ATI Leadership Remediate

An assistive personnel (AP) tells a charge nurse that it is unfair that they have to take care of all the clients who are incontinent. Which of the following responses should the charge nurse make?

"I delegate task to personnel based on their job description." This response addresses the AP's concerns and provides clear info about the charge nurse's responsibility when delegating task. It is not "Let's talk about organizing the workflow so you care for fewer of these clients." This response is inappropriate because the PA does not have the knowledge, skills, and ability to assist with client assignment.

A nurse discovers that a client was administered an antihypertensive medication in error. Identify the appropriate sequence of steps that the nurse should take using the following actions.

-Check vitals signs should be the first action using the nursing process. -Instruct the client to remain in bed until further notice -Notify the provider. -Complete an incident report. -Notify the risk manager.

A nurse is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following information should the nurse manager include? (SATA)

-Incident reports include a description of the incident and actions taken. -The risk management department investigates the incident. -Document factual description of the event in the client's health record. - Do not inform the client or individual involved that an incident report has been filed. Incident reports are for facility quality assurance. -Do not place the incident report in the client's health care record in order to shield it form discovery in the event of a lawsuit.

Collaboration Process and Interprofessional Teams

-Recognize the knowledge and skills each member of the team can bring. -Use Assertive communication with the inter-professional teams. -A nurse can serve as a facilitator but this role can be assumed by any member of the team. -Encourage the client and family to participate in the team meeting. -Support team member request for referral.

A nurse on an acute care unit is caring for a client following a total hip arthroplasty. The client is confused, moving the affected leg into position that could dislocate the new hip joint, and repeatedly attempting to get out of bed. After determining that restraint application is indicated, which of the following actions should the nurse take? (SATA)

-Secure the restraint to the frame of the bed because the bed frame is a movable part. -Get a prescription for restraints from the provider ASAP, typically within 1 hr. -Have a family member sign to consent for restraints. Most agencies encourage informed consent for restraints. Instruct the family on the purposes of, alternative to, and requirements for restraints. -A quick-release knot must be used to secure the restraint. -The distance between the restraint and the client should be two finger widths.

What type or precaution should you use? -shigella -measles -toxic shock syndrome -pertussis

-shigella (contact) -measles (airborne) -toxic shock syndrome (standard) -pertussis (contact)

A nurse is participating in an ethics committee meeting about a client who has a history of alcohol use disorder and needs a liver transplant. Which of the following actions should the committee take first?

1. Collect information related to the issues. According to evidence-based practice, the committee should take the first step in ethical decision-making by identifying the ethical issue and problem. This step includes asking questions to define the issue and the complexities of the situation. 2. Consider the possible choices of action. The second step in ethical decision-making involves identifying and analyzing all of the available alternatives for action, even if the actions seem unlikely. 3. Make a decision regarding transplant recommendation. The third step in ethical decision making involves selecting one of the alternative actions to follow. The committee should apply ethical principles to make the best decision possible. 4. Justify the recommendation for or against a transplant. This is the final step in ethical decision-making. The committee should specify reasons for the action selected and be able to present the ethical basis behind the decision made.

Steps to Take When Client Falls Out of Bed

1. Determine the client's level of conscious or check for injuries... Assess. 2. Call for help. 3. Notify the provider. 4. Complete an incident report.

*A facility has identified an increase in health care-associated urinary tract infections (UTIs) on the medical-surgical unit. A nurse is participating in a quality improvement process to address this problem. Which of the following should be the first step in the process?

1. Establish best practice guidelines for reducing the incidence of UTIs. Evidence based practice indicates the nurse should first establish best practice guidelines for reducing the incidence of UTIs in order to have a standard to measure performance. 2. Develop a plan that outlines the process for data collection. 3. Implement strategies to decrease the incidence of UTIs. 4. Determine the effectiveness of planned interventions.

Stages of Conflict Resolution

1. Latent Conflict- involves awareness of potential situations that can create conflict 2. Perceived Conflict- Those who are affected discuss the situation in an impersonal manner. 3. Felt Conflict- Those who are affected become personally involved 4. Manifest Conflict- Signaled by those who are involved taking action. 5. Conflict Aftermath- Those who are involved recognize the positive and negative outcomes of how the situation was managed.

Durable power of attorney

A durable power of attorney is a legal document that designates a person to make health care decisions for the client when the client is not longer able to do so. However, it is not a requirement for a living will.

Patient Self-Determination Act

A federal law passed in 1990 that requires hospitals and other health care providers to provide written information to patients regarding their rights under state law to make medical decisions and execute advance directives. This Requires the nurse asking if the client has an advance directive.

*Patient Self Determination Act (PSDA)

A federal law that mandates that every individual has the right to make decisions regarding medical care, including the right to refuse treatment and the right-to-die. The PSDA requires a nurse to give clients information about end of life options.

*Emergency Medical Treatment and Active Labor Act (EMTALA)

A federal regulation that ensures the public's access to emergency health care regardless of ability to pay. Also known as the "anti-patient-dumping statute," forbidding turning a patient away at the door or sending him to a public hospital because of inability to pay. The EMTALA includes guidelines for care within a health care facility for all clients, regardless of financial status.

