attend an in-service on therapeutic communication." "Have you ever been sexually abused?" "I can take that client off of your assignment this shift." "What specifically makes you uncomfortable?"
"What specifically makes you uncomfortable?" o It is important for the novice nurse to identify what it is about discussing sexual abuse that is anxiety producing so that those issues can be addressed and resolved. Asking this question will assist the novice nurse in engaging in self-reflection that can lead to a greater awareness of self and thus enhance the ability to be therapeutic. Suggesting the nurse have such abuse victims released from the nurse's care ignores the problem and minimizes the nurse's therapeutic effectiveness. Arranging for training is appropriate only if it is discovered that the problem relates to a lack of skills related to the nurse's therapeutic communication techniques. While prior sexual abuse may be the cause of the nurse's discomfort, it is not appropriate for the nurse manager to initiate this discussion in that manner.
A nurse is performing a sterile dressing change on a client's abdominal incision. While establishing the sterile field, the nurse drops the forceps on the floor. The nurse is unable to continue with the dressing change because there are no extra supplies in the room, and no one is present to bring new forceps. The nurse failed to organize: logistics and planning. skills and assistance. environment and client. equipment and personnel.
equipment and personnel. o A key component of the organizing interventions is to ensure adequate equipment (extra supplies) and sufficient personnel to assist with more complex tasks. Skills are first learned in nursing school but then validated with policies and procedures of the institution. Assistance is necessary to assist with the skill but is not the main issue in this scenario. Environment would be related to the lighting and space. Client issues would be the correct response if the client was cognitively aware and not confused. Logistics and planning may be related to other issues such as making sure all the elements such as personnel, client, environment, and assistance are all present.
An alert and oriented older adult female with metastatic lung cancer is admitted to the medical-surgical unit for treatment of heart failure. She was given 80 mg of furosemide in the emergency department. The nurse is instructing the unlicensed assistive personnel (UAP) to implement a nursing plan to manage potential incontinence. Which instruction will be most effective for this client? prescribing adult diapers for the client so she will not have to worry about incontinence requesting an indwelling urinary catheter to avoid incontinence placing a commode at the bedside and instructing the client in its use padding the bed with extra absorbent linens
placing a commode at the bedside and instructing the client in its use o A bedside commode should be near the client for easy, safe access. Measurement of urine output is also important in a client with heart failure. Putting diapers on an alert and oriented individual would be demeaning and inappropriate. Indwelling catheters are associated with increased risk of infection and are not a solution to possible incontinence. There is no reason to think that the client would not be able to use the bedside commode.
The charge nurse is planning staffing on a pediatric unit. Which client will the charge nurse assign to the registered nurse? the 12-year-old client with a urinary tract infection taking oral antibiotics the 8-year-old client recovering from an appendectomy who is ambulating the 1-year-old client with a respiratory disorder prescribed oxygen therapy the 6-year-old client admitted yesterday for oral rehydration following a mild gastrointestinal disorder
the 1-year-old client with a respiratory disorder prescribed oxygen therapy o The charge nurse would assign the RN to the most unstable client, which is the client with a respiratory disorder who is only 1 year of age. According to Child Health USA 2010, diseases of the respiratory system account for the majority of hospitalizations in children younger than 5 years of age, indicating this is a common occurrence. All other clients are stable and could be cared for by licensed practical nurses at this time.
Which nurse leader most clearly exemplifies transformational leadership? A leader who is dynamic and inspiring and promotes change by the power of the leader's convictions A leader who prioritizes the fact that every member of the team is considered valuable and equal A leader who is careful to thoughtfully assess the issues and priorities surrounding a problem prior to acting A leader who prioritizes the delegation of leadership to the individual members of the group
A leader who is dynamic and inspiring and promotes change by the power of the leader's convictions o Transformational leaders can create revolutionary change. They are often described as charismatic, and they are unique in their ability to inspire and motivate others. A careful examination of contextual factors is associated with situational leadership. Delegation to group members and an emphasis on equality are typical of laissez-faire and democratic leadership styles, respectively.
