NUR 221: Leadership for Exam #1

Makes decisions independently and then notifies staff of the decisions made. Maintains a high degree of control over the staff and allows little freedom of staff members

Autocratic

the right to self determination, independence, and freedom of choice

Autonomy

Guides staff toward reaching an objective and shares responsibility with the staff. This is an ideal type of leadership because a great amount of creativity can occur and many strategies can be developed

Democratic

A nurse in the emergency department is preparing to obtain informed consent for surgery from a client who received meperidine hydrochloride IV during transport from a rural hospital. which of the following actions should the nurse take to obtain content for the sx?

Obtain consent from a relative of the client A client who has received meperidine cannot give consent, because the medication can alter the client's ability to understand the consent process. The nurse should obtain consent from a relative of the client. If a relative is unavailable and the surgery is determined to be critical, the surgery can proceed without client consent. Consent for transfer to another facility for evaluation by a specialist does not assume consent for any further procedures, surgery, or care.

A nurse in an ER is caring for four clients. Which of the following findings requires the nurse to act as a mandatory reporter?

a child left unsupervised for several hrs at home and is being treated for a fractured leg This child exhibits findings of neglect and endangerment. The nurse is a mandatory reporter of any client situation in which children or older adult clients are being abused or neglected. For pneumonia client- This client would benefit from a referral to social services for assistance in regard to living conditions. Mandatory reporting of this situation to legal authorities is not indicated.

A nurse is caring for four clients who are scheduled for diagnostic tests. For which of the following tests should the nurse obtain written consent from the client? a. Cerebral arteriogram b. MRI c. CT scan

a. Cerebral arteriogram A cerebral arteriogram is considered invasive because it involves injecting contrast material into an artery to study the cerebral circulation. Written consent is required.

A nurse is caring for a pt who received a sedative-hypnotic med at bedtime. The pt gets out of bed and falls, sustaining a laceration that requires suturing. Which of the following statements should be included as part of the nurse's documentation in the chart? a. Client found sitting on the floor with 3 cm laceration above left eyebrow. Oriented to name only. Provider notified b. Client found sitting on the floor with blood running down face. Side rails had not been raised by the AP when the client was placed in bed

a. Client found sitting on the floor with 3 cm laceration above left eyebrow. Oriented to name only. Provider notified This statement is appropriate to include in the documentation. It presents objective facts and assessments related to this event. The nurse should also include vital signs, further assessments, the name of the provider that was notified, treatments or procedures that were done per the provider's prescription, and the client's response.

A nurse manager believes that a nurse is taking breaks that are too frequent and lengthy. Which of the following is an assertive statement that the charge nurse should use to initiate discussion of the issue? a. I understand that you are allowed to take scheduled breaks during each shift, but you are taking more than the number allocated. Let's set a time when we can discuss this behavior b. you are taking more breaks during each shift than hospital policy allows. You will need to take only the number of breaks specified and be sure you are back on time

a. I understand that you are allowed to take scheduled breaks during each shift, but you are taking more than the number allocated. Let's set a time when we can discuss this behavior Assertive communication uses "I" statements that describe the person's observations and feelings. It allows the person being confronted to respond to the issue with her own perceptions and feelings instead of feeling verbally assaulted. Subsequently, a verbal discourse that allows an open discussion of the issue can follow.

A nurse is delegating a client care task to an AP. Which of the following directions should the nurse give the AP? a. This client needs to ambulate using a walker three times today b. Please record strict I & O for this client

a. This client needs to ambulate using a walker three times today These directions include the type of task to be done, the frequency with which the task is to be performed, the duration of the task, and information about the mechanics of ambulating the client. Glucose monitoring task does not clarify if and where the values should be documented and if they should be reported to the RN.

A nurse is preparing to provide discharge teaching to an older adult client. Which of the following teaching considerations should the nurse include? a. allow frequent rest periods during teaching b. use colored paper with a glossy finish

a. allow frequent rest periods during teaching The nurse should allow frequent periods for rest because an older adult client is slower at processing information. The nurse should use white or buff-colored paper with a matte finish to avoid glare. The nurse should use at least 14-point font size for the older adult client when developing written materials. The nurse should present the information at a sixth- to eighth-grade reading level.

