Leadership/management

a nurse is working with two APs. the nurse notes the the APs has been taking long breaks and making personal calls. which of the following statements should the nurse make to resolve the conflict?

"I need to talk to you about unit expectations regarding timely completion of tasks

a nurse is reinforcing teaching about legal issues with a group of newly licensed nurses.which of the following statements by a newly licensed nurse indicates an understanding of the teaching?

"I will ask permission from the client before observing a procedure the client I having.

A nurse is assisting with the care of a group of clients on a gynecology unit. Which of the following clients should the nurse attend to first?

A client who has admitted 1 hr ago for an ectopic pregnancy

A nurse in a long term care facility is reinforcing teaching about safe delegation practices with a newly licensed nurse. Which statements should the nurse include in the teaching?

Delegated tasks require follow up to ensure compliance

a nurse tells another nurse that she thinks that he did not provide adequate care for a client who underwent a hip arthroplasty earlier that day. which of the following responses by the accused nurse demonstrates assertiveness?

I feel as though I met the standard of care. would you tell me more about your concerns?

A nurse is working with an assistive personnel (AP) who refuses a client assignment. When resolving this conflict, which of the following comments is appropriate for the nurse to make?

I need to talk to you about the unit

A nurse in a long term care facility is reinforcing teaching with a newly licensed nurse about methods to reduce the cost of client care. Which of the following statements an understating of the teaching?

I should encourage clients to receive an annual influenza immunization

a nurse has assigned care activities personal (AP). which of the following statements by the AP indicates a need for assistance in establishing priorities?

I will start with room 1 , then work my way to room 10.

a nurse is caring for a client who is semicomatose. the clients adult son tells the nurse that. the family does not want any heroic measures performed. how should the nurse respond?

I will verify the status of the clients advanced directives

A nurse is caring for a client undergoing hemodialysis who will be discharged in the morning. Which of the following client statements most influences the current plan of care?

My neighbor who drives me everywhere wrecked the car this morning

A licensed practical nurse (LPN) is working with an RN to deliver care to a group of clients. Which of the following tasks should thee LPN plan to complete?

Performing a dressing change for client who is 2 days postoperative following a total hip athroplasty

A nurse is caring for a client who has dementia and is scheduled for a procedure. Which of the following individuals should the nurse request to sign thee clients informed consent?

The clients son who has a durable power of attorney

a nurse is caring for a group of clients. which of the following clients should the nurse see first?

a client who has pneumonia and requests an analgesic for a headache.

a nurse is assisting with implementing new actions designed to reduce medications errors on her unit. which of the following should the nurse use to measure the effectiveness of these actions?

a comparison of the number of medication errors before and after the actions were implemented.

A nurse is assisting a client who is 2 days postoperative following a total hip arthroplasty to walk to a chair. When the nurse offends to help the client ambulate, the client refuses to get out of bed. Which of thee following actions should the nurse make?

acknowledge the clients wishes

A charge nurse is observing a newly licensed nurse perform client care. Which of the following situations requires intervention by the charge nurse?

administering an antibiotic medication to a client 1. hr prior to the prescribed time

a charge nurse is making client care assignments. which of the following tasks should the nurse delegate to AP? select all that apply.

bathe a client who had an amputation 2 days ago, assist a client to ambulate using a gait belt, feeding a client who had a stroke 3 months ago.

A nurse is planning to assign care activities to the assistive personnel (AP). Which of the following activities are appropriate for assignment to the (AP). Which of the following activities are appropriate for assignment for the AP?

checking the position of a client who is in soft wrist restraints, sitting with a client who has alcohol use disorder whose last drink was 4 days ago

a nurse is reinforcing teaching about delegation to an AP with a newly license nurse. which of the following statements should the nurse include in the teaching?

delegation permits a designated individual to meet a goal on you behalf

a nurse is caring for a client who signed an informed consent in preparation for a procedure. the client tells the nurse "which of the following actions should the nurse take?

inform the provider that the client is withdrawing consent

A licensed practical nurse (LPN) is planning. care for a group of clients and is delegating tasks to an assistive personnel (AP). Which of the following tasks should the LPN perform?

insert an NG tube for a client who has abdominal distention

A nurse enters a clients room to answer the call light and sees the clients in the bathroom on the floor. Which of the following should the nurse take first?

obtain the clients vital signs

a. nurse is delegating tasks to an AP. which of thew following task should the nurse assign to the AP?obtain vi

obtain vitals

A nurse is caring fro several clients on a medical surgical unit. Which of the following client care situation requires the nurse to complete an incident report?

a client tells the nurse that his dentures are missing

a nurse working in a long term care facility is assigned care for 4 clients following the 0700 morning change of shift report. which of the following clients should the nurse attend to first?

a client who has diabetes, and had a 0600 blood glucose level of 60mg/dLt

a nurse is receiving change of shift report for the four clients. which of the following findings should the nurse address as priority?

a client who is 4 hr postop following a total hip hip arthroplasty and has a urinary output of 15 ml/hr

a LPN is receiving change-of-shift report. which of the following clients should cause the nurse to request a change of assignment?

a client who is to receive a unit of packed RBCs at the start of the shift.