Living WIll

A living will is one component of advance directives. This legal document that expresses the client's wishes regarding health care decisions in the event the client becomes incapacitated of is unable to make decisions. The client has the right to change or revoke the living will at any time. A living will often can address treatments that have the capacity to prolong life. Examples of treatment include cardiopulmonary resuscitation, mechanical ventilation, and feeding by artificial means. A living will does not automatically result in a do-not-resuscitate (DNR) order. The provider should consult with the client and the family prior to administering a DNR order. The DNR order must be written in the client's char for each hospitalization. Living wills can be handwritten. The nurse should identify that a living will is part of advance directives. The Patient Self-Determination Act (PSDA) requires asking all clients admitted to a health care facility if they have advance directives. A client without advance directives must be given written info that outlines rights related to health care decisions and how to formulate advance directives.

Physical Therapist

A physical therapist assist clients with mobility issues by increasing strength and endurance.

*Good Samaritan Laws

A series of laws, varying in each state, designed to provide limited legal protection for citizens and some health care personnel when they are administering emergency care. However, healthcare professionals are still accountable for maintaining a reasonable standard of care.

Uniform Anatomical Gift Act

A state statute allowing persons 18 years of age and of sound mind to make a gift of any or all body parts for purposes of organ transplantation or medical research. Organ donation can be a provision in a will or done by signing a form designated by the state (e.g. on a driver's license). It must be in writing with a signature. An individual can revoke consent for organ donation by either destroying the card or revoking the gift orally in the presence of two witnesses. Nurses may serve as witnesses for individuals who wish to donate organs.

Structure

A structure audit evaluates the relationship between quality care and appropriated structure and includes inputs such as environment in which are is delivered.

Win-Lose Strategy

A win-lose strategy involves one party emerging victoriously and the other losing the struggle. If the losing party continues to pursue the situation, it becomes a competing strategy.

Social worker

Addresses financial concerns about affording care or family concerns upon discharge

Root Cause Analysis

An analytical technique used to determine the basic underlying reason that causes a variance or a defect or a risk. A root cause may underlie more than one variance or defect or risk. The nurse should use root cause analysis during the quality control process to determine why a standard is not being met.

Outcome

An outcome audit evaluates how the client's health status changed as a result of an intervention.

A nurse in a community health clinic is caring for four clients who each have a communicable disease. Which of the following conditions is considered a nationally noticeable infectious disease?

Chlamydia trachomatis Incorrect: Accordign to the CDC and prevention, RSV is not a nationally notifiable infectious disease

Collaboration

Collaboration is a conflict resolution strategy that involves finding a win-win solution.

Quality improvement team, how should the team evaluate the effectiveness of their plan?

Compare data from clients' records regarding skin integrity with established criteria. Chart audits are an efficient and accurate way to measure if a change in performance improvement indicator has occurred after an intervention is implemented.

Compromising

Compromising is a conflict resolution strategy that involves each individual agreeing to give up something they value.

A nurse on a sixth-floor medical unit is advised that a severe weather alert code has been activated. Which of the following actions should the nurse take? (SATA)

Correct: -Close the windows shades and drapes to protect clients from shattering glass. -Move the beds of non ambulatory clients away from the windows to protect clients from shattering glass. -Relocate ambulatory clients into the hallway to protect the clients from shattering glass. -Turn the radio on for severe weather report. -Instruct others that it is unsafe to use the elevators.

A nurse for a client who has chest pain. The client says, "I am going home immediately." Which of the following actions should the nurse take? (SATA)

Correct: -Document the client's intent to leave the facility against medical advice (AMA). -The nurse is legally responsible to warn the client of the risks involved in leaving the hospital against medical advice -Ask the client to sign a form relinquishing responsibility of the facility to provide legal protection for the hospital.

A nurse is preparing to teach the health care team about the concept of critical pathways. Which of the following statements about the purpose of a critical pathway should the nurse plan to include?

Correct: A critical pathway is a multidisciplinary tool that guides client care and bases outcome on an externally imposed timeline. A critical pathway outlines the actions that members of the health care team must complete in a timely manner to achieve desired client outcomes and an appropriate length of stay for the particular diagnosis. A critical pathway address appropriate nursing care and actions that other disciplines are responsible for as well. They provide a holistic approach to the plan of care. Critical pathways are not legal documents. They establish the standard of care in an institution, but variance from the pathway often occur for multiple reasons. Documentation of these variances is important, along with the revised plan to correct or address the variance. Critical pathways are developed for individual diagnoses. They are based on the typical interdisciplinary needs and length of stay for that particular diagnosis.

A charge nurse on a medical-surgical unit is assigning client care to the upcoming shift. Which of the following task should the nurse delegate to an assistive personnel (AP)? (SATA)

Correct: Measuring the intake and output of a client and providing postmortem care are within the range of function for an AP. Delegate to LPN: Performing a colostomy care, interpreting a client's lab values following surgery, and checking NG tube patentcy should be delegated to an LPN. The first two involve data collection and is within the scope of practice of an LPN

A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse advocate. Which of the following situations illustrates the advocacy role? (Select All that Apply)

Correct: Verifying that a client understands what is done during cardiac catheterization. Ensuring that the client has given informed consent illustrates nurse advocacy Informing members of the health care team that a client has DNR status. Ensuring that the client's care is consistent with their DNR status illustrates nurse advocacy. Reporting that a health member on the previous shift did not provide care as prescribe, ensures that all clients receive proper care illustrates advocacy. Incorrect: Discussing treatment options is NOT within the scope of practice of the nurse. Assisting a client to make decision about their care based on nurse recommendation is inappropriate. The nurse should support the client in making their own decisions.

