Nursing Management NCLEX Quiz Questions
You are the Nurse Manager for the trauma unit. Which of these staff incident reports indicate the need for you to provide an educational activity relating to confidentiality and information security? "A computer in the hallway was left unattended and a client's medical record was visible to me." "I just saw a nursing student looking at the medical record for a client that they are NOT caring for during this clinical experience." "As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes." "I refused the nursing supervisor's request to share my electronic password for the new nurse on the unit."
"As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes." Rationale: A staff members comment, "As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes" "indicates the need for the Nurse Manager to provide an educational activity relating to confidentiality and information security because dieticians often have the "need to know" about laboratory data so that they can, for example, assess the client's nutritional status in terms of their creatinine levels. The report that the nursing student was "looking at the medical record for a client that they are NOT caring for during this clinical experience" indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; the report that a "computer in the hallway was left unattended and a client's medical record was visible to me" indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; and lastly, "I refused the nursing supervisor's request to share my electronic password for the new nurse on the unit" also indicates that the staff member is knowledgeable about privacy and confidentiality.
After a change of shift, you are assigned to care for the following patients. Which patient should you assess first? A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab. A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation. A 70-year old with pneumonia who needs to be started on intravenous (IV) antibiotics. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.
A 50-year old with asthma who complains of shortness of breath after using a bronchodilator. Rationale: The patient with asthma who is still complaining of shortness of breath after a bronchodilator is still at risk for respiratory complications. Such needs are urgent.
The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an assistive personnel (AP)? A client requiring a colostomy irrigation A client receiving continuous tube feedings A client who requires urine specimen collections A client with difficulty swallowing food and fluids.
A client who requires urine specimen collections Rationale: The nurse must determine the most appropriate assignment based on the skills of the staff member and the needs of the client. In this case, the most appropriate assignment for the AP would be to care of the client who requires urine specimen collections. The AP is skilled in this procedure. Colostomy irrigations and tube feedings are not preformed by APs because these are invasive procedure. The client with difficulty swallowing food and fluids is at risk for aspiration.
The nurse has received the assignment for the day shift. After making initial rounds and checking all of the assigned clients, which client should the nurse plan to care for first? A client who is ambulatory demonstrating steady gait A post-operative client who has just received an opioid pain medication A client scheduled for physical therapy for the first crutch-walking session A client with a white blood cell count of 14,000mm^3 (14x10^9/L) and a temperature of 38.4 degrees Celsius
A client with a white blood cell count of 14,000mm^3 (14x10^9/L) and a temperature of 38.4 degrees Celsius Rationale: The nurse should plan to care for the client who has an elevated white blood cell could and a fever first, because the client's needs are the priority. The client who is ambulatory with steady gait and the client scheduled for physical therapy for a crutch-walking session do not have priority needs. Waiting for pain medication to take effect before providing care to the post-operative client is best
The nurse is assigned to care for four clients. In planning client rounds, which client should the nurse assess first? A postoperative client preparing for discharge with a new medication A client requiring daily dressing changes of a recent surgical incision A client scheduled for a chest x-ray after insertion of a nasogastric tube A client with asthma who requested a breathing treatment during the previous shift
A client with asthma who requested a breathing treatment during the previous shift Rationale: Airway is always the highest priority, and the nurse would attend to the client with asthma who requested a breathing treatment during the previous shift. This could indicate that the client was experiencing difficulty breathing. The clients described in options 1, 2, and 3 have needs that would be identified as intermediate priorities.
The nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on an evening shift. The nurse should assign priority to which client? A client complaining of muscle aches, a headache, and history of seizures. A client with chest pain who states that he just ate pizza that was made with a very spicy sauce. A client who twisted her ankle when rollerblading and is requesting medication for pain. A client with a minor laceration on the index finger sustained while cutting an eggplant.