A nurse is assigned a group of clients at the start of the shift. Which of the following clients should the nurse plan to see first?

a client who requests pain medication

a nurse is assigned 4 clients who are post-op. which of the following findings should the nurse identify as priority to report to the charge nurse?

a client whose blood pressure was 138/86 mm hg at 0800 and is 106/60 mm hg at 1200

A nurse on a pediatric unit has received changes of shift report. Which of the following clients should thee nurse plan to see first?

an infant who has pertussis and is receiving oxygen via nasal cannula

A nurse is caring for a client who has heart failure notices that the client did not received his scheduled dose of furosemide. When filling out an incident report about the occurrence which of the following information should the nurse include?

client breath sounds clear bilaterally, nurse documents the clients status as a result of the occurrence, clients statement about the occurrence

a nurse is reinforcing teaching with a newly hired AP who is assisting with the care of a client who has an indwelling urinary catheter. which of the following instructions should the nurse five to the AP?

close the tubing clamp when transferring the client from the bed to the chair

A nurse is preparing to perform a urinary cauterization to obtain a urine specimen for a client. the client tells the nurse that she is concerned about her privacy during the procedure. Which of the following actions should the nurse take to alleviate the clients concern?

close thee door and cover the client during the procedure

A nurse enters a clients room and finds the client on the floor. Which of the following actions should the nurse take first?

collect data on the client

a nurse is planning care for a group of clients on a medical surgical unit. which of the following actions should the nurse take first?

collecting data from a client who reports unilateral calf pain when ambulating

A nurse is delegating client care assignments for the upcoming shift. Which of the following tasks should the nurse plan to delegate to the assistive personnel (AP)?

collecting intake and output

A nurse mistakenly administers a dose of metformin within 1 hr of the previous dose. Which of the following findings should alert the nurse that the client is experiencing an adverse effect from the medication error?

diaphoresis and tachycardia

A nurse applies wrist restraints to a client who is confused and attempting to pull out a chest tube. Which of the following actions should the nurse take?

document. what. less restrictive interventions she tried

a nurse is assisting with the admission of a client who has meningococcal pneumonia. which of the following isolation precautions should the nurse initiate?

droplet

A nurse is caring for a client who is postoperative following an abdominal hysterectomy and has an indwelling urinary catheter in place. An Assistive personnel (AP) reports to the nurse that the clients abdominal dressing is saturated with blood. Which of the following. tasks should be delegated to the AP?

emptying the urinary collection bag

A nurse is preparing to administer a medication to a client. Which of the following actions by the nurse demonstrates advocacy for clients rights?

encouraging the clients to verbalize questions or concerns

A nurse is reinforcing teaching to with a client about advance directives. Which of the following topics should the nurse include?

eternal feeding tubes, cardiopulmonary resuscitation, durable power of attorney for health care

A nurse is assisting with revising a facility emergency response plan fro tornado disasters in the community. The nurse should plan to collaborate with which of the following agencies?

federal emergency management agency (FEMA)

A nurse on a pediatric unit is working with an assistive personnel (AP). Which of the following tasks should the nurse the have the AP perform first?

feed a school age client who has burns on both upper extremities

a nurse is delegating the collection of vital signs to an AP for a group of clients. which of the following clients' vital signs should the nurse not delegate to the AP for collection? select all that apply.

history of CHF, young adult client who is 1 day post op following an appendectomy, a client 2 days post I-following a laparoscopic cholecystectomy

a male client tells the nurse that he does not want the following AP involved in his care. which of the following statements should the nurse give?

ill notify the charge nurse of your request to have only male staff members assigned to care for you.

a nurse on a medical surgical unit is conducting a facility transfer with a client to an inpatient rehabilitation facility following a total hip replacement.which of the following info should the nurse include in the transfer of paperwork?

list of current medications.

a charge nurse planning care for a group of clients is delegating tasks to an AP. which of the following tasks should the nurse delegate to the AP?

measure the output from a clients urinary catheter.

a nurse is reinforcing teaching about advanced directives with a client admitted to the hospital and is is scheduled for surgery. which of the following statements made by the client indicates a need for further teaching?

