RN 2.0 Leadership Practice Quiz
A charge nurse on a pediatric unit is delegating tasks to an assistive personnel who is pregnant and reports that she is unsure of her immune status. Which of the following clients should the charge nurse assign to the AP?
A 2 year old child who has impetigo contagiosa *This is a safe assignment. If the AP practices universal precautions, there is no risk for contracting impetigo. Impetigo is a superficial skin infection caused by either staphylococcus or streptococcus.
A nurse in an emergency department is caring for four clients. which of the following requires mandatory report?
A child who was left unsupervised for several hours at home and is being treated for a fractured leg *This child exhibits findings of neglect and endangerment. The nurse is a mandatory reporter of any client situation in which children or older adult clients are being abused or neglected.
A charge nurse is making assignments for an oncoming shift. Which of the following clients should the charge nurse assign to a LPN?
A client who is disoriented and awaiting transfer to a long term care facility *A client who is disoriented will need observation and reality orientation, which is within the LPN's scope of practice. The client's condition can also be categorized as stable since discharge to a long-term care facility is scheduled.
A charge nurse is evaluating conflict resolution between two staff nurses. Which of the following conflict resolution styles is an example of one nurse putting aside her own goals to satisfy the other nurse?
Accommodation *Checking for level of consciousness is the first action the nurse should take when finding a victim. This client might have had a vasovagal response while defecating, resulting in a temporary loss of consciousness that does not require CPR.
A nurse is caring for a client who has stage 4 ovarian cancer and has decided to stop treatment and enter hospice care
Advocacy *By following the ethical principle of advocacy, the nurse supports the client in the decisions she makes about her own health care.
A nurse is preparing to provide discharge teaching to an older adult client. Which of the following teaching considerations should the nurse include?
Allow frequent rest periods during teaching *due to slower information processing
A nurse is working with an assistive personnel who appears to be under the influence of alcohol during the night shift.
Ask the nursing supervisor to observe the AP and validate the nurse's suspicion *After gathering data, the nurse must first validate suspicions with another observer, take the appropriate action to safeguard clients, and then document the incident.
An RN and a licensed practical nurse are caring for a client who has a small bowel obstruction and is NPO with a NG tube set to continuous suction
Assess for bowel sounds every 2 hr *Assessments are within the scope of practice for the RN only. While the LPN can also auscultate the client's abdomen for the presence of sounds, only the RN is qualified to evaluate the sounds and qualify them as hypoactive, normal, or hyperactive.
A nurse is delegating a task to an assistive personnel. The AP is to transfer a client who has a below the knee amputation from a bed to a wheelchair. the AP has never transferred a client with an amputation before. which of the following actions should the nurse take?
Assist the Ap after he has practiced the transfer. *The safest way for the nurse to determine if the AP has the knowledge and skill to transfer the client who has an amputation is by having the AP practice and demonstrate the task. By assisting the AP the first time a transfer is done, the nurse ensures that delegated care is safely provided.
A group of providers are participating in a cardiopulmonary resuscitation effort for a client who is in cardiac arrest. Which of the following types of leadership is required for this group to function efficiently?
Autocratic *Autocratic leadership is most efficient in an emergency situation. An autocratic leader will direct and issues commands necessary for successful cardiopulmonary resuscitation.
A nurse is caring for a client who received a sedative hypnotic medication at bedtime. The client gets out of bed and falls, sustaining a laceration that requires suturing
Client found sitting on the floor with 3 cm laceration above left eyebrow. Oriented to name only. Provider notified. *This statement is appropriate to include in the documentation. It presents objective facts and assessments related to this event. The nurse should also include vital signs, further assessments, the name of the provider that was notified, treatments or procedures that were done per the provider's prescription, and the client's response.
A nurse manager calls a meeting of the unit's staff members to discuss cost-contaminment issues
Democratic *This is an example of democratic leadership. A democratic leader guides staff toward reaching an objective and shares responsibility with the staff. This is the ideal type of leadership in this situation because a great amount of creativity can occur and many strategies can be developed.
A nurse is caring for a client who is in the bathroom. The nurse hears a loud thud and after opening the bathroom door, finds the client on the floor. What is the nurses first step to asses?
Determine level of consciousness Assertive communication uses "I" statements that describe the person's observations and feelings. It allows the person being confronted to respond to the issue with her own perceptions and feelings instead of feeling verbally assaulted. Subsequently, a verbal discourse that allows an open discussion of the issue can follow.
