Princeton Review Management of Care Drill 2
A nurse is assessing a client after morning rounds. The client tells the nurse that the healthcare provider was rude and did not explain the plan of care. How does the nurse respond to the client's concern? "You are entitled to receive competent and respectful care." "Healthcare providers are very busy during morning rounds." "What questions do you have regarding your plan of care?" "Has your healthcare provider made you feel this way before?"
A Rationale: A client has a right to receive medical care from providers who are competent and treat the client with respect. The nurse acknowledges the client's concern. The nurse should not excuse the behavior of the healthcare provider. The client's questions regarding the plan of care should be answered. However, the nurse is not addressing the client's concern in its entirety. The nurse's role is to acknowledge the client's rights. Asking about past experiences does not address the current concern.
A nurse manager has emphasized the use of bedside reporting to unit nurses. Which client outcome indicator suggests the performance improvement strategy is effective? Customer service reports indicate increased client satisfaction with nursing communication. Charge nurse rounds indicate over 80% of unit nurses are performing bedside reporting. Timesheets indicate nursing overtime has decreased by 10% on the unit. Nurses voice bedside reporting improves their workflow throughout the shift.
A Rationale: The goal of bedside reporting is to improve communication amongst healthcare providers and ensure that the client is informed about their plan of care. Increased client satisfaction with nursing communication indicates bedside reporting is successfully meeting performance improvement goals. The number of nurses performing bedside reporting is a process indicator, not an outcome indicator. The primary goal of bedside reporting is to improve communication, not decrease overtime. Nurses voicing improved workflow is not a client-centered outcome indicator.
A postoperative client with a hip fracture has been referred to a rehabilitation center for continuity of care. Which priority documentation will the nurse include with the referral? Question 19 Answer Choices The latest physical therapy progress notes The surgical report A record of current pain management A copy of the last physical assessment
A Rationale: The latest physical therapy progress notes provide information on the client's mobility and can help the rehabilitation center formulate a plan of care. The surgical report does not provide relevant information on the client's current progress. A record of current pain management provides information about the client's treatment; however, it does not provide relevant information regarding mobility. A copy of the last physical assessment provides information on the client's overall health status but is not specific to the diagnosis and client's rehabilitation needs.
The nurse is caring for a client who has a thoracentesis and physical therapy scheduled during the nurse's shift. Which action by the nurse is most appropriate to effectively manage this client's care? Request that the client's physical therapy be performed in the morning Cancel the client's physical therapy prescription for that day Ensure that the thoracentesis is performed before physical therapy begins Your Answer Medicate the client with analgesics prior to both activities
A Rationale: The most appropriate action would be to request that the physical therapy be performed in the morning prior to the thoracentesis. This action still allows both prescriptions to be completed but in the most effective way. Canceling the physical therapy and planning to complete the physical therapy after the thoracentesis are not the most effective management of care strategies. Medicating the client prior to these activities is not an incorrect action but does not address the schedule conflict.
A charge nurse is preparing the staffing assignment for the oncoming shift. Two nurses have called in and the client-to-nurse ratio will increase from 1:5 to 1:8. Which action does the charge nurse take? Call the nurse manager to report the situation before the end of the shift Ask the staff nurses to volunteer to work a double shift Finalize the staffing assignment for the oncoming shift Ensure all client care has been completed before the end of shift
A Rationale: The nurse must report the situation to the nurse manager. A significant increase in nurse-to-client ratios can pose a risk to client safety. Asking the staff nurses to volunteer to work a double shift is not a safe practice and is not a decision that can be made independently by the charge nurse. Finalizing the staffing assignment disregards the risk of client safety concerns. Ensuring all client care has been completed on the unit before the end of the shift is not a realistic goal. Client care is continuous.
The nurse manager is reviewing ways that a nurse may risk disciplinary action related to licensure. Which action would put the nurse's license at risk? Inserting a central catheter under the direct supervision of a healthcare provider Participating in lateral violence and bullying on the unit Arriving to work with evidence of body odors Your Answer Maintaining a habit of excessive absences and tardiness
A Rationale: The nurse should recognize that inserting a peripheral intravenous central catheter (PICC) even under the direct supervision of a healthcare provider is outside the nurse's scope of practice, which is not allowed as per the state board of nursing and Nurse Practice Act. Participating in lateral violence/bullying on the unit, arriving to work with evidence of body odors, and maintaining a habit of excessive absences and tardiness do not pose a risk to disciplinary action regarding licensure but may result in loss of employment if agency policy is violated.