A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify? Shared governance Institutional governance Directive leadership Participative leadership
Directive leadership o Directive (also known as autocratic or authoritarian) leadership describes a leader who makes all the decisions and tells followers what to do. Democratic, or participative, leadership style and shared governance involve sharing the decision-making process and activities with others who have an interest. Institutional governance is governance by the institution.
A nursing facility has recently implemented new policies regarding nurse-to-patient ratios. The nursing staff seems very resistant to the change. How can the nurse manager help the staff accept the change? Hold a unit meeting to discuss how the changes will benefit staff. Use the laissez-faire leadership style to address staff concerns. Institute the changes immediately and collectively to decrease anticipation anxiety. Challenge staff's beliefs and values regarding providing quality patient care.
Hold a unit meeting to discuss how the changes will benefit staff. o Holding meetings allows open communication and opportunities for feedback. Listing the benefits of change to the individual and group also helps with buy-in. Laissez-faire leadership styles tend to increase conflicts and anxiety during times of change. Challenging staff beliefs will increase anxiety and create unpleasant work environments. Change should be instituted gradually, if possible.
The nurse manager of a medical-surgical unit is planning to make changes, because the unit is understaffed. What is the first action the manager takes to plan the change for the unit? Plan to make the change Determine and analyze solutions to the problem Recognize the symptoms that indicate a change is needed and collect data Evaluate the interventions made to correct the issue
Recognize the symptoms that indicate a change is needed and collect data o The first step in planned change is recognizing symptoms that indicate a change is needed and collect supporting data. Determining and analyzing solutions to the problem comes after recognizing the symptoms. Planning and evaluation are the end results of the planned change.
The interdisciplinary team is discussing the best approach to planning the care for a client with complex psychiatric-mental health needs. When determining which tasks can be performed by the psychiatric-mental health registered nurse (PMH-RN) and which must be performed by the psychiatric-mental health advanced practice registered nurse (PMH-APRN), the team should prioritize guidelines from what source? The recognized norms in the jurisdiction where the team is working The policies and procedures manual of the institution The American Nurses Association Standards of Practice The World Health Organization Guidelines for Nursing Practice
The American Nurses Association Standards of Practice o The American Nurses Association standards outline the scope of practice for PMH-RNs and PMH-APRNs. These standards override institutional policies and local norms. There is no World Health Organization Guidelines for Nursing Practice.
Which action may a nurse on the orthopedic unit safely delegate to a licensed practical nurse (LPN)? obtaining vital signs during blood administration taking a telephone order for pain medications for a postoperative client teaching a client receiving warfarin about follow-up care assessing the hip wound during a dry sterile dressing change
obtaining vital signs during blood administration o The nurse may safely delegate obtaining vital signs during blood administration to the LPN. Teaching the client taking warfarin about follow-up care, assessing a hip wound, and taking a telephone order are actions that must be taken by the registered nurse because they aren't within the scope of LPN practice.
A nurse manager informs the staff members during a meeting that unlicensed assistive personnel will no longer be allowed to check patients' blood glucose levels. The nurse manager informs the group this was a new policy on the unit, and discussions will not change the enforcement of this policy. What type of leadership style is the nurse manager demonstrating? · Transformational · Autocratic · Laissez-faire · Democratic
· Autocratic o Autocratic leadership involves the leader assuming complete control of the decisions and activities of the group. An extremely autocratic leader might make all decisions for the workers or followers without considering their ideas or feelings.
Which statement by a registered nurse (RN) represents appropriate delegation to a nursing assistant? "Check the infusion rate." "Dispose of the disconnected IV set." "Discontinue the IV solution." "Inspect the site for thrombophlebitis."
"Dispose of the disconnected IV set." o Disposing of a disconnected IV set is a task that is within the scope of practice of a nursing assistant. Discontinuing an IV solution, inspecting an IV site for thrombophlebitis, and checking the IV infusion rate are not within the scope of practice of a nursing assistant and should be performed by the RN.