A nurse manager is planning staff development activities for the unit's new unlicensed assistive personnel. Which of the following activities should the nurse manager perform first?
Determine the learning needs of the APs *The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, she must first collect adequate data. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision; therefore, the nurse manager should first determine the learning needs of the APs.
Using quality monitoring tools, a facility committee identifies that clients who have congestive heart failure have an average length of stay this is 5 days instead of the established standard of 3 days
Determine which actions can be instituted to address this problem *Further analysis of data will identify factors that contribute to the longer lengths of stay. Identifying actions to shorten the clients' lengths of stay is the next step in the process.
Based on recommendations following a regulatory agency visit, the nurse manager mandates a policy change. One of the staff members on the unit is resistant to the change
Encourage the nurse to verbalize reasons for resisting the change
Based on recommendations following a regulatory agency visit, the nurse manager mandates a policy change. one of the staff nurses on the unit is resistant to the change, and the nurse manager notes that the nurse does not deliver care according to the new policy. which of the following actions should the nurse take?
Encourage the nurse to verbalize reasons for resisting the change *The nurse manager should realize that if the nurses who must implement the change are not invested in the change process, resistance to change is likely. This is especially problematic when the change is unplanned or imposed by outside forces. The resistant staff nurse has likely rejected the change for reasons such as habit, fear of the unknown, and lack of time to learn something new. A meeting between the nurse manager and the staff nurse will allow an open forum for the staff nurse to verbalize the reasons for his reluctance to adopt the new policy.
A charge nurse in an emergency department is making assignments for an assistive personnel for a shift with unexpected staff absences. Which of the following assignments should the charge assign to a float AP from the med-surg unit?
Escort clients from the emergency department to other areas of the facility for tests *Typically, transporting stable clients will be a task that may be delegated to AP. Escorting clients is likely a normal part of the AP's regular routine. This is an appropriate assignment.
A nurse manager believes that a nurse is taking breaks that are too frequent and lengthy. Which of the following is an assertive statement that the charge nurse should use to initiate discussion of the issue?
I understand you are allowed to take scheduled breaks during each shift, but you are taking more that the number allocated *Assertive communication uses "I" statements that describe the person's observations and feelings. It allows the person being confronted to respond to the issue with her own perceptions and feelings instead of feeling verbally assaulted. Subsequently, a verbal discourse that allows an open discussion of the issue can follow.
A nurse is caring for a child who has sustained extensive head injuries. The provider has diagnosed brain death. Which of the following statements should the nurse use to begin a conversation about the option of organ and tissue donation with the child's parents?
I want to give you some information about an option that you have regarding donating your child's organs to others who are in need *This is an appropriate statement to begin the discussion. It makes the nurse's intention to give the family factual information that is clear and does not make any emotionally laden statements.
A nurse is completing an incident report after administering an incorrect dose of medication to a client, even though the client experienced no ill effects from the error. which of the following should the nurse recognize as the purpose for completing the incident report?
Identifies situations that contribute to the occurrence of medications errors *The purpose of completing incident reports is to identify factors that contribute to the occurrence of the problem. This is one aspect of quality improvement efforts in health care facilities.
A home health nurse is caring for a client who asks what is included in a living will.
It allows the client to express personal wishes regarding health care decisions
A client in a long term care facility falls out of bed, fracturing his left hip. The side rails on the bed were not raised at bedtime
Negligence *Negligence occurs when a client is exposed to an unreasonable risk of injury. Raised side rails help to decrease the risk of falling out of the bed and are a standard of care for clients who have been identified as at risk for falling.
A nurse is making a client's bed and finds a capsule of medication in the sheets. Which of the following actions by the nurse is consistent with safe nursing practice?
Notify the provider of missed dose Complete a variance report Document the missed dose of medication on clients MAR
A nurse is preparing to give change of shift report to the oncoming nurse. Which of the following information should the nurse include?
Objective measurements about the client's condition
A nurse in the emergency department is preparing to obtain informed consent for surgery from a client who received meperidine hydrochloride IV during transport from a rural hospital
Obtain consent from a relative of the client *A client who has received meperidine cannot give consent, because the medication can alter the client's ability to understand the consent process. The nurse should obtain consent from a relative of the client. If a relative is unavailable and the surgery is determined to be critical, the surgery can proceed without client consent
A nurse is caring for a client who is a local public official. A local newspaper reporter repeatedly phones the unit seeking information and states, "it is the public's right to know the health status of elected officials." Which action should the nurse take?