A nurse overhears two other nurses discussing a conflict they are having about who should complete certain client-case tasks. The nurses agree that they are tired of the conflict and will let the nurse a manager decide who should complete the tasks. The nurse should identify this outcome as which of the following approaches to conflict management?

Correct: Win-Yield. This involves both parties not longer trying to resolve the conflict. Instead of taking the initiative to end the conflict, they agree to honor whatever the nurse manager decides.

After a disaster plan is enacted, a nurse in a pediatric unit is asked to prepare a list of clients who can be discharged home due to a local incident involving many children. Which of the following clients should the nurse place on the potential discharge list? (SATA)

Correct: -A preschooler with asthma who has scattered wheezes that resolves with PRN. The nurse should place clients who can be quickly and safely discharges on the potential discharge list. Children who have asthma can be managed at home once the acute phase of the illness has resolved. Because the preschool client's manifestations are responsive to the prescribed medication, this child can be safely discharged home with appropriate discharge teaching and follow-up care planning. -A school-age child with a femur fracture in an external fiction device whose pain is controlled with PRN oral codeine. External fixation devices are work for weeks to months; they are often managed at home once the device is placed and the client has learned how t care for the immobilized limb. Thus school-age client's pain is responsive to oral codeine. Prior to discharge, the client might need instructions on ambulation and weight-bearing, as prescribed. -An adolescent client who's is developmentally delayed, has a PICC line, and needs 6 more weeks of antibiotics. Long-term antibiotic therapy is typically completed in the home following PICC line placement. A visiting nurse can assist this adolescent client with home care management. The client's developmental delay has no bearing on whether the client is safe to discharge. Incorrect: - A toddler with a ventricular septal defect and bronchiolitis who is on 28% oxygen by oxyhood. This toddler with a chronic health problem (a congenital heart deft) is now experiencing an acute illness (severe lower respiratory illness). Because the client's increased care needs may potentially cause more complex problems, the child is not considered safe to discharge. -An adolescent client who is 1 day postoperative following scoliosis repair and is on a PCA pump. Clients are typically hospitalized for 4-6 days following scoliosis (curvature of the spine) repair (spinal fusion). The client is still on a PCA pump for pain control and is only 1 day postoperative. Commonly, spinal fusion clients must be fitted for a brace and taught how to apply it prior to discharge. This is not considered safe to discharge.

A nurse is planning safety interventions at a new clinic. Which of the following interventions should the nurse include?

Correct: -Have staff who will be performing x-rays wear dosimeters. -Use non-latex products when possible, to reduce the risk for latex allergy development or reaction. -Place sharps container at the point of care to reduce the risk for needle stick injury. -Instruct staff to remove equipment with frayed cords from the client care area, and have someone certified repair the equipment.

A nurse is reviewing the components of a surgical informed consent with a newly licensed nurse. Which of hte following statements should the nurse include?

Correct: "The nurse should ensure that the client understands the information given by the surgeon." The nurse has the responsibility to assess the client's understanding of the procedure as well as any misconceptions. It is best to ask the client to state what was explained to them using their own words. The surgeon has the responsibility to provide a THOROUGH explanation of the surgical procedure being performed. The surgeon should also include the diagnosis or condition requiring the procedure, the purpose of the procedure, and the intended benefits of the procedure. The surgeon has the responsibility to inform the client of any possible risk or negative outcomes of the surgical procedure to the client. The nurse has the responsibility to inform the surgeon if a client has further questions. The surgeon is responsible for responding to any questions the client might have.

There has been a massive community disaster and stable clients must be discharged from a facility to prepare for the influx of new casualties. A nurse should identify that which of the following clients is safe to discharge.

Correct: A client who has multiple sclerosis and reports ataxia. The client is safe to discharge because mult- sclerosis is a chronic disorder and ataxia is an expected finding. Incorrect: A client with DVT and a aPTT within expected range still requires aPTT monitoring at least daily and is at risk for developing a pulmonary embolism. The nurse should not recommend this client for discharge. A client who has right lower quad pain and positive rebound tenderness likely has appendicitis and is at risk for developing peritonitis. A client whose amylase and lipase levels are twice the expected value indicate pancreatitis, which places the client at risk for sepsis or hemorrhage. THe nurse should not recommend this client for discharge.

A community experiences an outbreak of meningitis, and hospital beds are urgently needed. Which of the following clients should the nurse recommend for discharge?

