Exam 1

A client with stage IV Parkinson's disease is admitted to the emergency department with heart failure. The client's advance directive dictates no cardiopulmonary resuscitation, intubation, or artificial feedings. The client is receiving diuretics to treat heart failure. The licensed practical nurse states, "This client shouldn't have come to the hospital because they have an advance directive." Which response by the registered nurse is best?

"Just because the client has an advance directive doesn't mean that we shouldn't treat reversible conditions such as heart failure."

A new nurse in the emergency department is caring for a pregnant woman who was beaten by her partner. Which statement by the new nurse would require intervention from the supervising nurse?

"That woman must be doing something to get beaten like that."

A nurse working in a blood conservation program is being mentored by a supervising nurse. A client asks for information about iron supplements and epoetin alfa as alternatives to a blood transfusion. Which response by the nurse causes the supervising nurse to plan a review of professional and ethical standards?

"You should take the unit of blood. It will help you feel better."

Conflict has emerged on a nursing unit because new graduates have found that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict?

Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible.

A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code?

Autocratic leadership

The nurse working with the hospital's infection control team is attempting to decrease the transmission of healthcare-associated pathogens. Which intervention will be most effective?

Incentivizing health care workers to utilize hand hygiene

A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have?

Provide early, thorough discharge planning.

A nurse is present when a health care provider tells a couple that the results of their genetic testing came back normal. Later, the nurse notes that the completed genetic report identifies the couple positive for a genetic disorder. What is the most appropriate action by the nurse?

Report it to the nursing supervisor.

The registered nurse is working with an unlicensed assistive personnel. Which client should the nurse not delegate to the unlicensed assistive personnel?

The client with continuous pulse oximetry who requires pharyngeal suctioning.

The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate?

The nurse practice act or facility's policy and procedures

The charge nurse on the adolescent unit must decide which nurse should admit a new client. Based on the present client care assignments, who is the best candidate to admit the client?

a nurse who was reassigned from another ward at the beginning of the shift

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

facilitating return to school by working with the school nurse

The new graduate nurse is preparing to administer medication to a 4-year-old client. When would it be appropriate for the supervising nurse to intervene? The new graduate:

had two whole tablets to administer to the child.

A nurse is successful in promoting change on the nursing division. This nurse would be considered a:

leader.

An alert and oriented older adult female with metastatic lung cancer is admitted to the medical-surgical unit for treatment of heart failure. She was given 80 mg of furosemide in the emergency department. The nurse is instructing the unlicensed assistive personnel (UAP) to implement a nursing plan to manage potential incontinence. Which instruction will be most effective for this client?

placing a commode at the bedside and instructing the client in its use

The nursing supervisor is evaluating how many clients each of the department nurses has been assigned for the shift. This type of evaluation would be considered:

structure.

The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse?

unhooking a weight while providing pin care

The registered nurse (RN) and licensed practical nurse (LPN) are caring for a adolescent clients. The RN will intervene if the LPN is seen in which situation while caring for a client?

using medical terminology to answer the client's questions

Which nurse leader most clearly exemplifies transformational leadership?

A leader who is dynamic and inspiring and promotes change by the power of the leader's convictions

Two nurse managers working on different units in a hospital are planning for a major change to occur on both units. One nurse manager reports to the other having identified a key power player on the unit. Which description most applies to a key power player in this context?

A regular employee who is a natural leader

Which task may be safely delegated to a licensed practical nurse (LPN)?

changing the dressing of a client who underwent surgery 2 days ago

A nurse-manager appropriately behaves as an autocrat in which situation?

directing staff activities if a client experiences a cardiac arrest

A nurse is performing a sterile dressing change on a client's abdominal incision. While establishing the sterile field, the nurse drops the forceps on the floor. The nurse is unable to continue with the dressing change because there are no extra supplies in the room, and no one is present to bring new forceps. The nurse failed to organize:

equipment and personnel.

Which attributes should be characteristic of a nurse mentor? Select all that apply.

-Is supportive -Is resourceful -Demonstrates leadership abilities -Is an experienced, licensed professional

A nurse is caring for a client with pneumonia. Which task is most appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)?

Obtaining vital signs every 4 hours

The nursing instructor is observing a student nurse care for a child who suffered a skull fracture with cerebrospinal fluid (CSF) leaking from the child's nose. What action by the student nurse would indicate a need for intervention by the nursing instructor?

assisting the child to place tissue in the nose to halt the drainage

The nurse manager is holding a meeting with the nursing team to discuss management's decision to reduce staffing on the nursing unit. During the discussion, one of the staff nurses stands up and yells at the nurse manager, using profanity, and threatening "to take this decision further." To defuse this situation, which would be the best step for the nurse manager to take?

Call a break in the meeting and talk to the nurse in a private place.

The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which conflict resolution style does the nurse manager display?

Collaborating

The nurse is assigned a client who had an uneventful colon resection 2 days ago and requires a dressing change. To which nursing team member should the nurse avoid delegating the dressing change?

Nursing assistant

The nurse is coordinating care for a client with continuous pulse oximetry who requires pharyngeal suctioning. To which staff member should the nurse avoid delegating the task of suctioning?