Refer media inquiries to nursing supervisor *The HIPAA Privacy Rule prohibits disclosing client information to individuals not involved in client care without that client's express consent. The reporter should be told that, due to confidentiality issues, no information can be given out about any clients. The nurse should refer the reporter to the nursing supervisor.
A nurse is reviewing laboratory results for a client who is at 12 weeks gestation.
Serum creatinine 0.4mg/dL
A nurse is caring for several clients who require diagnostic testing and is delegating tasks to an assistive personnel. Which of the following tasks should the nurse direct the AP to perform first?
Take an arterial blood gas specimen to the laboratory *Arterial blood gas specimens are placed on ice and must be transported to the laboratory immediately to prevent degradation of the sample. Since this task needs to be done within a specified time frame, it is the first task the AP should perform.
A charge nurse is observing a group of newly licensed nurses. Which of the following observations should the charge nurse report to the nurse manager as a violation of HIPAA?
Talking about clients with other nurses in the cafeteria. *The nurse should not discuss information about clients, including their personal concerns, diagnoses, and treatments, with anyone who is not directly involved in the client's care. Doing so is a violation of HIPAA regulations. Nurses should take special care not to compromise this right by discussing client care in such places as elevators, restaurants, or other areas that are accessible to the public in which the discussion might be overheard.
A nurse is caring for a client who is dying and unable to make decisions for himself. The client's adult children disagree on his code status. Which of the following sources should the nurse depend on for decisions regarding the client's end of life care?
The client's health care proxy *In the event that the client cannot speak for himself, the nurse should follow the directions of the client's health care proxy, as this is the person the client chose to make decisions under these circumstances.
A nurse is working with an assistive personnel in a long term care facility. According to the five rights of delegation, which of the following determinations should the nurse make prior to assignment of tasks?
The degree of supervision that the AP will require to complete the task *Successful delegation involves assigning the right task to the right person under the right circumstance. The person that is to perform the task must be given adequate direction and specification regarding the amount of supervision that will be provided. The right communication of expectations and the right feedback on performance must also be supplied.
A nurse on a medical surgical unit is caring for a group of clients. For which of the following situations should the nurse complete a variance report?
The discovery that a preoperative client has received and eaten breakfast *This situation represents a variation from the standard of care. A change in the client's plan of care is necessary for this client because the surgical procedure will need to be delayed. The nurse should complete a variance report for this situation.
A nurse manager is participating in a root cause analysis following a sentinel event on her unit
The root cause analysis investigates deviations from standards of care surrounding the event *A root cause analysis is a function of quality improvement, the purpose of which is to determine what factors led to a deviation from established standards of care resulting in errors in client care.
A nurse is delegating a client care task to an assistive personnel. Which of the following directions should the nurse give the AP?
This client needs to ambulate using a walker three times today *These directions include the type of task to be done, the frequency with which the task is to be performed, the duration of the task, and information about the mechanics of ambulating the client.
A nurse is ambulating a client who has an IV with an infusion pump
Turn the pump off *The pump must be turned off immediately to protect the client and the nurse from the risk of electrical injury and fire. The nurse should consider any electrical equipment that shows a sign of malfunction unsafe and place it out of service until the equipment can be checked by the facility's maintenance department.
A nurse is providing discharge teaching about home safety with an older adult client and his family. which of the following statements should the nurse include in the teaching?
You should install a handrail on at least one side of the stairs *In order to decrease potential risk of falls
A charge nurse receives a call from his nursing supervisor about an explosion at a local factory and an urgent need for facility beds
a 44 year old client who has asthma and admitted for carpal tunnel surgery *A client who is admitted for carpal tunnel surgery is a stable client having an elective procedure. Therefore, the nurse should recommend this client for discharge.
A nurse is discussing with a newly licensed nurse about how to obtain informed consent from a client who is to undergo an epidural procedure. Which of the following principles should the nurse include in the teaching?
autonomy *Informed consent is based on the ethical principle of autonomy, which is the right to self-determination, independence, and freedom of choice.
A nurse is caring for four clients who are scheduled for diagnostic tests. Which of the following tests should the nurse obtain written consent from the client?
cerebral arteriogram *A cerebral arteriogram is considered invasive because it involves injecting contrast material into an artery to study the cerebral circulation. Written consent is required.