A nurse discovers that the wrong med was given to a confused client who answered to the name the nurse stated when entering the room. The provider is notified and states that the med the client received will cause any harm. Which of the following actions should the nurse take? a. Complete an incident report documenting the occurrence b. Make a note in the client's medical record that an incident report was completed

a. complete an incident report documenting the occurrence

A nurse manager is planning staff development activities for the unit's new AP's. Which of the following activities should the nurse manager perform first? a. determine the learning needs of the AP's b. Administer a skills pretest to the new APs

a. determine the learning needs of the AP's The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, she must first collect adequate data. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision; therefore, the nurse manager should first determine the learning needs of the APs.

A charge nurse in an ER is making assignment for an AP for a shift with unexpected staff absences. Which of the following assignments should the charge assign to a float AP from the med surg unit? a. escort clients from the ER to other areas of the facility for tests b. sit at the reception desk answering and directing clients

a. escort clients from the ER to other areas of the facility for tests Clients in the emergency department often require transport to other departments. Typically, transporting stable clients will be a task that may be delegated to AP. Escorting clients is likely a normal part of the AP's regular routine. This is an appropriate assignment.

A charge nurse is making assignments for an oncoming shift. Which of the following clients should the charge nurse assign to a LPN? a. A client who is to be discharged with a PICC line b. A client who is disoriented and awaiting transfer to a long term facility c. A client who is 16 hr post op following a total larryngectomy

b. A client who is disoriented and awaiting transfer to a long term facility A client who is disoriented will need observation and reality orientation, which is within the LPN's scope of practice. The client's condition can also be categorized as stable since discharge to a long-term care facility is scheduled.

A nurse is working with an AP who appears to be under the influence of alcohol during the night shift. Which of the following is the priority action the nurse should take? a. Confront the AP regarding alcohol use and remove him from the client care b. Ask the nursing supervisor to obverse the AP and validate the nurse's suspicions c. Document observations made about the AP's behavior in a factual manner

b. Ask the nursing supervisor to observe the AP and validate the nurse's suspicions After gathering data, the nurse must first validate suspicions with another observer, take the appropriate action to safeguard clients, and then document the incident. The second step in handling this situation is to confront the AP and remove him from client care to protect the clients from unsafe practice.

A nurse is discussing with a newly licensed nurse about how to obtain informed consent from a client who is to undergo an epidural procedure. Which of the following ethical principles should the nurse include in the teaching? a. Benedicence b. Autonomy c. Paternalism

b. Autonomy Informed consent is based on the ethical principle of autonomy, which is the right to self-determination, independence, and freedom of choice.

A nurse manager calls a meeting of the unit's staff members to discuss cost-containment issues. The nurse manager has asked for staff input regarding strategies that might help reduce costs. Which of the following types of leadership is the nurse manager using? a. Autocratic b. Democratic c. Laissez-faire d. Moral

b. Democratic This is an example of democratic leadership. A democratic leader guides staff toward reaching an objective and shares responsibility with the staff. This is the ideal type of leadership in this situation because a great amount of creativity can occur and many strategies can be developed.

A nurse is caring for a child who has sustained extensive head injuries. The provider has diagnosed brain death. Which of the following statements should the nurse use to begin a conversation about the option of organ and tissue donation with the child's parents? a. I want to talk to you how important it is for you to consider donating your child's organs for transplantation b. I want to give you some info about an option that you have regarding donating your child's organs to others who are in need.

b. I want to give you some info about an option that you have regarding donating your child's organs to others who are in need This is an appropriate statement to begin the discussion. It makes the nurse's intention to give the family factual information that is clear and does not make any emotionally laden statements.

A home health nurse is caring for a client who asks what is included in a living will. Which of the following statements should the nurse include in the teaching? a. It establishes who will make health care decisions if the client is not able b. It allows the client to express personal wishes regarding health care decisions c. It serves as an informed consent for procedures

b. It allows the client to express personal wishes regarding health care decisions The purpose of a living will is to allow the client an opportunity to specify what aspects of care and treatment are to be accepted or refused in the event that the client can no longer communicate those decisions.