Correct: A client who was per admitted for rotator cuff surgery. This client is stable and their condition can be managed at home with surgery rescheduled. This meets the criteria of first discharging clients who are ambulatory and require minimal care. Incorrect: -A client newly admitted with angina and a history of myocardial infraction 1 yr ago. Recognize that a client who has angina is at risk for cardiac event. Do not recommend this client for discharge because the client is unstable. -A client admitted the day before with pneumonia is incorrect because their infection and dehydration requires ongoing nursing care. -A client who has a fractured hip and is scheduled for total in replacement the next day is incorrect because they are unstable are at risk for further damage to the hip. If the client were 1 day or more postoperative, discharging the client to a tertiary facility might have been possible.

A nurse manager is presenting an in-service about preventing readmission of clients due to complications following joint arthroplasty. Which of the following leadership tasks is the nurse performing?

Correct: Advocacy; the nurse acts as an advocate by promoting and protecting safety for staff and clients by providing information that allows staff to act autonomously.

A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take to verify the client gave informed consent? -Verify that the client understands the risk of the surgery. -Ask the client to explain the procedure that is being performed. -Answer the client's questions about the outcome of the surgery. -Determine if the client understands the benefits of the procedure.

Correct: Ask the client to explain the procedure. The nurse should ask the client to explain the procedure that is being performed. This allowed the nurse to verify the client's understanding of the information provided by the provider prior to Witnessing the client's signature on the consent form. It is not Verify that the client understand the risk of the surgery. It is the responsibility of the Provider to ensure that the client has all necessary information about the risks of the surgery in order to make an informed decision and provide consent.

An Rn and a LPN are caring for a client who has a small bowel obstruction and is NPO with NG tube set to continuous suction. Which of the following task should the RN perform? -Obtain daily weight. -Inspect the client's oral cavity for dryness hourly. -Measure and record the NG tube output every 4 hours. -Assess for bowel sounds every 2 hours.

Correct: Assess for bowel sounds every 2 hours. Assessment are within the scope of practice for the RN only. While the LPN can also auscultation the client's abdomen for the presence of sounds, only they RN is qualifies them as hypoactive, normal, or hyperactive. Incorrect: Obtaining a daily weight is within the scope of practice of an LPN. While the RN could also perform this task, it should be delegated to an LPN so that the Rn is available to perform other task. Oral care is considered part of outline hygiene and includes observing the membranes of the mouth for dryness. It is within the scope of practice for the LPN. While the RN could also perform this task, it should be delegated to an LPN so the RN is available to perform other tasks. Measuring and recording the NG tube output is within the scope of practice for the LPN. While the RN could also perform this task, it should be delegated to an LPN so the RN is available to perform other task.

A nurse is caring for a client who is terminally ill and receiving nutritional support. The client's adult children disagree about continuing nutritional support. The dilemma is referred to the ethics committee. Which of the following actions should the nurse expect the committee to take? -Assist in weighing the options involved in the decision. -Provide a legal representative for the family. -Recommend the best course of action for the client. -Decide how the nursing team should resolve the dilemma.

Correct: Assist in weighing the options involved in the decision. (Ethic committees are members of the interprofessional team who assist with problem solving related to ethical dilemmas. The ethics committee examines all of the facts and provides support for the clients and caregivers). -It is not deciding how the nursing team should resolve the dilemma because ethics committees do not impose a specific decision. The decision maker in this case, and many ethical dilemmas, **is the client or the family.*

A health care facility's leadership team is implementing a new computerized charting system. When preparing for the implementation date, which of the following actions should the nurse manager take first?

Correct: Collect the staff members' input about planning and implementing the change. The nurse manager should apply the nursing process priority-setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection . Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, he/she must first collect adequate data form the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse manager' input and collaborating about implementing the change smoothly and efficiently. The nurse manager should discuss the importance of the charge nurse's role in implementing the change; Educating staff members about the change will promote understanding and implementation of the new system; The manager should enlist informal leaders in promoting the change...however, these actions should not be taken first. The first thing to do is collect and assess. Incorrect:

An RN is working on the surgical unit when a client who's has abdominal pain is admitted. Which of the following activities must be performed by the RN?

Correct: Completing the client's initial admission assessment; completing the client's initial assess emend is within the RN's scope of practice. Incorrect: The nurse should assign a licensed practical nurse to administer PO medication. The nurse should assign other personnel to assemble the client's medical record.

A Charge Nurse is leading a committee that is revising the policy for client discharge. After developing the initial plan, which of the following actions should the nurse take next? -Set Target dates for completion. -Identify areas of support. -Determine goals and objectives. -Implement recommended strategies.

Correct: Determine goals and objectives -According to Evidence-base practice, the nurse attempting to make a change or revision to a policy should first develop the initial plan and then determine goals and objectives. Objectives define strategies or implementation steps to attain the identified goals

A charge nurse is leading a committee that is revising the policy for client discharge. After developing the initial plan, which of the following actions should the nurse take next?

Correct: Determine goals and objectives. According to evidence based practice, the nurse attempting to make a change or revision to a policy should first develop the initial plan and then determine goals and objectives. Objectives define strategy or implementation steps to attain the identified goals.

*A nurse manager is completing a performance improvement audit and determines documentation of client discharge teaching is below the expected benchmark. Which of the following actions should the nurse implant first.

Correct: Determine the factors that interfere with the documentation of client education (first action in the nursing process is assessment). Determining the factors that interfere with the nurses documenting client discharge teaching is necessary in order to develop and implement interventions that specifically address the causative factors.