A nurse manager of a hospital unit is working within a decentralized management structure. Which nursing action best exemplifies this type of system? Decisions are made by those who are most knowledgeable about the issue. Senior managers make all the decisions. Nurses are not intimately involved in decisions involving client care. Nurse managers are not accountable for clients, staffing, supplies, or budgets.
Decisions are made by those who are most knowledgeable about the issue. o The best example of a nurse manager of a hospital unit working within a decentralized management structure would be that decisions are made by those who are most knowledgeable about the issue. Nurses would be greatly involved in decisions involving client care. Senior managers would not make all the decisions within a decentralized management structure. Nurse managers could be accountable for clients, staffing, supplies, and/or budgets.
A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style? Autocratic Laissez-faire Transformational Democratic
Laissez-faire o In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The democratic leadership style is characterized by a sense of equality among the leader and other participants. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally, to grow professionally, and to learn.
The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying? Quantum Laissez-faire Democratic Autocratic
Laissez-faire o Laissez-faire leadership style involves the leader relinquishing power or control to the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatric client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene? The UAP wears a mask when entering the client's room. The UAP places a lunch tray in the client's room. The UAP takes a rectal temperature on the client. The UAP assists the client to ambulate in the room.
The UAP takes a rectal temperature on the client. o Precautions must be taken to protect the client from infection. The RN would intervene if the UAP takes a rectal temperature because this increases the client's risk for infection. The client should not receive rectal suppositories as well. The RN would ensure meticulous oral care is provided and encourage appropriate and adequate nutrition. Delivering a meal tray, wearing a mask when entering the room, and assisting the client to ambulate in the room are all appropriate actions by the UAP.
A nurse administrator is observing the behavior of nurses in the hospital. Which behaviors would the nurse administrator consider inappropriate? Select all that apply. A nurse speaking to a client at a distance of 4 feet A nurse holding the hand of a client who is depressed because of the client's child's chronic illness. A nurse palpating the neck of a client during the assessment A nurse hugging a client who had come in for an initial visit A nurse speaking to a depressed client in a very strict, disciplinarian tone
A nurse hugging a client who had come in for an initial visit A nurse speaking to a depressed client in a very strict, disciplinarian tone o Hugging a client who has come in for an initial visit is an inappropriate nursing behavior. This behavior indicates that the nurse is not maintaining professional boundaries. Speaking to a depressed client in a very strict, disciplinarian tone is an inappropriate nursing behavior. The depressed client needs support, and speaking in a strict tone would not be helpful to the client. Speaking to a client at a distance of 3-6 feet facilitates good therapeutic communication. Holding the hand of a client who is depressed because of her child's chronic illness is an appropriate nursing behavior, as the client needs a person to support the client at this moment.
The nurse is preparing to teach a class on cultural differences to a group of clients from the community. Which principle of culture will the nurse consider while planning the class information? Culture is always centered around religious activities and beliefs. Culture is determined by one's own morals and personal beliefs. Individuals are born with an understanding of their specific culture. Each generation learns about culture from family and the community.
Each generation learns about culture from family and the community. o Culture is a shared, not individual, system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned from family and the community through a process called enculturation. Individuals are not born with a sense or awareness of culture. Some cultures are heavily centered on religious practices and customs, however, all are not.
The new nurse is evaluating the effectiveness of the assigned nurse mentor. Which characteristic should the new nurse recognize as being inappropriate for the nurse mentor to role model? Advising the new nurse to consult the nurse mentor before making decisions regarding client care Introducing the new nurse to members of the interdisciplinary team Providing daily feedback to the new nurse Encouraging the new nurse to enroll in continuing education courses
Encouraging the new nurse to enroll in continuing education courses o Effective mentors should provide feedback to the mentee, encourage opportunities for continued growth, and provide resources that will be supportive in the new role of nurse, including members of the interdisciplinary team. Effective mentors should promote confidence in the new nurse in the decision making process. Requiring the new nurse to report to the nurse mentor before making decisions can hinder the new nurse's confidence level.