A charge nurse is evaluating conflict resolution between two staff nurses. Which of the following conflict resolution styles is an example of one nurse putting aside her own goals to satisfy the other nurse? a. avoidance b. accommodation

b. accommodation Accommodation is when one person puts aside her own goals to satisfy the needs of another person. The nurse is using accommodation in order to resolve the conflict.

A nurse is delegating a task to an AP. The AP is to transfer a pt who has a below the knee amputation from a bed to a wheelchair. The AP has never transferred a pt with an amputation before. Which of the following actions should the nurse take? a. provide the AP with a manual on how to b. assist the AP after he has practiced the transfer c. transfer the client while the AP observes

b. assist the AP after he has practiced the transfer The safest way for the nurse to determine if the AP has the knowledge and skill to transfer the client who has an amputation is by having the AP practice and demonstrate the task. By assisting the AP the first time a transfer is done, the nurse ensures that delegated care is safely provided.

A nurse is making a client's bed and finds a capsule in the sheets. Which of the following actions by the nurse is consistent with safe nursing practice? Select all that APPLY a. administer the med to the client b. notify the provider of the missed dose c. complete a variance report d. document the missed dose of the med on the MAR e. place the med back in the med drawer

b. notify the provider of the missed dose c. complete a variance report Documenting the finding in the client's electronic medical record is incorrect. The nurse should not document the finding in the client's electronic medical record. The nurse should identify that information in the client's medical record is subject to attorney review should the client decide, for any reason, to file suit against the facility or the healthcare staff. Instead, the nurse should follow facility policy and report the incident to the nurse manager and risk management through the use of a variance report. **In addition, the nurse should avoid documenting in the medical record that a variance report was filed because this can also allow for the variance report to be subpoenaed should the client decide to file suit.

A nurse on a med surg unit is caring for a group of pts. For which of the following situations should the nurse complete a variance report? a. clarification of a med dose prescribed by the provider b. the discovery that a pre-op client has received and eaten breakfast

b. the discovery that a pre-op client has received and eaten breakfast This situation represents a variation from the standard of care. A change in the client's plan of care is necessary for this client because the surgical procedure will need to be delayed. The nurse should complete a variance report for this situation.

Based on the principle that actions should be taken with the intent to do good. It is associated with nonmaleficence, which is the requirement that health care providers do no harm to their clients.

beneficence

A nurse is caring for a pt who has stage 4 ovarian cancer and has decided to stop tx and enter hospice care. Which of the following ethical principles is the nurse displaying by supporting the client in her decision? a. Responsibility b. Accountability c. Advocacy d. Confidentiality

c. Advocacy By following the ethical principle of advocacy, the nurse supports the client in the decisions she makes about her own health care.

A group of providers are participating in a cardiopulmonary resuscitation effort for a client who is in cardiac arrest. Which of the following types of leadership for this group to function efficiently? a. transformational b. participative c. Autocratic

c. Autocratic Autocratic leadership is most efficient in an emergency situation. An autocratic leader will direct and issues commands necessary for successful cardiopulmonary resuscitation.

A nurse is caring for a client who is a local public official. A local newspaper reporter repeatedly phones the unit seeking info and states, "it is the public's right to know that health status of elected officials." Which of the following actions should the nurse take? a. Acknowledge that the person is a client on the unit but give no specific details b. Refer any calls directly to the client's room so that the client and the family can decide what to tell the press c. Refer media inquires to the nursing supervisor d. Hang up on callers from the news media because the nurse is not required to speak to them

c. Refer the media inquires to the nursing supervisor The HIPAA Privacy Rule prohibits disclosing client information to individuals not involved in client care without that client's express consent. The reporter should be told that, due to confidentiality issues, no information can be given out about any clients. The nurse should refer the reporter to the nursing supervisor.

