test 2 leadership
The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse: a. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines. b. is at risk for HIPAA violations. c. has properly followed policy and protected the patient by not using her name. d. is demonstrating the logical fallacy of slippery slope.
b.HIPPA violation ANS: B The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before.
During shift report, the nurse prepares a list of activities. At this time it is most important that the nurse identify the:
Most seriously ill patient
defines legal scope of practice within a state or territory for nurses
Nurse Practice Act
The nurse moving right into client care, beginning with the room closest to the nurses station is an example of which pitfall?
Failure to differentiate between priority and non priority tasks
The ultimate decision regarding appropriateness of delegation is determined by:
The RN
In preparation for delegation, before making assignments the charge nurse should:
Assess the delegates competency and determine what supervisor the delegate will require
When establishing priorities, which of the following actions normally takes precedence:
Assessment
A licensed practical nurse (LPN) is planning the clients assignments for the day. Which of the following is an appropriate assignment for the nursing assistant? 1. A client requiring a colostomy irrigation 2. A client receiving continuous tube feedings 3. A client who requires 24 hour urine specimen collections 4. A client with difficulty swallowing food and fluids
3. A client who requires 24 hour urine specimen collections
Which of the following descriptions best defines delegations?
An essential decision making skill necessary for effective use of personnel
The licensed practical nurse (LPN) employed in a long term care facility is planning assignments for the client on a nursing unit. The LPN needs to assign four clients and has another LPN and three nursing assistants on a nursing team. Which of the following clients should the nurse assign the LPN? 1. A client who requires a bed bath 2. An older client requiring frequent ambulation 3. A client who requires hourly vital sign measurements 4. A client requiring abdominal wound irrigations and dressing changes every 3 hours
4. A client requiring abdominal wound irrigations and dressing changes every 3 hours -bed bath, assisting with ambulation, and vital signs can all be performed by UAPs NCLEX ch 7
A nurse instructor asks a nursing student to identify situations that indicate a Secondary level of prevention in health care. Which statement, if made by the student, would indicate a need for further study of the level of prevention? A) Teaching a stroke client how to use a walker B) Encouraging a client to take antihypertensive medications as prescribed C) Screening for hypertension in a community D) Encouraging a woman over age 40 to obtain periodic mammograms
A -Teaching a stroke client how to use a walker Explanation : Secondary prevention focuses on the early diagnosis and prompt treatment of disease. Tertiary prevention is represented by rehabilitation services. Options 3 and 4 identify screening procedures, and option 2 identifies a treatment of a disease. Option 1 identifies a rehabilitative service.
Which of the following patients should be given priority for care?
A 40 year old newly admitted with severe headache, vomiting, and stiff neck
An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect
A. Appeal to emotion is an attempt to manipulate other peoples emotions for the purpose of avoiding the real issue
A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad, how can you get cancer without smoking?" Which statement by the nurse represents empathy? a."Research is identifying many risk factors for cancer besides smoking." b."I understand how you could feel angry about the diagnosis." c."He is still a good husband." d."Why do you think he got cancer?"
ANS: B The nurse is placing herself in the wife's position and sharing her emotions.
The RN cannot delegate which one of the following activities?
Actions requiring professional nurse skills and knowledge
A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, " You don't care that I threw the needle into the trash. You just want an all female staff: putting the team leader in a defensive position. This communication technique is known as: A. Straw Man B. Red Herring C. Slippery slope D. Confusing cause and effect
B. A Red Herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue.
The nurse is caring for a client admitted with a cerebral vascular accident (CVA). Based on this limited scenario, identify the priority nursing activity.
Check neurologic status
The nurse is assigned to an 86 year old client with a patient controlled analgesic (PCA) pump infusing morphine via central line for pain control. While the patient is getting into a chair, the dressing comes off and the central line catheter is pulled out. Which aspect of his care would receive highest priority?
Covering the central line site with a 3x 4 inch dressing
Which component of an email shown below would be effective? A. Subject: A short concise subject line: meeting B. Body: I would like you to answer these questions before the next meeting: where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? C. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. D. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582.
D. This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication. P.339
Which of the following should the RN NOT delegate?
Initial assessment of patients
James Conley had an ORIF (open reduction internal fixation) for a fractured femur. The RN delegates the act of assisting Mr. Conley to ambulate four times each day to an LPN Mr. Conley falls during his afternoon ambulation. Who is accountable?
LPN and RN
Which activities can be delegated to a UAP?
Routine care with predictable outcomes
Using Maslow's hierarchy of needs, the nurse would perform which activity first?
Suction the patients airway
The nurse has an overwhelming assignment today because of several staff call ins and chronic short staffing on her assigned nursing unit. Which activity may be the least helpful?