The nurse manager has recently promoted a staff nurse to the charge nurse position. Which type of power does the charge nurse now have? Implied Explicit Reward Coercive
Explicit o Explicit power is determined by virtue of the nurse's position. A charge nurse is responsible for making decisions and carrying out tasks not performed by staff nurses. Implied power involves a person without a leadership position being in a position of authority with peers. Reward power involves rewarding staff with something that they deem important. Coercive power involves using threats of punishment to force staff to do something they do not want to do.
Which action may a nurse on the orthopedic unit safely delegate to a licensed practical nurse (LPN)? taking a telephone order for pain medications for a postoperative client assessing the hip wound during a dry sterile dressing change teaching a client receiving warfarin about follow-up care obtaining vital signs during blood administration
obtaining vital signs during blood administration o The nurse may safely delegate obtaining vital signs during blood administration to the LPN. Teaching the client taking warfarin about follow-up care, assessing a hip wound, and taking a telephone order are actions that must be taken by the registered nurse because they aren't within the scope of LPN practice.
A client with borderline personality disorder has had 21 admissions to the mental health unit, each of which was precipitated by a suicide attempt resulting in superficial cuts. During this admission, the client has developed a relationship with a highly supportive nurse and has progressed to having a pass to spend an afternoon in a nearby shopping mall. Later the day that the client uses the pass, the nurse is shocked when the emergency department calls to say that the client has just been brought in with multiple self-inflicted lacerations. The nurse asks a supervisor, "Everything was going well. How could this happen?" What response by the supervisor reflects an understanding of borderline personality disorder? "The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety." "I know what you mean. You put a lot of energy into working with this client. It must be disappointing for something like this to happen." "I could have told you this would happen. Clients like these always get you in the end. I hope this will teach you not to get so involved." "I wonder if all this could have been avoided if I'd clued you in on the client. This is a usual pattern. The client burned me once, too, when I first worked here."
"The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety." o It will be instructive for the more experienced nurse to share with the rationale behind self-inflicted injuries as a feature of borderline personality disorder. Understanding professional boundaries is a vital nursing role. Reinforcing an overhelping relationship or boundary blurring would not be professional or instructive. Berating the client and the client's behaviors would not be professional.
An RN is working on a medical-surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which action by the RN is considered negligent if injury results from this action? Asking the LPN/LVN to teach a new diabetic client how to administer insulin Obtaining vital signs on a newly admitted client Calling the health care provider about abnormal lab results Delegating oral medication administration to the LPN/LVN
Asking the LPN/LVN to teach a new diabetic client how to administer insulin o Negligence is harm that results because a person did not act reasonably. As nurses perform the role of delegators, they must know which tasks are legal and appropriate for particular health care providers to perform (scope of practice), as well as the policy for the facility at which they are employed. Teaching is not in the current scope of practice for a LPN/LVN, and thus the RN's delegation of this task to the LPN/LVN could be considered negligence. The other actions are within the scope of practice for a LPN/LVN.
The nurse-manager of an outpatient facility isn't satisfied with discharge planning policies and procedures. Knowing other managers at similar facilities regarded as the "best" in the country, which steps should the nurse-manager take as part of a continuous quality-improvement process? Contact the nurse-managers at the best facilities and compare their discharge planning policies and procedures with those of her facility. Ask the nurse-managers at the best facilities for their policies and procedures so she can adopt them. Ask her staff nurses to investigate discharge policies and procedures at other outpatient facilities and recommend changes. Ask the staff nurses to form a task force to review and revise discharge policies and procedures.