A client is being discharged with a postoperative infection, requiring daily home IV antibiotics through a peripherally inserted central catheter (PICC) line. Which of the following actions should the case manager perform prior to discharge?

Correct: Ensure that home infusion therapy has been arranged. It is the case manager's responsibility to ensure that all necessary referrals have been made to facilitate the client's transition to home care. —>The home health nurse caring for the client has the responsibility to assess the clients home environment. The nurse who is discharging has the responsibility to verify the patentcy of the PICC line and provides dressing change and wound assessment teaching.

Two nurses on a unit each contend that the other is not doing a fair share of work. The conflict is affecting the functioning of the unit. A charge nurse should approach this conflict in which of the following ways? -Schedule the nurses to work on alternating shifts. -Organize a task force to evaluate the situation. -Tell the nurses that it is their responsibility to cooperate with coworkers. -Explore alternative solution to address unit workflow with the nurses.

Correct: Explore alternative solutions to address unit workflow with the nurses. Exploring alternative solution will allow the nurses to collaborate, which creates a higher probability that the nurses will reach a successful resolution. Wrong: Telling the nurses that it their responsibility is dismissive of the nurses' concerns. Scheduling alternating shifts avoids the issue and might not meet staffing requirements. Organizing task for is wrong because an interpersonal issue between two nurses does not require a task force. The charge nurse should address this issue.

A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within the next 2 hrs. The client tells the nurse that she has called a taxicab and is leaving the hospital. After notifying the surgeon, which of the following actions should the nurse take next?

Correct: Inform the client about the risks she may encounter by leaving the facility. The greatest risk to this client is injury form peritonitis; therefore, the first action the nurse should take is to inform the client about the risks of not receiving treatment. The nurse should have the client sign a Against Medical Advice (AMA) form to provide documentation. The nurse should document the client's statements in the medical record to provide a legal record, but this is not the first action the nurse should take. The nurse should notify the risk manager.

A nurse is caring for four clients. Which of the following tasks can the nurse assign to an AP?

Correct: Perform chest compressions on a client who is in cardiac arrest. Not within AP scope: -Change a sterile dressing on a client's leg wound. -Checking the residual of a client's gastrostomy tube. -Instruct the client on the use of blood glucose —> These require knowledge and skill of a RN.

A public health nurse is developing a list of recommendation for the supervisor about how to use evidence-based practice to improve community outcomes. Which of the following should the nurse recommend a s qualitative research method? -Meta-Analysis -Experimental Study -Phenomenology -Secondary Analysis

Correct: Phenomenology- a qualitative research method that provides additional understanding of participants experiences with emotional variances, such as grief and hope.

A home health nurse is planning her daily visits and reveives laboratory results for four adult clients. The nurse should first visit the client who has which of the following lab values? -Digoxin 1.0 ng.mL. -WBC 6,000/mm^3 -Platelets 100,000/mm^3 -Serum potassium 4.0 mEq/L

Correct: Platelets 100,000/mm^3 (A client who has a platelet count of 100,000/mm^3 is unstable because value is below (150,000- 400,000/mm^3). Risk for bleeding). -Digoxin (0.8 to 2 ng/mL). -WBC (5,000 to 10,000/mm^3). -Serum Potassium (3.5 to 5 mEq/L)

While participating in a continuous quality-improvement program, a nurse is reviewing medical records to determine the time of first postoperative ambulation of clients who had abdominal surgery. In which type of quality audit is the nurse participating? -Outcome -Structure -Strategic planing -Process

Correct: Process A process audit measures the interventions used to facilitate expected and desired outcomes for clients. Early ambulation is essential for the prevention of postoperative complications.

A nurse is tracking the outcomes of clients on the unit who have received postoperative pain management. This activity demonstrates which of the following competencies of the Quality and Safety Education for Nurses (QSEN) initiative? -Safety -Informatics -Patient-Centered Care -Quality Improvement

Correct: Quality Improvement. This QSEN competency involves using data to track outcomes with the goal of devising processes to improve clients' outcomes. Incorrect: -Safety: This QSEN competency involves using national safety guidelines and goals to provide safe client care. -Informatics: This QSEN competency involves navigating clients' electronic health records and using technology effectively to manage client care. -Patient-Centered Care: This QSEN competency involves determining clients' needs preferences, and values and providing care that addresses these parameters.

A nurse is caring for a client who's is dying and unable to make decisions for himself. The client's adult children disagree about 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 oldest child. -The attending provider. -The client's health care proxy. -The facility's ethics committee.

Correct: The client's health care proxy. If 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. IF the client does not have advance directives or has not named a health care proxy, the family may be asked to make end-of-life decisions. The attending provider may offer suggestions on end-of-life care, but the client or the client's health care proxy directs treatment. In the absence of advance directives, the facility's ethics committee may be called upon to intervene if a conflict occurs regarding end-of-life decisions.

A nurse manager is developing a class for newly licensed nurse on strategies to promote client rights. Which of the following should the nurse manager include?