A nurse manager is participating in a root cause analysis following a sentinel event on her unit. Which of the following descriptions defines the purpose of a root cause analysis? a. A root cause analysis in preparing a legal defense for the event b. A root cause analysis estimates the costs involved in the event c.The root cause analysis investigates deviations from the standards of care surrounding the event

c. The root cause analysis investigates deviations from the standards of care surrounding the event

An RN and a LPN are caring for a pt who has a small bowl obstruction and is NPO with a NG tube set to continuous suction. Which of the following tasks should the RN perform? a. obtain daily weight b. inspect the pt oral cavity for dryness hourly c. assess for bowel sounds every 2 hrs

c. assess for bowel sounds every 2 hrs

Using quality monitoring tools, a facility committee identifies that clients who have congestive heart failure have an average length of stay that is 5 days instead of the established standard of 3 days. Which of the following steps should the nurse implement next in the quality improvement process? a. educate staff members on shortening the length of stay for these patients b. collect data regarding length of stay for these patients c. determine which actions can be instituted to address this problem

c. determine which actions can be instituted to address this problem Further analysis of data will identify factors that contribute to the longer lengths of stay. Identifying actions to shorten the clients' lengths of stay is the next step in the process.

A nurse is preparing to give change of shift report to the oncoming nurse. Which of the following info should the nurse include? a. routine care procedures b. biographical info c. objective measurements about the client's condition

c. objective measurements about the client's condition

A charge nurse is observing a group of new RNs. Which of the following observations should the charge nurse report to the nurse manager as a violation of HIPAA? a. assigning a client who requested a private room to a semi private due to unavailability b. placing a client who is confused in restraints c. talking about clients with other nurses in the cafe

c. talking about clients with other nurses in the cafe The nurse should not discuss information about clients, including their personal concerns, diagnoses, and treatments, with anyone who is not directly involved in the client's care. Doing so is a violation of HIPAA regulations. Nurses should take special care not to compromise this right by discussing client care in such places as elevators, restaurants, or other areas that are accessible to the public in which the discussion might be overheard.

A nurse is caring for a pt who is dying and unable to make decisions for himself. The pt's adult children disagree on his code status. Which of the following sources should the nurse depend on for decisions regarding the clients end of life care? a. The pt's oldest child b. the attending provider c. the pt's health care proxy

c. the pt's health care proxy

A charge nurse on a ped unit is delegating tasks to an AP who is pregnant and reports that she is unsure of her immune status. Which of the following clients should the charge nurse assign to the AP? a. A 9 yr old child who has fifths disease b. A 4 yr old child who has varicella c. A 6 yr old child who has rubella d. A 2 yr old child who has impetigo contagiosa (impetigo)

d. A 2 yr old child who has impetigo contagiosa This is a safe assignment. If the AP practices universal precautions, there is no risk for contracting impetigo. Impetigo is a superficial skin infection caused by either staphylococcus or streptococcus. Erythema infectiosum is a communicable disease and has been associated with early fetal loss. There is no immunization for Fifth disease. Varicella and Rubella is a communicable disease and a known teratogen.

A charge nurse receives a call from his nursing supervisor about an explosion at a local factory and an urgent need for facility beds for newly admitted clients. Which of the following clients should the nurse recommend for discharge? a. A 60 yr old client who has type 2 diabetes mellitus admitted 48 hr ago with uncontrolled glucose levels b. A 58 yr old client who is 12 hr post-op following a total knee arthoplasty c. A 80 yr old client admitted 24 hr ago for vomiting and diarrhea d. A 44 yr old client who has asthma and was admitted for carpal tunnel surgery

d. A 44 yr old client who has asthma and was admitted for carpal tunnel surgery A client who is admitted for carpal tunnel surgery is a stable client having an elective procedure. Therefore, the nurse should recommend this client for discharge.

A nurse is completing an incident report after administering an incorrect dose of med to a patient, even though the client experienced no ill effects from the error. Which of the following should the nurse recognize as the purpose for completing the incident report? a. Alerts facility administration of a possible litigation situation b. Tracks employee performance for possible disciplinary action c. Provides detailed report of the occurrence for the family d. Identifies situations that contribute to the occurrence of med erros

d. Identifies situations that contribute to the occurrence of med errors

A nurse is reviewing lab results for a client who is at 12 weeks gestation. Which of the following findings should the nurse report to the provider? a. Hgb 12 g/dL b. WBC 15,000/mm3 c. Fasting blood glucose 80 mg/dL d. Serum creatinine 0.4 mg/dL

d. Serum creatinine 0.4 mg/dL This value is below the expected reference range for a client who is pregnant. The nurse should report this value to the provider.