A client with chest pain who states that he just ate pizza that was made with a very spicy sauce. Rationale: In an emergency department, triage involves brief client assessment to classify clients according to their need for care and includes establishing priorities of care. The type of illness or injury, the severity of the problem, and the resources available govern the process. Clients with trauma, chest pain, sever respiratory distress or cardiac arrest, limb amputation, and acute neurological deficits and those who have sustained chemical splashes to the eyes are classified as emergent and are the highest priority. Clients with conditions such as simple fracture, asthma without respiratory distress, fever, hypertension, abdominal pain, or a renal stone have urgent needs and are classified as a second priority. Clients with conditions such as a minor laceration, sprain, or cold symptoms are classified as nonurgent and are a third priority.
A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team approach. The nurse determines that which scenario is characteristic of team-based model of nursing practice? Each staff member is assigned a specific task for a group of clients. A staff member is assigned to determine the clients needs at home and begin discharge planning. A single registered nurse (RN) is responsible for providing care to a group of 6 clients with the aid of an assistive personnel (AP). An RN leads 2 licensed practical nurses (LPNs) and 3 APs in providing care to a group of 12 clients.
An RN leads 2 licensed practical nurses (LPNs) and 3 APs in providing care to a group of 12 clients. Rationale: In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A identifies functional nursing. Option B identifies a component of case management. Option C identifies primary nursing (relationship-based practice.
The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the nursing assistant (UAP) under your supervision? Observe how well the patient performs pursed-lip breathing Plan a nursing care regimen that gradually increases activity intolerance Assist the patient with basic activities of daily living Consult with the physical therapy department about reconditioning exercises
Assist the patient with basic activities of daily living Rationale: Experienced LPN's can use observation of patients to gather data regarding how well patients preform interventions that have already been taught. Assisting patients with ADL's is more appropriate for a nursing assistant. Planning and consulting require additional education and skills, appropriate to an RN.
A patient with chronic obstructive pulmonary disease (COPD) is admitted to the unit. Which intervention for airway management should you delegate to a nursing assistant? Assisting the patient to sit up on the side of the bed. Instructing the patient to cough effectively. Teaching the patient to use incentive spirometry. Auscultation of breath sounds every 4 hours.
Assisting the patient to sit up on the side of the bed. Rationale: Assisting patients with positioning and activities of daily living is within educational preparation and scope of practice of a nursing assistant.
Henry is a Unit Manager I the Medical Unit. He is not satisfied with the way things are going in his unit. The patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. He decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Henry? Call for a staff meeting and take this up in the agenda. Seek help from her manager. Develop a strategic action on how to deal with these concerns. Ignore the issues since these will be resolved naturally.
Call for a staff meeting and take this up in the agenda. Rationale: This will allow for the participation of every staff in the unit. If they contribute to the solutions of the problem, they will own the solutions; hence the chance for compliance would be greater. It's one thing to articulate the change required and entirely another to conduct a critical review against organizational objectives and performance goals to ensure the change will carry the unit in the right direction strategically, financially, and ethically.
Alexandra is tasked to organize the new wing of the hospital. She was given the authority to do as she deems fit. She is aware that the director of nursing has substantial trust and confidence in her capabilities, communicates through downward and upward channels, and usually uses the ideas and opinions of her staff. Which of the following is her style of management? Benevolent -authoritative Consultative Exploitive-authoritative Participative
Consultative Rationale: A consultative manager is almost like a participative manager. The participative manager has complete trust and confidence in the subordinates, always uses the opinions and ideas of subordinates, and communicates in all directions. Consultative leadership is a leadership style that targets team building and uses the skills of others to create plans and make decisions. Leaders consult with their team to obtain their suggestions and opinions to help them make informed and strategic decisions.
Ms. Caputo is newly promoted to a patient care manager position. She updates her knowledge on the theories in management and leadership in order to become effective in her new role. She learns that some managers have low concern for services and high concern for staff. Which style of management refers to this? Organization Management Impoverished Management Country Club Management Team Management
Country Club Management Rationale: Country club management style puts concern for the staff as the number one priority at the expense of the delivery of services. He/she runs the department just like a country club where everyone is happy including the manager. This leadership style assumes that if people are happy in their job, they will naturally work harder.