my children can make changes tony living will if I am incapacitated

A staff nurse suspects that a newly licensed nurse is chemically impaired. Which of the following actions should the staff nurse take?

notify the charge nurse of the situation

a nurse is delegating tasks for an AP to preform for a client who is 1 day postoperative following abdominal surgery. which of the following tasks should the nurse perform herself?

removing the abdominal dressing.

a nurse is performing care for several clients with the help of an AP. which task should the nurse ask the AP to perform first?

take an ABG specimen to the lab.

a nurse is reinforcing teaching about interdisciplinary care plans with a group of newly licensed nurses. which of the following statements should the nurse include in the teaching?

the care plan is designed to improve continuity of client care

a charge nurse in a long term care facility is reviewing client outcomes when delegating tasks to AP with newly licensed nurse. which of the following statements should the charge nurse include in the teaching?

the final step in delegation is evaluation of the outcomes.

a nurse is caring for a group pf clients on a medical-sergical unit. the nurse delegates various tasks the clients require to another LPN an a NP. the nurse should identify that the responsibility for making sure the client received the care the plan of care specifies belongs to which of the following team members?

the nurse who delegated the tasks.

a nurse is caring for a client who is scheduled for a transurethral resection of the prostate. which of the following statements indicates that informed consent was provided?

there is a chance I may become impotent

a nurse is caring for a client who requires wrist restraints. which of the following actions should the nurse take?

wrap sheepskin around the wrist before applying the restraint.

A nurse is assisting with planning an in service for staff nurses about disaster management and triage. Which of the following color tags should the nurse include as identifying a client who requires treatment within 30 min to 2 hr

yellow

a nurse is obtaining consent from a client who is scheduled for a total hip arthroplasty. which of the following statements should the nurse include?

your provider will discuss other treatment options.

a nurse is reinforcing teaching with a group of newly licensed nurses about completing an incident report. for which of the following situations should the nurse complete an incident report?

a clients family member becomes short of breath and reports having chest pain.

a nurse is caring for 4 clients on a surgical unit. which of the following tasks should the nurse delegate to the AP?

assist a client to a chair who is 2 days postop following a vertical laminectomy.

a nurse is planning care for a group of clients. which of the following tasks should the nurse assign tho the AP.

assist a client who is 1 day post-op following an open cholecystectomy to ambulate.

a nurse is collaborating on care for a client following a stroke. which of the following should be addressed by an occupational therapist?

completing self care

a nurse observes two APs arguing over who should go on break first. the nurse interrupts the conversation and states one AP can take break now, but the other AP will get to take an early lunch. which of the following types of conflict management is the nurse demonstrating?

compromising

a nurse is caring for a client who asks if home oxygen will be provided to her after discharge. which of the following actions should the nurse take?

consult with the case manager.

a nurse is reinforcing teaching about the prevention of the deep vein thrombosis with a group of newly licensed nurses. which of the following interventions should the nurse include in the teaching?

place sequential compression devices bilaterally.

a nurse requests that an AP change all the Linens and give bed baths to four clients on the unit. the previous day, the AP was not able to complete these same tasks. which of the following actions should the nurse take in addressing the situation?

set a time frame to complete them

a charge nurse is asked to witness a surgical consent form. upon entering the room, the client tasks, " are there other options besides surgery?" which of the following responses should the nurse give?

several treatment options are available for your disease. have you discussed this with your provider?

A nurse is caring for a client. who is to undergo a total knee arthroplasty. Which of the following actions should the nurse take when participating in the informed consent process?

verify the client is giving consent voluntarily

a nurse is assisting with the care of a group of pediatric clients. which of the following actions should the nurse take first?

deliver a breakfast tray to a child who has been administered regular insulin.

A nurse is planning an in service that encourages active member. participation and feedback about decreasing nosocomial infections on the unit. Which of the following leadership styles does the nurse plan to use?

democratic

A nurse asks an assistive personnel (AP) to take a specimen to a laboratory and the AP refuses. Which of the following actions should the nurse take?

discuss thee incident with the AP

a medical surgical unit ha implemented a policy change. the nurse manger has noticed that one of the nurses, who has a history of being resistant to change, is not delivering care according to the policy. which of the following actions should the nurse manager take?

encourage the nurse to verblize the reasons for resistance to the change.

a nurse notes that a provider frequently arrives to the unit with bloodshot eyes and smelling like alcohol after lunch. which of the following actions should the nurse take?

notify the nurse manager or charge nurse about the concerns.