Based on recommendation following a regulatory agency visit, the nurse manager mandates a policy change. One of the staff nurses on the unit is resistant to the change, and the nurse manager notes that the nurse does not deliver care according to the new policy. Which of the following actions should the nurse take? a. explain the disciplinary consequences of not implementing the new policy b. reinforce with the staff nurse the importance of implementing the policy change c. ignore the resistance d. encourage the nurse to verbalize reasons for resisting the change

d. encourage the nurse to verbalize reasons for resisting the change

A nurse is caring for several clients who require diagnostic testing and is delegating tasks to an AP. Which of the following tasks should the nurse direct the AP to perform FIRST? a. change the transparent dressing on a pt who has a stage 2 pressure ulcer b. bring a pitcher of fresh water to a pt who has just had a lumbar puncture c. transport a pt to the radiology department for a routine chest x-ray d. take an arterial blood gas specimen to the lab

d. take an arterial blood gas specimen to the lab Arterial blood gas specimens are placed on ice and must be transported to the laboratory immediately to prevent degradation of the sample. Since this task needs to be done within a specified time frame, it is the first task the AP should perform. This type of dressing change is not usually on a strict schedule and can be done when time allows.

A nurse is working with an AP in a long term care facility. According to the five rights of delegation, which of the following determinations should the nurse make prior to assignment of tasks? a. whether the AP has consented to the performance of delegated tasks b. the client's willingness to consent to the care of the AP c. whether the task can be more efficiently completed by the nurse d. the degree of supervision that the AP will require to complete the task

d. the degree of supervision that the AP will require to complete the task Successful delegation involves assigning the right task to the right person under the right circumstance. The person that is to perform the task must be given adequate direction and specification regarding the amount of supervision that will be provided. The right communication of expectations and the right feedback on performance must also be supplied.

A nurse is ambulating a client who has an IV with an infusion pump. Upon returning to the client's room and plugging the infusion pump in, the client reports a slight tingling in his hand. Which of the following actions should the nurse take? a. plug the pump into a different outlet b. place a service tag on the pump for a routine inspection c. unplug the pump and plug it back into the same outlet to see if the sensation of tingling is repeated d. turn the pump off

d. turn the pump off The pump must be turned off immediately to protect the client and the nurse from the risk of electrical injury and fire. The nurse should consider any electrical equipment that shows a sign of malfunction unsafe and place it out of service until the equipment can be checked by the facility's maintenance department.

A nurse is providing discharge teaching about home safety with an older adult client and his family. Which of the following statements should the nurse include in the teaching? a. you should set the water heater temp to 125 degrees F b. you should grasp the cord when unplugging it c. you should use a gas stove for cooking d. you should install a handrail on at least one side of the stairs

d. you should install a handrail on at least one side of the stairs The nurse should instruct the client to set the hot water thermostat to 48.9° C (120° F) or less to prevent scalding and burns. The nurse should instruct the client to grasp the plug when unplugging items, not the cord. The nurse should instruct the client to use microwave or electrical toaster ovens instead of open flames and burners. Gas stoves are a potential fire risk.

A nurse is caring for a client who is in the bathroom. The nurse hears a loud thud and, after opening the bathroom door, finds the client on the floor. What is priority action?

determine LOC Checking for level of consciousness is the first action the nurse should take when finding a victim. This client might have had a vasovagal response while defecating, resulting in a temporary loss of consciousness that does not require CPR.

A pt in long term care facility falls out of bed, fracturing his right hip. The side rails on the bed were not raise at bedtime, although this pt was a high fall risk. The nurse should identify what tort has occurred?

negligence Negligence occurs when a client is exposed to an unreasonable risk of injury. Raised side rails help to decrease the risk of falling out of the bed and are a standard of care for clients who have been identified as at risk for falling.

a principle that is based on the assumption that one person can assume responsibility for making the decisions for another person

paternalism