Taking a break early to collect thoughts and face the assignment
If all of the following expected outcomes were appropriate, which would have the highest priority?
Will have decreased thickness of sputum and maintain patent airways
A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee? a. Actually observe the delegatee perform the assigned task. b. Ask the delegatee how many times he/she has performed the task. c. Ask the patient if the care provided was satisfactory. d. Ask other nurses if they feel the delegatee is competent.
a. Actually observe the delegatee perform the assigned task.
The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to: a. the registered nurse (RN). b. the licensed practical/vocational nurse (LPN/LVN). c. unlicensed assistive personnel (UAP). d. all levels of staff, because the information is about the past and cannot change.
a. the registered nurse (RN).
A licensed practical nurse (LPN) has received the assignment for the day shift. After making rounds and checking all of the assigned clients, which client will the LPN plan to care for first?
A client with a fever who is diaphoretic and restless
A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? a. Assertive b. Aggressive c. Passive d. Passive-aggressive
ANS: D Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering.
Delegation of which of the following by the supervisor would constitute a violation of the Nurse Practice Act?
Responsibility to someone who does not possess the appropriate qualifications and competency for the task.
4. Which statement accurately describes communication? a.The components of communication are mutually exclusive. b.Communication is linear. c.Communication involves only the sender and the receiver; everything else is superficial. d.When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.
d.When the receiver becomes the sender, the subcomponent of communication that is in use is feedback. ANS: Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes.
A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance
d. Circumstance
Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegatee has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.
d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.
The new director of nurses has instituted "walking rounds" on all nursing units, rather than the usual taped shift reports. A veteran nurse exclaims, "She doesn't know how we do things here!" The nurse is demonstrating: a. appeal to emotion. b. appeal to tradition. c. red herring. d. straw man.
B. Appeal to traditions ANS: B An appeal to tradition is the argument that doing things a particular way is best because they've always been done that way.
The nurse is demonstrating active listening when: a. while assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." b. eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. he or she states, "I know how you feel, I recently lost my father and I am still hurting." d. cultural values are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."
B. Eye contact is maintained while focusing on the patient as the patient describes the current pain level and location.
Which behavior by the nurse is least likely to empower the client? A. asking the client to state in his own words what he has learned B.Telling the client to do something because it is for his own good c. using easily understood terminology when teaching d. providing feedback to the client
B.Telling the client to do something because it is for his
The licensed practical nurse (LPN) employed in a long-term care facility is asked to assist in planning implementation of a change in the method of documentation system in the nursing unit. Many problems have occurred as a result of the present documentation system, and the nurse manager determines that a change is required. The LPN understands that which is the initial step in the process of change? 1.Plan strategies to implement the change. 2.Set goals and priorities regarding the change process. 3.Identify the inefficiency that needs improvement or correction. 4.Identify potential solutions and strategies for the change process.
4.Identify the inefficiency that needs improvement or correction Rationale: When beginning the change process, the nurse should identify and define the problem or the inefficiency that needs improvement or correction. This important first step can prevent many future problems because if the problem is not correctly identified, a plan for change may be aimed at the wrong problem. This is followed by goal setting, identifying potential solutions and strategies, and setting goals and priorities. The nurse then plans strategies to implement the change. Client Needs: Safe and Effective Care Environment Cognitive Ability: Applying Content Area: Managing Client Care: Prioritizing Integrated Process: Nursing Process/Planning Priority Concepts: Health Policy, Leadership Strategy(ies): Data in the Question, Steps of the Nursing Process, Strategic Words
A nurse is overhead saying "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly I don't trust any politician anyway. I plan to take a few weeks off next month". She works independently to research strategies to improve patient centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends "lets think the suggestions over and come back together next week". This nurse communication style is consistent with what generation? a. baby boomer b. traditionalist c. generation x d. milleniums
ANS: C Generation X individuals grew up in when there was a high rate of divorces; they tend to be more cynical and value work-life balance and teamwork. Holidays are often associated with family gatherings which may have been absent in this generation's family; belief that ALL politicians are untrustworthy may be viewed as cynical. The need to take time to form suggestions to save time and come together to reach team decision are reflective of this generation.
A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "What exercise practices do you participate in?"
d. "What exercise practices do you participate in?" ANS: D "What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances.
A licensed practical nurse (LPN) has been assigned to assist a community nurse, who is the leader of a task force, to identify interventions for teenagers from a local community who are abusing drugs. At the first meeting of the task force, the group members express concern that more information is needed to determine appropriate measures for the target teenagers. The LPN makes which suggestion to the community nurse to direct the group most effectively? 1.Initiate a drug abuse program in all of the schools. 2.Prepare posters that can be distributed to the schools. 3.Seek out the teenage drug abusers and refer them to drug abuse centers. 4.Prepare a survey that can be distributed to community members to determine their understanding of the drug abuse problem.