Correct: Verify that a provider prescription is in the medical record for clients who have restraints. A nurse should verify that there is a provider prescription for a client who has restraints to prevent false imprisonments. Incorrect: A nurse should meet the needs of each client using priority of need, rather than using a time-based schedule. A nurse should educated clients on the purpose of treatment but should not prevent a competent client form leaving the facility. A nurse should verify that clients have given informed consent, but it is up to the provider the info the client needs to make an informed decision.

Media Liason

Expect media liason to communicate with members of the media and press on behalf of the facility.

Incident commander

Expect the incident commander to manage the incident and key leaders within the facility.

Experimental Study

Experimental study is a quantitative research method that uses control and treatment groups to test at lease one independent variable.

Indicators that a nurse may be impaired while working.

Frequent use of restroom. Frequent errors. Mood Swings. Inability to focus. Excessive wasting of controlled substances. Isolating oneself from others. Displayed increase increase in controlled substances or offering to administer pain meds for other clients. Making poor judgement.

Good Samaritan Laws

Good Samaritan Laws apply to health care workers and sometimes non-medical professionals who attempt to aid a person in an emergency outside of a medical setting. These laws protect the healthcare worker from liability as long as the scope of practice is not exceeded.

Steps in the problem solving process

Identify the problem - stayed it in objective terms, minimizing emotional overlay. Discuss possible solutions - brainstorming solutions as a group may stimulate new solutions to the old problems. Encourage individuals to think outside the box. Analyze identified solutions - the potential pros and cons of each possible solution should be discussed and attempt to narrow down the number of viable solutions. Select a solution - based on this analysis, select a solution for implementation. Implement the selected solution - a procedure and timeline for implementation checkoff me the implementation of the selected solution. Evaluate the solutions ability to resolve the original problem. The outcome surrounding the new solution should be evaluated according to the predetermined time line. The solution should be given adequate time to become established as a new routine before is evaluated. If the solution is deemed unsuccessful, the problem-solving process will need to be reinstituted and the problem discussed again.

Aquathermia Pad

Instruct client to report if aquathermia pad gets too warm because it can cause injury. Check the leg 15-20 min after applying the pad to ensure no evidence of complications. The client should NOT adjust the temperature because it can result in pain and impaired circulation. Ensure the call light is within reach of the client. The nurse should monitor the client's skin for increased redness and should discontinue the pad if it is noted, the nurse should report this finding to the provider.

Lose-Lose Strategy

Lose-Lose strategy is also an avoidance approach. The two parties abandon the struggle and take no further action, but hte conflict remains. In this outcome, no one wins.

Occupational Therapist

Occupational therapist- Assist clients with activities of daily living such as dressing, bathing, and using utensils when eating.

A charge nurse is preparing to observe a newly licensed nurse perform a routine abdominal assessment. Which of the following actions should the charge nurse expect the newly license nurse to take?

Place the client in a dorsal recumbent position for the examination and ensure the client relaxes her abdominal muscles. Use the bell of the stethoscope to auscultation for vascular bruits. Begin the assessment by inspecting the client's abdomen for changes in color, contour, and symmetry. Have the client empty the bladder before beginning the procedure for optimal examination of the abdomen.

*A nurse is assessing a client who is postoperative and has a PCA. The client exhibits restlessness, an elevated pulse, and decreased blood pressure. Which of the following actions should the nurse take?

Place the client in a modified Trendelenburg position. The client's restlessness and change in vital signs indicates a change in the client's status, possible caused by hemorrhage or hypovolemic shock. Placing the client in a modified Trendelenburg position increases venous circulation.

National League for Nursing (NLN)

Professional organization whose members represent multiple disciplines. The National League for Nursing conducts many types of programs, including accrediting nursing education programs. The NLN is a national organization for faculty nurses and leaders in nurse education. It offered faculty development, networking opportunities, testing services, nursing research grants, and public policy initiatives.

Other HIPAA

Providers use a standardized transfer process when transferring electronic info amount health care organizations. A Standard format is used for standardized numbers, which identify the client's health plans, providers, and employers (eg. an employer's tax ID number).

Punitive Damages

Punitive damages are a form of financial compensation awarded to a client who has been injured. The compensation goes beyond the costs of the loss and is intended as a punishment to the party who caused the damage.

Secondary Analysis

Quantitative research method that uses previously collected data to answer newly formed hypotheses.

Meta-analysis

Quantitive research method that provides a statistical analysis of multiple studies conducted on the same topic

A nurse ask a newly hired AP to remove a client's indwelling urinary catheter. Which of the following actions should the nurse take to ensure that the AP is qualifies to perform this task?

Review the AP's skill competency checklist. A review should validate that they have demonstrated the ability to safely perform the procedure.

A nurse is caring for a client who is experiencing adverse effects after receiving a new medication. Which of the following communication tools should the nurse use for management of this complication?

SBAR framework- The nurse should use SBAR to identify the situation, background, assessment, and recommendation for a specific circumstance. The nurse can focus on the client's immediate circumstances to promote clinical decision making.

What should a nurse manager do after sending a nurse home who was chemically impaired. Which icf the following actions should the nurse manager take?

