Management B

A nurse is assisting with triage following a mass casualty event. The nurse should recommend that which of the following clients be attended to first?

a client who has a crush injury to the pelvis and whose pedal pulse in the right foot is absent

A nurse is assisting with the selection of clients to discharge to make needs available following a tornado in the community. Which of the following client should the nurse recommend for discharge?

a client who is recon from a laproscopic appendectomy that was preformed 24 hr ago

A nurse on a pediatric unit is assisting with. the care of four clients which of the following clients should the nurse plan to see first?

a preschooler who has respiratory syncytial virus and is wheezing

A nurse is assisting with the development of presentation for newly licensed nurses regarding client confidentiality. Which of the following actions should the nurse include as an example of a breach of client confidentiality?

accessing client medical records from other units to compare outcomes with currently

A nurse is assisting in planning care for a client who has heart failure. Which of the following interventions should the nurse include?

administer furosemide 40 mg daily, apply oxygen to keep SPO@ greater then 95%,obtain daily weight

A nurse is planning to delegate care for a group of clients following change of shift report. Which of the folliwng tasks should the nurse plan to assign to the AP?

applying bilateral sequential compression devised to a client legs

A nurse is completing documentation on the computer at the nursing station when an AP requests to use the computer to enter morning vital signs. Which of the following actions should the nurse take?

ask the AP to find another computer

A nurse at rehabilitation facility is supervising a newly hired assistive personnel (AP) during the transfer of a client from the bed to a chair. Which of the following actions by the AP demonstrates safe transfer technique?

bends at knees

A nurse is serving on a performance improvement committee which is reviewing client falls. The data shows that most falls occur between 2000 and 2200. Which of the following recommendations should the committee make?

check on clients hourly

A nurse is assisting with the discharge of a client who was in a motor vehicle crash 24 hr ago. The client tells the nurse "My vision seems blurry, and I am having difficulty speaking clearly." Which of the following actions should the nurse take first?

check the client for indications of increased intracranial pressure

A nurse is preparing to reinforce discharge teaching with a client who speaks a different language than the nurse. The client has a new diagnosis and his partner is at the bedside. Which of the following actions should the nurse take?

contact an interpreting service via telephone to assist with the instructions

A nurse at a rehab facility is participating in an inter professional care for a client who is 1 wk postoperative following and above the knee amputation. Which of the following findings is the priority for the nurse to report at the conference?

the clients incision site has purulent drainage

A nurse is contributing to the plan of care for a group of clients. Which of the following scenarios demonstrates effective use of time management techniques?

the nurse groups activities for a surgical client based on the clients pain medication schedule

A nurse is caring for a client who is recovering following a total hip arthroplasty. The nurse receives a telephone call from the clients sister requesting information about the clients status. Which of the following actions should the nurse take?

transfer the call to the client

A nurse is assisting with the care of a client who suddenly becomes uncounscious and requires emergency surgery. The client does not have advance directives and the only family member available is the clients 14 yr old daughter. Which of the following actions should the nurse plan to take?

transport the client to the operating room with implied consent

A nurse is assisting with the development of a slide presentation for staff education about preventing medication errors. Which of the following actions should the nurse take when developing the slides?

use sentences that have maximum of six words

A nurse is participating in a peer evaluation based on overall performance of its nursing staff. Which of the following strategies ensures that the peer evaluation process is impartial and fair?

uses the same objective measurement tool for all nurses

A nurse is observing a newly licensed nurse administer ophthalmic medication to a client. Which of the following actions should the newly licensed nurse take first?

verify the medication with the clients medication administration record (MAR)

A newly hired nurse recognizes that the unit staff and nurse manager seem to be in constant conflict. The nurse should identify that the nurse manager is using which of the following conflict management approaches when she decides that her plans are best and the unit staff. is no longer trying to resolve conflict?

win-yield

A nurse is delegating collection of a random specimens to an assistive personnel (AP). Which of the following information should the nurse provide?

wrap tongue blades used to retrieve the specimen in a paper towel prior to disposal

A nurse is contributing to the plan of care for a client who states he is a devout hindu. To adhere to the clients religious dietary practices which of the following food options should the nurse offer to the client?

yogurt

A nurse in a long term care facility is caring for an older adult client who has heart failure and is refusing to take a new medication. Which of the following responses should the nurse make?

you have the right to refuse medication

A nurse is reinforcing discharge teaching with a client who has a new presicprtion for home oxygen therapy. Which of the folliwng client statements indicates understanding of the teaching?

I will scheduled monthly appt for my equipment

A nurse is verifying informed consent with a client who is scheduled to have a total open abdominal hysterectomy with bilateral Salpingo- oophorectomy for the treatment of uterine cancer. The nurse should notify the provider for which of the following client statements?