Prepare a survey that can be distributed to community members to determine their understanding of the drug abuse problem 4.Prepare a survey that can be distributed to community members to determine their understanding of the drug abuse problem. Rationale:Option 4 is the only option that addresses the subject of the question and will identify the additional information required by the task force. Options 1, 2, and 3 do not provide the additional information required in order for the task force to proceed with the necessary task of the group. Test-Taking Strategy(ies):Note the strategic words, most effectively, and use the steps of the nursing process to answer the question. In addition, focus on the subject of the question, that more information is needed. Options 1, 2, and 3 relate to implementation measures. The subject of the question is the need for further data. Option 4 is the only option that addresses the process of data collection.
During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting: a.assertive communication. b.active listening. c.empathy. d.passive communication.
b.active listening.ANS: B In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.
During height and weight assessments at a school's health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, "Drinking coffee stunts a child's growth." This logical fallacy is referred to as: a. appeal to common practice. b. confusing cause and effect. c. ad hominem abusive. d. red herring.
b. confusing cause and effect. ANS: B Cause and effect are confused when one assumes that a particular event must cause another just because the two events often occur together.
A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through: a. empathy .b. positiveness. c. supportiveness. d. accommodation.
c. supportiveness. ANS: C Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position
An older adult is unable to reach the phone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a."You are just too late for that. Where were you when he needed you?" b."Did you ever consider purchasing a cell phone for your dad to prevent this from happening?" c."I'll close the door so you can spend time with your dad. I will check back in a few minutes." d."I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."
c."I'll close the door so you can spend time with your dad. I will check back in a few minutes." ANS: C Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person.
The nursing instructor asks a nursing student to identify the priorities of care for an assigned client. Which statement indicates that the student correctly identifies the priority client needs? 1. Actual or life-threatening concerns 2. Completing care in a reasonable time frame 3. Time constraints related to the client's needs 4. Obtaining needed supplies to care for the client
1. Actual or life-threatening concerns Rationale:Setting priorities means deciding which client needs or problems require immediate action and which can be delayed until a later time because they are not urgent. Client problems that involve actual or life-threatening concerns are always considered first. Although completing care in a reasonable time frame, time constraints, and obtaining needed supplies are components of time management, these items are not the priority in planning care for the client, based on the options provided.
During a staff meeting, a nurse who is mentoring new BSN graduate states, "We are lucky to have a new nurse join our staff who is a BSN graduate from our local university." Another staff nurse is heard saying, "BSN. BSN is you don't have a BSN you aren't valued. You don't see anyone welcoming any nurses with associate degrees—we are not valued." The conversation places the mentor in a negative position when her intention was simply to welcome the new employee. The staff nurse's negative response represents which logical fallacy? a. Straw man b. Appeal to tradition c. Confusing Cause and Effect d. Appeal to Common Practice
a. Straw man Correct: Straw man occurs when a person's position on a topic is misrepresented. Incorrect:b. Appeal to tradition is the argument that doing things a certain way is best because they have always been done that way.c. Confusing cause and effect occurs when one assumes that one event must cause another such as walking under a ladder is bad luck after observing a painter walk under a ladder then fall and break his leg.d. Appeal to common practice is accepting an answer or situation because most people do it that way.
A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often take short cuts. b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." c. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." d. "This drug always occludes the line because it is so viscous."
b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not."ANS: B The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation.
An LVN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for: a. delegating the task to another UAP if he or she does not have the time or skill to complete the task. b. keeping the LVN informed of any abnormal blood pressure readings. c. calling the physician when the patient's vital signs are not within established parameters. d. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive.
b. keeping the LVN informed of any abnormal blood pressure readings.
A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a.Is today Wednesday? b.Do you know what day it is? c.Tell me what day of the week today is. d.Do you know what is the first day of the week? ANS: CThe patient must be able to name the day of the week rather than use answer yes or no."Is today Wednesday?" can be answered yes or no, which is not representative of open communication.
c.Tell me what day of the week today is.
A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately place in charge of the telemetry unit. The staffing consists of two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPN and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should: Contact the state board of nursing to determine legal scope of practice for LPNs a.query the state nursing association to determine their stance on the role of LPNs b.ask the LPNs on the unit to list what tasks they routinely performed. c.contact the state board of nursing to determine legal scope of practice for LPNs. d.refer to California's nurse practice act because the scope of LPNs/LVNs is consistent across the United States.
c.contact the state board of nursing to determine legal scope of practice for LPNs.