Set a formal meeting with the nurse w/in 24 hrs. Once the nurse manager has removed the nurse fr the work environment and arranged for safe transportation home, the nurse manager should arrange to meet with the nurse within the next 24 hrs. The nurse manager should confront the nurse who was chemically impaired and clearly identify the facility's expectations. The nurse manager is NOT responsible for taking on the role of counselor or treatment provider for a nurse who is impaired. The nurse should not discuss the situation to co-workers. Impaired employees are Not reported to risk management, the nurse manager should outline the rehabilitation measures for the nurse who is chemically impaired.

*Smoothing

Smoothing is a conflict resolution strategy that focuses on areas of agreement instead of differences.

Spiritual Support

Spiritual Support services assist clients with meeting religious needs.

Professional negligence

Standards of care establish safe nursing practices. Professional negligence occurs when a nurse is acting in a manner that a reasonable and prudent nurse would not, resulting in unsafe care. Professional negligence constitutes malpractice.

A nurse is serving on a committee that is considering the creation of a policy that will allow nurses to insert peripherally inserted central catheters in the intensive care unit. Which of the following resources should the nurse consult in planning for this policy?

State Nurse Practice Act (NPA)

Strategic Planning

Strategic planning is done as a part of the planning process. It typically examines the purpose, mission, philosophy, and goals of an organization.

American Academy of Nursing (AAN)

The AAN is a professional organization that generated, synthesizes, and disseminates nursing knowledge to contribute to health policy and practice for the benefit of the public and the nursing profession in general.

Agency for Healthcare Research and Quality (AHRQ)

The AHRQ is part of the United States Department of Health and Human Services, which supports research and is designed to improve the outcome and quality of health care.

American Nurses Association Code of Ethics

The American Nurses Association Code of Ethics provides nurses with a set of standards for nursing practice.

The Patient Care Partnership (Patients Bill of Rights)

The Patient Care Partnership outlines the rights of individuals in health care setting. It is a document that addresses clients' rights when receiving care.

HIPAA

The Privacy Rule of HIPAA ensures client privacy and confidentiality.

Case Manager

The case manager coordinates and plan client care, collaborate with other heath care professionals, and monitor costs and quality care. A case manager will coordinate the care of a client as an inpatient and assist with discharge planning. Case managers do not complete direct client care. The case manager is involved in client care throughout the client's stay in the facility , serving as a facilitator and care coordinator. The case manager does not wait until the time of discharge to meet with the client. The case manager is responsible for facilitating the use of cost effective care measure during hospitalization but is not responsible for completing insurance claim forms.

Conflict Resolution—"I didn't mean to make you feel overwhelmed. Why don't you look over the assignments with me and suggest changes?"

The charge nurse is using collaboration by putting aside individual desires and focusing on shared decision making.

Conflict Resolution—"Would you accept the assignment if we reassigned your client who has total care needs and assign another client who can provide more self care?"

The charge nurse is using compromise by giving up a demand while asking the staff nurse also to give up a demand.

*Conflict Resolution— "You always complete your work on time and do a great job. I believe you can handle the assignment well."

The charge nurse is using smoothing as a conflict resolution strategy by complimenting or focusing on shared ideas to reduce the emotional component if the conflict.

Nursing process to address increase cases of UTI

The first action the nurse manager should take when using the nursing process is to assess. The nurse should conduct a chart audit to gain important info about the factors responsible for the increased incidences of infection.

Incident reporting

The identification and reporting of occurrences that could have led, or did lead, to an undesirable outcome. The nurse should complete an incident report as part of error reporting and quality improvement, and does not relate to the management of client care.

Triage officer

The individual in charge of the incident command triage sector who directs the sorting of patients into triage categories in a mass-casualty incident., they prioritize the treatment of incoming clients.

Setting Standards for Performance of a procedure

The institutional policy and procedure manual will provide instructions on how to perform the procedure that is consistent with established standards. This is the resource that should be used.

State Nurse Practice Act (NPA)

The nurse should consult the NPA in this situation Because the NPA defines the scope and boundaries of professional nursing practice. The NPA provides guidelines for developing standardized procedures within specific facilities where expanded nursing functions have been approved in collaboration with nurses, providers, and administration.

Social Worker

The nurse should identify that a social worker assist clients with issuers such as finances, day to days concerns, and suitable housing options.

What should the nurse include in a verbal report prior to transfer to the medical-surgical unit?

The nurse should include objective data regarding the client's current consciousness status in the verbal report (client's level of consciousness). The nurse should not include routine care procedure in the verbal report (like clients dressing change schedule). The nurse should only include VS from the current shift in the verbal report. The nurse should only include essential background information, not thins like client's occupation.

Notifying the quality improvement team

The nurse should report any unusual occurrences or trends, such as ventilator-associated pneumonia (VAP) within the unity, to the quality improvement team. This team will analyze and evaluate the data to implement needed changes.

State Nurse Practice Act

The nurse state practice act identifies scope of practice and other aspects of the law, but it does not set standards for performance of a procedure.

Patient Self-Determination Act

The patient Self-Determination Act is a federal legislation that requires that all clients admitted to a health care facility be asked whether they have advance directives.

Privacy Rule of HIPAA

The privacy rule gives the client the right to access personal health information and medical records.