The nurse is giving a bed bath to an assigned client when an assistive personnel (AP) enters the client's room and tells the nurse that another assigned client is in pain and needs pain medication. Which is the most appropriate nursing action? Finish the bed bath and then administer the pain medication to the other client. Ask the AP to find out when the last pain medication was given to the client. Ask the AP to tell the client in pain that medication will be administered as soon as the bed bath is complete. Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client.
Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client. Rationale: The nurse is responsible for the care provided to assigned clients. The appropriate action in this situation is to provide safety to the client who is receiving the bed bath and prepare to administer the pain medication. Options 1 and 3 delay the administration of medication to the client in pain. Option 2 is not a responsibility of the AP.
One leadership theory states that "leaders are born and not made," which refers to which of the following theories? Trait Charismatic Great Man Situational
Great Man Rationale: Leaders become leaders because of their birthright. This is also called Genetic theory or the Aristotelian theory. This quote sums up the basic tenet of the Great Man theory of leadership, which suggests that the capacity for leadership is innate. According to this theory, you're either a natural-born leader or you're not. The term "Great Man" was used because, at the time, leadership was thought of primarily as a male quality, especially in terms of military leadership.
Mike is hopeful that his unit will make a big turnaround in the succeeding months. Which of the following actions demonstrates that he has reached the third stage of change? Wonders why things are not what it used to be Finds solutions to the problem Integrate the solutions to his day-to-day activities Selects the best change strategy
Integrate the solutions to his day-to-day activities Rationale: Integrate the solution to his day to day activities is expected to happen during the third stage of change when the change agent incorporate the selected solutions to his system and begins to create a change.
The nurse manager is discussing the facility protocol in the event of a tornado with the staff. Which instructions should the nurse manager include in the discussion? Select all that apply. Open doors to client rooms Move beds away from windows Close window shades and curtains Place blankets over clients who are confined to bed Relocate ambulatory clients from the hallways back into their rooms
Move beds away from windows Close window shades and curtains Place blankets over clients who are confined to bed Rationale: In this weather event, the appropriate nursing actions focus on protecting clients from flying debris or glass. The nurse should close doors to each client's room and move beds away from the windows, and close window shades and curtains to protect clients, visitors, and staff from shattering glass and flying debris. Blankets should be placed over clients confined to bed. Ambulatory clients should be moved into the hallways from their rooms, away from windows.
After a conference with the family, a patient's care provider writes a Do-Not-Resuscitate (DNR) order. What does the nurse understand when planning care for this patient? DNR orders from a previous hospitalization will be valid and legal. Death will take place within the next 72 hours, so the family should prepare. Nursing care will continue with the treatment orders in place. The patient and family may no longer make medical decisions.
Nursing care will continue with the treatment orders in place. Rationale : A DNR order only controls CPR and similar life-saving treatments. All other care and treatment should continue as ordered. Competent patients can still decide about their own care, including whether to rescind the DNR order. A new DNR order is written with each hospitalization.
A 16-year old patient with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nursing activity is most important to include in the patient's care? Perform postural drainage and chest physiotherapy every 4 hours. Allow the patient to decide whether or not she needs aerosolized medications. Place the patient in a private room to decrease the risk of further infection Plan activities to allow at least 8 hours of uninterrupted sleep.
Perform postural drainage and chest physiotherapy every 4 hours. Rationale: Airway techniques should always take priority for any patient, but especially cystic fibrosis patients.
Which of the following is the best guarantee that the patient's priority needs are met? Checking with the relative Preparing a nursing plan in collaboration with the patient Consulting the physician Coordinating with other members of the team
Preparing a nursing plan in collaboration with the patient Rationale: The best source of information about the priority needs of the patient is the patient himself. Hence using a nursing care plan based on his expressed priority needs would ensure meeting his needs effectively.