Contact the nurse-managers at the best facilities and compare their discharge planning policies and procedures with those of her facility. o Benchmarking is a good approach for the nurse-manager to take. Benchmarking is the process of comparing an organization's delivery of client care practices in one organization to those in the best health care organizations. Because the nurse-manager already has contacts at the best facilities, she's the most appropriate person to obtain the necessary information. The nurse-manager, however, shouldn't automatically change her policies and procedures to match those of the best facilities. Instead, she should evaluate the policies to determine which ones might be implemented at her facility. Then she and her staff should make appropriate recommendations for change. Asking her staff to form a task force is a good idea, but benchmarking saves time and effort and enables the nurse-manager to obtain information from excellent resources.
The charge nurse is unable to replace a registered nurse for a shift on an acute medical unit. The staffing department states they are able to send an additional unlicensed assistive personnel (UAP) to assist. What priority action would the charge nurse take in this situation? Create the client assignment by considering available staff's skill level and client needs. Refuse to create the client assignment and tell management that a nurse must be found. Notify the local nursing regulating body about the unsafe working conditions at the facility. Call charge nurses on other units to request a registered nurse come assist on the unit.
Create the client assignment by considering available staff's skill level and client needs. o When working with less than an ideal number of registered nurses for a given number of clients, the charge nurse's first priority is to ensure safe distribution of client needs among the available staff members. The charge nurse's primary duty is to the safety of the clients. If there were serious impediments to safely adjusting the workload, it may be reasonable to voice this concern to the management, but the priority is to attempt to create the safe client assignment within the current staffing realities. The nurse should not attempt to arrange for staffing independently by calling other charge nurses as this is outside the role and responsibilities and may create safety concerns on other units. If the working conditions are considered unsafe, this could be a matter to be brought forward to a regulating body. However, in the moment, the charge nurse's priority is to attempt to distribute the clients' care in a safe manner.
Which attributes should be characteristic of a nurse mentor? Select all that apply. Is an experienced, licensed professional Is supportive Is resourceful Is driven by financial reward Deconstructs health care networks Demonstrates leadership abilities Embraces disruptive conflict
Is an experienced, licensed professional Is supportive Is resourceful Demonstrates leadership abilities o Mentors should demonstrate characteristics that will help the less experienced person grow in the profession. Mentors should be supportive, resourceful, experienced, respectable, and trustworthy leaders. Mentors do not receive financial compensation for their effort as preceptors typically do. Mentors should not embrace conflict that is disruptive to tasks. Mentors should build and use health care networks, not deconstruct them.
The nurse-manager of a 20-bed coronary care unit is not on duty when a staff nurse makes a serious medication error that results in a client's overdose. The client nearly dies. Which statement accurately reflects the accountability of the nurse-manager? Although the nurse-manager is off duty and not responsible for what happened, the nursing supervisor would call the nurse-manager only if time permits. The nurse-manager would receive a call at home from the on-duty nursing supervisor, apprising the nurse-manager of the problem as soon as possible. Because the nurse-manager is off duty and not accountable for incidents that occur in their absence, the nurse-manager need not be notified. The nurse-manager only needs to be informed of the incident when the nurse-manager reports to work on the next scheduled day.
The nurse-manager would receive a call at home from the on-duty nursing supervisor, apprising the nurse-manager of the problem as soon as possible. o The nurse-manager is accountable for what happens on the unit 24 hours per day, 7 days per week. If a serious problem occurs, the nurse-manager should be notified as soon as possible. None of the other choices accurately reflect the nurse--manager's accountability in this situation.
The RN is working with hospital administrators to transform care at their facility. Which nursing competency will be critical for the nurse to utilize? Do things the way they have always been done Correctly utilize and troubleshoot high-tech equipment Navigate the electronic medical records system Work effectively in interdisciplinary teams
Work effectively in interdisciplinary teams o The RN working with administrators to transform care will need to be able to work effectively as part of an interdisciplinary team. The nurse will need to work as a team member with members of the administration, as well as representatives from other health disciplines involved in the project. The ability to use and troubleshoot equipment and to navigate the electronic medical records are important to the nurse, but will not necessarily help when working with administration to transform care. Doing things the way they have always been done is a barrier to transformation of care.