A charge nurse is discussing emergency response with a newly licensed nurse. The charge nurse should identify which of the following as a triage officer during the time of a disaster?

nurses and other emergency medical personnel

A nurse is caring for a group of clients on medical surgical unit. Which of the following tasks is unsafe to assign to an assistive personnel (AP)?

observe a confused surgical client who has multiple tubes

A nurse assigned care for a group of clients is planning to delegate tasks to an assistive personnel (AP). Which of the following tasks should the nurse plan to perform?

observing a clients sacrum for edema

a nurse is preparing to obtain consent from a client who has a tibial fracture. the clients received IV morphine sulfate prior to arrival on the unit and is scheduled for surgery. which of the following actions should be taken?

obtain consent from a relative.

A nurse is planning care for a group of clients at the beginning of the shift. Which of the following tasks should the nurse assign to the assistive personnel (AP)?

obtaining vital signs of a client who has an appendectomy 12 hr

a nurse has received change of shift report and is delegating tasks to AP. the nurse should direct the AP to perform which of the following tasks first?

perform a blood glucose monitoring of a client who requires insulin administration prior to eating.

A nurse is preparing to administer medication to client. Which of the following client identifiers should the nurse use prior to administering medication to the client?

phone number

A nurse is preparing to perform a urinary catheterization fro an older adult client who speaks a different language than the nurse. Which of the following actions should the nurse take to explain the procedure to the client?

provide an interpreter to explain the procedure

a nurse is assigning tasks for the upcoming shift. which of the following tasks should the nurse delegate to an AP? select all that apply.

providing postpartum care to a client that just passed away, transferring a client to radiology for X-ray , performing a simple dressing change on an arm.

A nurse enters the hospital cafeteria for lunch and overhears two assistive personnels (AP) discussing a client who is currently hospitalized. Which of the following actions should the nurse take?

quietly tell thee APs that the conersation is inappropriate

a nurse on a medical surgical unit is providing care for a client who is hospital employee. several nurses have called seeking info about the client. which of the following actions should the nurse take in response to inquiries from the nurse?

refer questions to the nursing supervisor.

a. nurse is planning care for a group of clients and reviewing tasks to be delegated the AP. which of the following tasks should the nurse complete?

removing and cleaning of the cannula of a client who has a new tracheostomy.

A float nurse is given a client assignment that requires the use of unfamiliar skills and techniques. Which of the. following actions should the nurse take?

request the charge nurse to modify the assignment

A charge nurse in a longer term care facility checks with other nursing personnel on the unit throughout the day to determine If they are completing tasks. Which of the following rights of delegation s the nurse demonstrating?

right supervision

a nurse observes another nurse performing a procedure in the incorrect sequence. the procedure does not harm the client. which of the following actions should the nurse take first?

speak with the other nurse privately.

A nurse is providing care to a client who has COPD and is receiving supplemental oxygen. Which of the following findings should the nurse report to the RN immediately?

speaks in short phrases

A nurse on a medical unit is planning the sift assignments. Thee nurse may delegate collection of which of the following specimens to an assistive personnel (AP)?

sputum specimen, stool specimen, urinalysis specimen

A nurse enters the room of a client who is confused and finds the client sitting on the floor. After determine that the client is free from injury and completing an incident report which of the following actions should the nurse take?

submit thee incident report to the risk manager

a nurse is assisting with the discharge plan of a client who has a permanent tracheotomy and breathes on his own. which of the following equipment should the nurse ensure is available for home care of the tracheostomy? select all that apply.

suction machine, slit gauze pads

a nurse is receiving change of shift report for several clients. which of the following activities should the nurse plan to attend to first?

suction the tracheostomy of a client who has copious secretions.

a nurse has received report from an RN on a group of newly assigned clients.which of the following statements by the RN during report indicates that the nurse should assume total care for the client, rather than assigning tasks to the AP?

the clients bp and pulse have been unstable.

A nurse is caring for an infant who has respiratory syncytial virus. Which of the following actions should thee nurse take?

wear a gown when changing the infants diaper

A nurse is caring for a client who is scheduled for surgery. The client states " I have changed my mind and I don't want the surgery." Which of the following. responses should the nurse give?

you cam change your mind about the surgery at any time

a nurse is providing change of shift report to the oncoming nurse.which of the following info should the nurse include in the report?

the client in room 108 has Benn prescribed a new pain med.

a nurse is caring for a client. one of the clients family members requests to view the clients medical record. which of the following responses should the nurse make

the client must provide written permission to share the record.

a nurse is planning care for a client who has anorexia nervosa. which of the following client goals should the nurse identify as priority?

attaining a weight that is greater than the 75th percentile for age and height.

a nurse in a long term care facility is delegating tasks to an AP. which of the following tasks should the nurse assign the AP?

attending to a client who has fallen out of bed