I wish I knew if there was another way to treat this other than surgery

A nurse is participating in a disaster drill and is assigned to assist with clients In the yellow tag staging area. The nurse should expect to assist in treating which of the following clients?

A client who has burns to the trunk and legs

A charge nurse in a skilled facility identifies an increased rate of client falls. Which of the following statements to the nursing staff indicates the charge nurse is addressing the problem with an autocratic leadership style?

I have made it mandatory for all nursing staff to attend an educational session or reducing client falls

A nurse is reinforcing teaching about home safety with an older adult client. Which of the following client statements indicates an understanding of the teaching?

I should participate in a supervised exercise program

A nurse is assisting with a presentation about preparing a home disaster supply kit a community health fair. Which of the following statements by a participant should the nurse identify as understanding of the information?

I will purchase canned fruit for the kit

A nurse in a providers office is reinforcing discharge teaching with an adult client who has a new prescription for ear drops for an inner ear infection. Which of the following instructions should the nurse include?

Lie on your side when preparing to instill the ear drops

A nurse is discussing the meaning of utilitarianism with a newly licensed nurse. Which of the following statement by the newly licensed nurse indicated an understanding of this ethical theory?

Utilitarianism provides the greatest good for the greatest number of people

A nurse is assisting with the admission of a client who report that she signed advance directives during a previous admission. Which of the following actions should the nurse take?

document in the clients medical record that she has advance directives, ensure that copies of the clients advance directives are located in her chart, inform the oncoming nurse of the clients advance directives during change of shift

A charge nurse is discussing legal issues with a newly licensed nurse. Which of the following actions should the charge nurse identify as negligence?

falling to provide one to one observation for a client who is suicidal

A nurse is assisting an RN with developing a meal plan for a client who has neutropenia. Which of the following foods should the nurse recommend to include?

fried fish

A nurse in a long term care facility is caring for a client who is refusing his prescribed medications. Which of the following actions should the nurse take first?

identify the clients concerns about taking the medications

A newly licensed nurse is caring for a client who requires a straight catheterization. The nurse informs the charge nurse that he has only observed the procedure on two occasions. Which of the following responses should the charge nurse make?

lets discuss the procedure and ill assist you with it the first time

A nurse is observing assistive personnel (AP) provide care for a group of clients. The nurse should intervene when the AP dons gloves prior to performing which of the following tasks?

making a surgical bed for a client returning from surgery

A nurse realizes she has administered the wrong medication to a client. Which of the following actions should the nurse take first?

monitor the clients vital signs

A charge nurse is planning a discussion concerning scope of practice with newly licensed nurses. Which of the following tasks should the charge nurse identify as within the PN's scope of practice?

participate in health promotion counseling for a client, evaluate a clients response to nursing interventions, assist in the development of unit policies affecting client care

A nurse is providing care for a group of clients who have signed a general consent for treatment. The nurse should identify that which of the following procedures requires an additional written informed consent?

performing an amniocentesis

A nurse in a long term care facility is preparing to demonstrate administration of a cleansing enema to a group of newly licensed nurses. Which of the folliwng actions should thee nurse plan to take during the demonstration?

place the client in a left side lying position

A nurse is participating in discharge planning for a client who has a new tracheostomy. Which of the following equipment should the nurse ensure is avaliable for providing care for the client at home?

portable suction

A nurse is assisting with the development of an in service about the process of evidence based practice. Which of the following actions should the nurse include as the first step of this process?

question a current clinical practice that does not seem effective

A charge nurse notices a nurse on the unit arriving to work 30 min late. The nurse appears unkempt and has slurred speech. Which of the following actions should the charge nurse take first?

reassign the nurses clients to another nurse

A nurse is reinforcing teaching with a newly licensed nurse about ethical principles to consider during client care. Which of the following actions should the nurse include as an example of client advocacy?

relaying a clients concerns about an upcoming procedure to the provider

A nurse is supervising an assistive personnel (AP) fax a clients morning laboratory results to a providers office. Which of the following actions by the AP requires intervention by the nurse?

sends laboratory results from the past week

A nurse is discussing time management with a newly licensed nurse. Which of the following actions should the nurse recommend to organize daily assigned client tasks?

setting goals

A nurse is assisting with the care of an older adult client who is recovering from a stroke and is experiencing difficult swallowing and performing ADLs. The client will be living with his adult son following discharge. The nurse should recognize that which of the following client referrals has the highest priority?

speech therapy

A nurse is collecting data from a client following abdominal surgery. The nurse should recognize which of the following client findings is the priority to report to the provider?

surgical dressing saturated with bloody drainage

A nurse is collecting data form a client and notices smoke coming from an electrical outlet. Which of thee following actions should the nurse take first?

take the client out of the room

A nurse assisting with disaster triage is examining a client who has a large open wound to the lower extremity. Which of the following actions should the nurse take?

tell the client she should receive treatment within 2 hour