A student is choosing an educational path and desires a nursing degree with a track for community nursing and leadership and that allows for classes in liberal arts. The student would best be suited in which type of program? certification in a nursing specialty licensed practical nursing program baccalaureate program diploma nursing program
baccalaureate program o The baccalaureate degree in nursing offers students a full college or university education, with a background in liberal arts. It is an intense program as it includes a focus on nursing leadership skills with additional requirements for clinical practice labs and clinical internships throughout its duration. Licensed practical nursing programs, certification in a nursing specialty, and diploma nursing programs are shorter length programs who curriculum is focused more on clinical nursing skills.
A client is admitted to an acute care facility after having a stroke. The client will require a variety of healthcare services throughout the hospital stay as well as coordination of care prior to discharge. What referral would be a priority for overseeing the client's care? Physical therapy Dietary services Occupational therapy Case management
Case management o The person responsible for overseeing the client's care, usually an RN with a bachelor's or master's degree or another highly experienced health professional, is called the case manager. Physical therapy, occupational therapy, and dietary services are all important care disciplines but do not encompass all of the client's needs.
A staffing agency is assigning a licensed practical/vocational nurse (LPN/VN) to cover a shift on a pediatric unit. Because the unit manager is unfamiliar with the nurse's skill level, what assignment is best for the LPN/VN? 10-year-old child who had a tonsillectomy that morning 9-year-old child with Legg-Calve'-Perthes disease 8-year-old child admitted that morning with suspected meningitis 9-year-old child receiving subcutaneous insulin for diabetes mellitus
9-year-old child receiving subcutaneous insulin for diabetes mellitus o The unit manager should assign the LPN/VN to the child with diabetes mellitus. Because the client is receiving subcutaneous insulin rather than IV insulin, the diabetes is likely stable. Meningitis is an acute condition with the potential to progress into respiratory depression and seizures; this child will require frequent nursing assessments. The child who had a tonsillectomy remains at risk for hemorrhage during the first 24 hours following surgery. Legg-Calve'-Perthes disease is associated with impaired circulation to the femoral capital epiphysis; the child with this condition requires aggressive monitoring.
A primary unit nurse tells the nurse-manager that a registered nurse hired 6 weeks ago needs an additional week of orientation to function effectively on the staff. Which action is most appropriate for the nurse-manager to take? Meet with the new nurse and the primary nurse and help set up an additional week of orientation. Schedule a staff meeting to find out if there are deficiencies or flaws in the orientation process. Explain to the primary nurse that a 6-week orientation is standard. Meet with the new nurse and question the new nurse about deficits in performance.
Meet with the new nurse and the primary nurse and help set up an additional week of orientation. o The nurse-manager is responsible for adequate orientation of new staff. A need for additional orientation does not mean that a nurse is not competent or that there are deficits in performance. Although a 6-week orientation may be standard, orientation periods should be individualized to meet the needs of the staff as well as provide the best client outcomes. Periodically reviewing and revising the orientation process is a good idea. However, in this case, the most appropriate course of action is to help the new nurse complete the orientation as efficiently as possible.
A charge nurse on the orthopedic unit functions to promote teamwork and to help the unit run smoothly. Which action should the charge nurse reconsider in order to promote teamwork? coordinating admissions and discharges to even the workload asking the nursing assistant to pick up medications from the pharmacy directing two nurses to cover a third nurse's clients while the nurse transfers a client to the intensive care unit assisting the nurse to schedule Doppler ultrasonography for a client without discussing it with the physical therapist
assisting the nurse to schedule Doppler ultrasonography for a client without discussing it with the physical therapist o Scheduling Doppler ultrasonography without first coordinating scheduling with the physical therapist doesn't promote teamwork. This lack of coordination may cause the client to miss a physical therapy session. Coordinating admissions and discharges to even the workload, having nurses cover for each other during client transfers, and delegating tasks to nursing assistants as appropriate promote teamwork.