Mechanical Restraints

The provider should evaluate the client within 1 hr of initiation of mechanical restraints. A nurse should NOT restrain a client who is manic and packing, as this behavior is an expected finding and assists the client in managing excess motor energy. A nurses should assess and document every 15 MINUTES for range of motion, circulation, and psychological status when a client is in mechanical restraints. A nurse should CONSTANTLY observe a client who is in mechanical restraints.

Advanced directives

The purpose of this is to outline the client's wishes if they become unresponsive. Advance directive s can be changed anytime. There is NO need for the client's partner to be present if the client becomes unresponsive. The nurse should place a copy of the client's advanced directives in the medical record so the client's wishes are clear. The client's provider does NOT make the client's health care decisions if they become unable. The provider will follow the client's wishes as outlined in the advance directives.

Quality Improvement Process

The quality improvement process begins with identification of standards and outcome indicators based on evidence. -Outcome (clinical) indicators reflect desired client outcomes related to the standard under review. -Structure indicators reflect the setting in which care is provide and the available human and material resources. -Process indicators reflect how client care is provided and are established by policies and procedures (clinical practice guidelines). -Benchmarks are goals that are set to determine at what level the outcome indicators should be met. While process indicators provide important info about how a procedure is being carried out, an outcome indicator measure whether that procedure is effective in meeting the desired benchmark. Eg. The use of incentive spirometers in postoperative clients can be determined to be 92% (process indicator). If the benchmark is set at 5%, the benchmark for that outcome indicator is not being met and the structure and process variables need rot be analyzed to identify potential areas for improvement.

Security Rule of HIPAA

The security rule provides a uniform level of protection of clients' records, which includes maintaining the confidentiality, intergrity, and availability of the client's records.

Win-Win Strategy

This conflict resolution strategy assumes that a reasonable solution can be reached that will satisfy the needs of all parties and is a collaborative approach. There is no power struggle, and both parties work together for a positive outcome that meets a common goal.

*Patient Protection and Affordable Care Act

This is the health care reform law. Focuses on reform of the private health insurance market; providing better coverage for those with pre-existing conditions; improving prescription drug coverage in Medicare; protect the patient form annual and lifetime coverage limits; allows parents to insure their dependents until the age of 26; protects clients form cancellation of their insurance due to illness.

Conflict Resolution— "Tell me what changes we need to make so that you'll feel comfortable with the assignment."

This is using cooperation by giving up her own desires for the desires of the staff nurse.

Intentional Torts

Torts are wrongdoings committed against a person. An intentional tort is an act that violates the right of another, such as assault, battery, false imprisonment, and invasion of privacy.

*A charge nurse is evaluating a plan of care that a newly license nurse developed for a client who's is to relieve a continuous NG tube feeding. Which of the following interventions should the charge nurse ensure is part of the plan of care?

Use a 60 mL-syringe to flush out a clogged tube. The nurse should gently put pressure tp a 60 ml piston syringe to flush a clogged tube. A smaller syringe will provide a higher amount of pressure, which can damage the NG tube. Flush the tube every 4 hr using 30-50 mL tap water. Use tap water to unclog a blocked tube. For medication administration, the nurse should first dissolve a medication in 30 mL of sterile water. Then, the nurse should stop the enteral feeding, flush the tube with 15-30 mL of sterile water, administer the med, and flush the tube again.

Medical command physician

as defined in a hospital's emergency response plan, the person responsible for determining the number, acuity, and medical resource needs of victims arriving from the incident scene and or organizing the emergency health care team response to injured or ill patients. Expect the medical command physician to oversee use of resources (equipment and personnel).

case manager

coordinate resources to achieve health care outcomes based on quality, access, and cost. Includes resources for home care. The

State Nurse Practice Act

defines the scope and limitations of professional nursing practice. States nurse practice acts are administrative laws that provide formal guidelines for nursing practice.

A facility has identified an increase in health care-associated urinary tract infections (UTIs) on the medical-surgical unit. A nurse is participating in a quality improvement process to address this problem. Which of the following should be the first step in the process?

establish best practice guidelines for reducing the incidence of UTIs. Evidence based practice indicates the nurse should first establish best practice guidelines for reducing the incidence of UTIs in order to have a standard to measure performance.

Critical Pathway

prestandardized plan of care that indicates patient and family outcomes that should occur within a specified time frame. The nurse should use a critical pathway as a cost-effective strategy to guide for clients who have a specific medical diagnosis or are undergoing a specific procedure. Nurses use critical pathways to implement evidence-based strategies and promote cost effective care for clients who have specific, common diagnosis. Nurses who use this pathway usually spend more time on administrative duties, which often increases the amount of paperwork and review times required by a case manager. Critical pathway do NOT include specific provider preferences. The pathway shows an estimate of the number of days the client will be hospitalized. Critical pathways are specific to a client diagnosis and show the average length of stay a client with the diagnosis type will have; this pathway often reduces the cost of care by streamlining care services. Deviance from the pathway require documentation of explanation, because it usually indicated the client is not progressing at the expected rate. Critical pathways include a projection of treatments the client will receive.

Five Rights of Delegation

right task right circumstance right person right direction/communication right supervision/evaluation Ie "Tell me what time the client in room 205 voids for the first time after the catheter is removed." The nurse is using the five rights of delegation by providing specific information about the task, expectation, timeframe, and when to report the information back to the nurse.