The nurse overhears an unlicensed assistive personnel (UAP) tell a family member, "The client that injured your spouse in the motor vehicle accident (MVA) should go to jail, but he just died." Which action should the nurse implement first? Interrupt the conversation, and discuss the situation with the UAP privately Allow the UAP to finish her conversation, and discuss the situation later Apologize to the family member for the UAP's comments Tell the UAP that the comment is a violation of confidentiality
A Rationale: The nurse should stop the conversation immediately and ask the UAP to discuss the situation privately, so the nurse does not embarrass the UAP. Gossiping about another client is a violation of his or her privacy and a breach of confidentiality and HIPAA protocol. The nurse should not allow the conversation to continue. The nurse could apologize for the UAP's comments, but this is not the first intervention. The nurse should tell the UAP about the breach of confidentiality but addressing the situation with her privately and immediately is the priority intervention.
A graduate nurse tells the charge nurse that a terminally ill client has verbalized wanting to end all medical treatment. The client's family is concerned with the client's statement. How does the charge nurse explain advocacy to the graduate nurse? "It is our duty to recognize the needs of both the client and their family." "We need to respect the wishes of our client only." "Always do what is medically necessary to keep the client healthy." "A terminally ill client should not make decisions without the family's consent."
A Rationale: The nurse's role as an advocate is to recognize and understand the needs of the client and their family. It is important for nurses to find solutions that benefit both the client and their loved ones. Although nurses advocate for the client's autonomy, they must also take the family's concern into consideration. Nurses should provide competent care but should also respect the client's autonomy regarding medical treatment. A terminally ill client who is coherent has the right to voice their own medical decisions.
The nurse is planning care for a client with pancreatitis who has a prescription for intermittent nasogastric suction. Which intervention is the priority for the nurse to include in the plan of care? Administer the prescribed intravenous (IV) dose of ondansetron Encourage supine position to limit gastric losses Resume high-fat diet based on client tolerance Administer prescribed oral opioid analgesics
A Rationale: The priority intervention of the nurse to include in the plan of care for a client prescribed nasogastric suction for severe nausea and vomiting is the administration of ondansetron intravenously as prescribed. The client should be placed in a side-lying position for comfort and to decrease the risk of aspiration. When diet is resumed, oral intake should be started slowly with small, frequent, high-carbohydrate meals. A high-fat diet will exacerbate acute pancreatitis. The client will not be able to receive oral opioid analgesia with nasogastric suction.
The nurse is caring for a client admitted with respiratory distress, and endotracheal intubation is indicated. Which member of the healthcare team should the nurse collaborate with to ensure the ventilator is set up and operational? Respiratory therapist Healthcare provider Biomedical services Charge nurse
A Rationale: The purpose of mechanical ventilation is to maintain alveolar ventilation and oxygen delivery. Respiratory therapists are trained in techniques and equipment that improve oxygenation and pulmonary function, including ventilators. The healthcare team continually assesses the patient for adequate gas exchange, signs and symptoms of hypoxia, and response to treatment. Therefore, the nursing diagnosis of impaired gas exchange is, by its complex nature, multidisciplinary and collaborative. The team members must share goals and information freely.
A nurse is discussing advance directives with a client during an admission history. Which client statement indicates an understanding of a healthcare power of attorney? "The person I choose to make medical decisions for me must be someone within my immediate family." "I can appoint a person I trust to make medical decisions for me when I can no longer do so." "My healthcare proxy will make medical decisions for me anytime I am hospitalized." "Once I choose a person to be my power of attorney, I cannot select someone else."
B Rationale: A durable power of attorney appoints a healthcare proxy to make decisions for the client when they can no longer do so themselves. The proxy can be any competent adult the client chooses. A healthcare proxy will make decisions only when the client is no longer able to do so themselves. The choice of a healthcare proxy can be revoked or revised at any time by the client.
The nurse is preparing to administer newly prescribed simvastatin to a client who had a myocardial infarction. The client states, "I am not sure I want to take that medication; I heard it has side effects." Which statement by the nurse is appropriate? "You need this medication to prevent another myocardial infarction." "I can discuss with you the side effects that can occur with this medication." "I will inform your healthcare provider that you are refusing the medication." "You need to take the first dose to see if you will have any side effects."
B Rationale: Clients have the right to refuse treatment or procedures. Often the client will refuse because of concerns related to outcomes, such as side effects with medications. The nurse should recognize and respect the client's right to refuse but should also provide additional information or resources for the client to make the decision. Discussing side effects could provide the client with more information to make the decision. The nurse may need to inform the healthcare provider, but this does not address the client's concerns. Telling the client what would happen if they do not take the medication dismisses the client's concerns.
A nurse reviews new prescriptions for several clients on a medical-surgical unit. Which intervention will the nurse perform first? Provide discharge instructions to a client post-abdominal surgery Initiate a patient-controlled analgesia pump for a client with uncontrolled pain Administer intravenous antibiotics to a newly admitted client Perform wound care on a client with a foot ulcer
B Rationale: The nurse should initiate the patient-controlled analgesia pump for a client with uncontrolled pain. Managing a client's pain (the fifth vital sign) is a priority intervention for the nurse. Discharge instructions indicate the client is stable. Providing discharge instructions to a stable client is not a priority intervention. Administering intravenous antibiotics to a newly admitted client is an important intervention but is not a priority for the nurse. The client with uncontrolled pain should be seen first. Wound care is a routine treatment and can be performed after the nurse completes the rest of the prescribed interventions.