A registered nurse (RN), a licensed practical nurse (LPN), and an assistive personnel are caring for a group of clients. The RN asks the assistive personnel to check the pulse oximetry level of a client who underwent a laminectomy. The assistive personnel reports that the pulse oximetry reading is 89% on room air. The client has a prescription for oxygen at 2 L/min for a pulse oximetry level below 92%. The RN is currently assessing a postoperative client who just returned from the postanesthesia care unit. How will the RN proceed? Complete the assessment of the new client before attending to the client who underwent laminectomy. Ask the assistive personnel to notify the provider of the low pulse oximetry level. Immediately go the client's room and assess vital signs, administer oxygen at 2 L/minute, and notify the provider. Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy.
Ask the LPN to obtain vital signs and administer oxygen at 2 L/min to the client who underwent laminectomy. o Because it's important to get more information about the client with a decreased pulse oximetry level, the RN should ask the LPN to obtain vital signs and administer oxygen as prescribed. The RN must attend to the newly admitted client without delaying treatment to the client who is already in their care. The RN can effectively do this by delegating tasks to an appropriate health team member such as an LPN. The RN doesn't need to immediately attend to the client with a decreased pulse oximetry level; the RN may wait until the newly admitted client's assessment is complete. The primary health care provider doesn't need to be notified at this time because the client has a prescription for oxygen administration.
The nurse manager on an orthopedic unit has determined that the nurses are not keeping the nursing diagnoses up-to-date on client care plans and, in turn, are not using the plan of care. What is a feasible approach to correcting this problem? Provide an in-service on interviewing and physical assessment skills; discuss the importance of these skills with the staff. Delegate the updating of nursing diagnoses for all clients on the unit to one nurse for each shift. Request that a staff development nurse instruct the nurses on concept mapping to use instead of care planning. Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses.
Develop a process for periodic review of care plans that focuses on deleting and updating the nursing diagnoses. o Upon recognizing that the nursing diagnoses are not up-to-date, an effective approach by the nurse manager is to establish a process for periodic review of the plan of care. This review process will require deletion of nursing diagnoses that have been resolved and, conversely, adding new diagnoses as needed. Implementing concept mapping will not correct the problem of poorly updated nursing diagnoses, as concept mapping requires the identification of nursing diagnoses. Developing interviewing and assessment skills is an important component of the assessment phase of the nursing process. Also, one nurse should not be responsible for updating nursing diagnoses for all client care plans on the unit.
A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention? Shoe covers are used. Scrub top and drawstring are tucked into pants. Hair is pulled back and covered by a cap. Mask is placed over nose and extends to bottom lip.
Mask is placed over nose and extends to bottom lip. o The mask should fit tightly, covering the nose and mouth. The mask should extend down past the chin. The mask may not effectively cover the mouth if extended only to the bottom lip. The hair, scrub top, drawstring, and shoe covering are all appropriate and do not require intervention.
The nurse is caring for an obese client who needs to be turned every 2 hours. Which action by this nurse is an example of reflection-for-action? During the first attempt to turn the client, the nurse realizes the need for assistance and calls the front desk for help. Reflecting on prior experience and best practice, the nurse includes assistance with turning in the client's plan of care. The nurse decides to turn the client every 4 hours because everyone is too busy to help. After turning the client alone, the nurse realizes that the nurse should have insisted on having help.
Reflecting on prior experience and best practice, the nurse includes assistance with turning in the client's plan of care. o There are three types of reflection as defined by Schon: reflection-in-action, reflection-on-action, and reflection-for-action. Reflection-for-action is the desired outcome of the first two types and helps the person to think about how future actions might change as a result of the reflection. When the nurse realizes the need for help turning the client when first attempting to turn the client, this is reflection-in-action. When reflecting whether everyone is using appropriate resources, this is reflection-on-action. When adapting the client's plan of care based on these other reflections, this is reflection-for-action. Turning an obese client without assistance is unsafe and resources should be used. The client's outcomes should not be jeopardized by altering the plan of care due to the time constraints of staffing.