Nursing assistant who is a nursing student

The nurse manager is holding a staff meeting and indicates that the unit is looking at a 3% budget cut for the coming year. The nurse manager asks the staff what they see as priorities for the unit, and solicits suggestions from the staff as to what budget areas might be reduced. Which standard for establishing and sustaining healthy work environments does this action represent?

Effective decision making

A nursing facility has recently implemented new policies regarding nurse-to-patient ratios. The nursing staff seems very resistant to the change. How can the nurse manager help the staff accept the change?

Hold a unit meeting to discuss how the changes will benefit staff.

Which action should the nurse take to ensure that an unlicensed assistive personnel (UAP) understands the instructions to perform a delegated task?

Instruct the UAP to repeat the instructions to be sure the nurse has communicated clearly.

When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what?

Instructing the staff to enforce all unit rules consistently

A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style?

Laissez-faire

A registered nurse serves as the chair of the Nursing Practice Committee for the hospital. The meetings of this committee do not have a planned agenda; members of the committee who are interested in a particular topic feel free to suggest it and then to lead the subsequent discussion. This chair's leadership style could be most accurately termed what?

Laissez-faire

The charge nurse on the orthopedic unit believes in giving the staff as much power as possible. The nurses are allowed, among other things, to create their own work schedules, provide dates and times for unit meetings, and create the agendas, to which the charge nurse contributes. The charge nurse's style of leadership can be described as which?

Laissez-faire

The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying?

Laissez-faire

When a person works to prevent relapse and to sustain the gains made from actions taken, he or she is in which stage of the Transtheoretical Model of Change?

Maintenance

A primary unit nurse tells the nurse-manager that a registered nurse hired 6 weeks ago needs an additional week of orientation to function effectively on the staff. Which action is most appropriate for the nurse-manager to take?

Meet with the new nurse and the primary nurse and help set up an additional week of orientation.

A registered nurse is caring for a group of clients on a psychiatric unit. Which task can the nurse delegate to the licensed practical/vocational nurse?

Redressing lacerations on the wrists of a client who attempted suicide.

Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status?

Staff nurses are developing innovative solutions to problems.

A student is choosing an educational path and desires a nursing degree with a track for community nursing and leadership and that allows for classes in liberal arts. The student would best be suited in which type of program?

baccalaureate program

Two new nurses are requesting the same preceptor for unit orientation and say they will be unhappy if they do not receive their choice of preceptor. Which illustrates the nurses using an accommodating approach to conflict resolution?

The nurses agree for one nurse to obtain the preceptor for orientation in exchange for that nurse working each weekend.

A nurse-manager in the office of a group of surgeons has received complaints from discharged clients about inadequate instructions for performing home care. Knowing the importance of good, timely client education, the nurse-manager should take which steps?

Work with the surgeons' staff and the nursing staff in the hospital and outpatient surgical center to evaluate current client education practices and make revisions as needed.

After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to:

assess whether the desired results have occurred.

The nurse is caring for a client with inflammatory bowel disease. Which action is appropriate for the nurse to delegate to the nursing assistant?

assistance with ambulation

The nurse has provided an in-service presentation to ancillary staff about standard precautions on the birthing unit. The nurse determines that one of the staff members needs further instructions when the nurse observes which action?

wearing of sterile gloves to bathe a neonate at 2 hours of age

A nurse is caring for a client with a fresh postoperative wound following a femoral-popliteal revascularization procedure. The nurse fails to routinely assess the pedal pulses on the affected leg, and missed the warning sign that the blood vessel was becoming occluded. The nurse manager is made aware of the complication and the nurse's failure to assess the client properly. What action should be taken by the nurse manager?

Address the nurse's omissions as negligent behavior.

The nurse manager notices a trend in nurses routinely arriving to work late. How can the nurse use the transactional leadership style to get nurses to arrive to work on time?

Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation.

Following notification of two client falls on the unit, a nurse manager decides a formal investigation is necessary and informs the staff. Which statement indicates the primary reason the nurse manager would perform an investigation to determine the causes of the falls?

"I would like to establish the causes and trends related to client falls."

A registered nurse (RN) is working on a medical-surgical unit with an experienced licensed practical/vocational nurse (LPN/LVN). Which task(s) is appropriate for the LPN/LVN to perform if delegated by the RN? Select all that apply.

-Administer oral aspirin and lisinopril to the client with hypertension -Insert a nasogastric tube in a client with absent bowel sounds -Reinforce a postsurgical abdominal dressing

A registered nurse is delegating activities to unlicensed assistive personnel (UAP) on a hospital unit. Which activities could this nurse normally delegate? Select all that apply.

-Giving a bed bath to a client -Taking routine vital signs -Transferring a client to another floor

The nurse has recently been promoted to nurse manager on a pediatric unit and has decided to accept input from staff regarding changes they would like to see on the unit. Which type of leadership style is the nurse embodying?

Democratic

Nurses who work in a pediatric psychiatric-mental health facility should do what?

Develop self-awareness of issues that remind them of their own childhood and adolescence.