The nurse is performing an initial skin assessment on a client transferred from a different unit. The nurse observes redness to the gluteal folds. How should the nurse document the finding? Blanching Erythema Correct Answer Pressure injury Atrophy
B Rationale: The initial sign of pressure is redness of the skin, which is called erythema. Blanching is seen when whiteish coloration of the skin remains longer than normal when pressure is applied. A pressure injury is evaluated and staged accordingly, and erythema is not classified as a pressure injury. Atrophy refers to the decrease in the size of an organ, body part, or tissue.
The nurse is preparing to complete a daily assessment and dressing change for a client who is immobile and has a wound on the coccyx. Which of the following actions by the nurse is appropriate to manage time effectively? Remove the old dressing before gathering supplies Complete the dressing change while giving the client a bed bath Correct Answer Delegate the dressing change to the unlicensed assistive personnel Postpone the dressing change until after morning care has been completed
B Rationale: The nurse should perform the wound assessment and dressing change while the client is being bathed. Combining these two actions is an efficient way to get both tasks completed because the client will need to be positioned and exposed for both procedures. The nurse cannot delegate an assessment to an unlicensed assistive personnel, and the other responses are not the most efficient use of the nurse's time.
The nurse is preparing a questionnaire for the pediatric inpatient unit to evaluate patient satisfaction. The nurse understands which of the following could impact the results? Socioeconomic status Marital status of the parent Moral evaluations Family size
C Rationale: For the nurse to properly evaluate patient satisfaction, moral evolutions should be reviewed and understood. Moral evaluations are judgments that conform to the standard of what is right and good. Moral evaluations assess human actions and institutions and avoid giving special place to a person's own welfare. Socioeconomic status, family size, and marital status are not likely to influence the results but should all be taken into consideration when caring for clients.
The nurse observes a social media post by a staff nurse that discusses the care of a client. Which of the following actions should the nurse take? Request the post be deleted Inform the client about the post Report the post to a supervisor Notify the board of nursing
C Rationale: Social media are web-based technologies that allow users to create, share, and participate in virtual communities. These social media networks provide nurses the opportunity to share ideas, develop professional connections, and access education. There are policies in place to prevent sharing of client information. Disclosing information or posting defamatory remarks could lead to serious consequences. The nurse should report the post to a supervisor. Requesting the post to be deleted does not address the issue.
The registered nurse is caring for a client who had a cardiac catheterization. Which action is appropriate to delegate to the licensed practical nurse (LPN/LVN)? Performing the initial assessment of the catheter insertion site Teaching the client about the post-procedure plan of care Administering the scheduled lipid-lowering medication Evaluating the effectiveness of the nursing interventions
D Rationale: The Five Rights of Delegation are right task, right circumstance, right person, right directions and communication, and right supervision and evaluation. Professional nurses are responsible for delegating nursing activities, but although RNs may delegate elements of care, they do not delegate the nursing process itself. Nursing care or tasks that should never be delegated, except to another RN, include initial and ongoing nursing assessment, determination of the diagnosis and plan of care, evaluation, and client education. Any task that is delegated should be based on the training and competence of the individual accepting the delegation.
The nurse is caring for a client who is going to have an invasive procedure. The healthcare provider has completed the informed consent discussion. Based on knowledge of the nurse's role in informed consent, what action by the nurse is most appropriate? Answer any additional questions that the client has about the procedure Determine if the client has additional questions about the proposed procedure Sign the documentation in the role of the witness Encourage the family to support the client's decision
D Rationale: The most important part of the consent process is informing the client. A client's signature is meaningless if the client is not informed. Nurses are often told that when they obtain a client signature on a consent form, they are only witnessing the signature and not verifying that informed consent was obtained. However, nurses have ethical and professional accountabilities to ensure the client is fully informed and capable of giving consent. It is appropriate for the nurse to assess if the client has full understanding of the proposed treatment and then advocate to ensure that the client received the necessary information from the provider.
The nurse is evaluating the time management skills of staff members. Which action by the staff member demonstrates effective time management? Asking the unit manager to complete some of the assigned tasks Delaying non-essential tasks until the next shift Documenting all nursing interventions after the shift has concluded Reviewing the clients' prescriptions before beginning to see clients
D Rationale: The nurse should review all of the clients' prescriptions before beginning to complete tasks. Doing this ahead of time allows the nurse to plan which interventions can be prioritized. Delaying tasks until the next shift and documenting after the normally scheduled shift are not appropriate time management techniques. Asking the unit manager for help is not an indicator of time management.