A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role? The staff nurse is learning about all the hospital policies from the charge nurse. The charge nurse is being paid to supervise the staff nurse. The charge nurse is providing support for the staff nurse in new responsibilities. The staff nurse is orienting to the unit as a newly hired nurse.
The charge nurse is providing support for the staff nurse in new responsibilities. o A mentor is not a paid position, but, instead, is a person who provides support and encouragement to a less experienced nurse who is learning new responsibilities for a current role or an expanded one. Preceptorship typically is a paid position, and is provided for a new or experienced nurse who is training for a new position on a unit. The preceptor would teach the new nurse about hospital policies and procedures, as well as supervise the nurse in daily assignments.
An experienced pediatric nurse is orienting a new graduate nurse. Which action by the new graduate would require intervention by the experienced nurse? The nurse offers the medicine to the child and says to "take this liquid candy." The nurse identifies the child using the ID band and asking the child's name. The nurse asks the experienced nurse to check the dosage calculations. The nurse looks up the medication in the Harriet Lane book.
The nurse offers the medicine to the child and says to "take this liquid candy." o It is inappropriate to call medication candy, as it is deceptive and children may try to take the "candy" at another time on their own. It is appropriate for the new nurse to look up the medication, have someone double-check dosage calculations, and identify the child with the ID band and the child's name.
The charge nurse is unable to replace a registered nurse for a shift on an acute medical unit. The staffing department states they are able to send an additional unlicensed assistive personnel (UAP) to assist. What priority action would the charge nurse take in this situation? Notify the local nursing regulating body about the unsafe working conditions at the facility. Call charge nurses on other units to request a registered nurse come assist on the unit. Refuse to create the client assignment and tell management that a nurse must be found. Create the client assignment by considering available staff's skill level and client needs.
Create the client assignment by considering available staff's skill level and client needs. o When working with less than an ideal number of registered nurses for a given number of clients, the charge nurse's first priority is to ensure safe distribution of client needs among the available staff members. The charge nurse's primary duty is to the safety of the clients. If there were serious impediments to safely adjusting the workload, it may be reasonable to voice this concern to the management, but the priority is to attempt to create the safe client assignment within the current staffing realities. The nurse should not attempt to arrange for staffing independently by calling other charge nurses as this is outside the role and responsibilities and may create safety concerns on other units. If the working conditions are considered unsafe, this could be a matter to be brought forward to a regulating body. However, in the moment, the charge nurse's priority is to attempt to distribute the clients' care in a safe manner.
Nurses who work in a pediatric psychiatric-mental health facility should do what? Develop self-awareness of issues that remind them of their own childhood and adolescence. Ensure that their own physical and mental health needs are placed above those of the clients. Use self-disclosure of personal struggles with problems of childhood and adolescence with clients. Ensure that their professional life is a higher priority than their personal life.
Develop self-awareness of issues that remind them of their own childhood and adolescence. o To care for themselves, nurses need to recognize and discuss their job-related stressors. They should acknowledge and deal with issues that remind them of their own childhood and adolescence. Equally important, they need to attend to their own physical and mental health. Proper nutrition, rest and sleep, exercise, health care, maturity, and balance in personal and professional lives maximize the energy available to work therapeutically with youth and their families.
A nurse manager is considering the reasons for the current problems with the health care system. Which are negative consequences of higher spending in health care? Select all that apply. · Higher spending may result in overutilization of services. · Higher spending guarantees a higher quality of care. · Higher spending may result in overuse of technology. · Higher spending may result in higher quality of care. · Higher spending may result in duplication of services.
· Higher spending may result in overutilization of services. · Higher spending may result in overuse of technology. · Higher spending may result in duplication of services. o Sometimes higher expenditures in health care result in duplication of services, overutilization of services, and overuse of technology. These are all negative outcomes of higher spending. Higher spending may result in a higher quality of care, and this would be a positive outcome of higher spending. Higher spending does not guarantee a higher quality of care.