When assigning tasks to unlicensed assistive personnel (UAP), the nurse can ask them to do all of the following EXCEPT: Measure intake and output. Report signs of skin breakdown. Assist a patient who is choking. Provide patient and family education.
Provide patient and family education. Rationale: Unlicensed assistive personnel (UAP) are not allowed to give instruction or education to patients or family members. They are also not permitted to administer medications, perform invasive procedures, or perform patient assessments. They can only report what they observe, without interpretation or assessment of the situation. They are also certified to give emergency assistance. Providing education involves assessing understanding and adapting the information to meet the needs of the patient and family.
Aubrey thinks about primary nursing as a system to deliver care. Which of the following activities is not done by a primary nurse? Collaborates with the physician. Provides care to a group of patients together with a group of nurses. Provides care for 5-6 patients during their hospital stay. Performs comprehensive initial assessment.
Provides care to a group of patients together with a group of nurses. Rationale: This function is done in team nursing where the nurse is a member of a team that provides care for a group of patients. Primary care nursing is when a single nurse is identified as the point of contact and primary caregiver for a patient during his or her particular hospital stay or other episodes of care. As envisioned by staff nurses at the University of Minnesota in 1969, the primary care nursing team is composed of that lead nurse, who directly supervises the engagement of a licensed practical nurse and/or nursing assistant in that patient's care.
A 75-year-old female recovering from a broken hip is being discharged from a healthcare facility. After completing her care plan for discharge, the nurse learns that her patient has a 78-year-old husband with dementia that she cares for at home. He has been staying with other family members during her convalescence. Which of these is the correct course of action for the nurse? Re-evaluate and revise her discharge care plan to ensure that the patient and her husband are both well taken care of at home. Confront the patient and ask her why she didn't disclose the information about caring for her husband prior to completing her discharge care plan. Trust that the patient's rehabilitation has been sufficient and she can immediately resume all previous activities related to caring for her husband at home. Leave the discharge care plan as it is; assume that the family will continue taking care of her husband.
Re-evaluate and revise her discharge care plan to ensure that the patient and her husband are both well taken care of at home. Rationale: Case management as a nurse involves creating care plans that continue after a patient leaves your care. This may include identifying and helping the patient utilize proper external resources to ensure their safety and health at home. In this case, the nurse needs to re-evaluate and revise her care plan for her patient. The nurse should initiate a discussion of the patient's needs (with her family as well) to determine the best care plan. Never base a care plan on assumptions or intuition or alienate the patient from this process.
A patient with sleep apnea has a nursing diagnosis of Sleep Deprivation related to disrupted sleep cycle. Which action should you delegate to the nursing assistant (UAP)? Discuss weight-loss strategies such as diet and exercise with the patient Teach the patient how to set up the BiPAP machine before sleeping Remind the patient to sleep on his side instead of on his back Administer Modafinil (Provigil) to promote daytime wakefulness
Remind the patient to sleep on his side instead of on his back Rationale: The nursing assistant can remind patients about actions that they have already been taught by the nurse and are part of the patients care plan. Discussing and teaching require additional education and training. These actions are within the scope of practice of the RN. The RN can delegate administration of medication to an LPN, but not PCT.
The nurse plans to care for a client in the post-anesthesia care unit. Which of the following should the nurse assess first? Respiratory status Level of consciousness Level of pain Reflexes and movement of extremities
Respiratory status Rationale: All of these choices are important, but Airway & Breathing should always be checked first.
A nurse in the cardiac unit was discussing management styles of the previous managers. She stated that her former manager demonstrated passion for serving her staff rather than being served. She takes time to listen, prefers to be a teacher first before being a leader, which is characteristic of: Transformational leader Transaction leader Servant leader Charismatic leader
Servant leader Rationale: Servant leaders are open-minded, empathic, non-judgmental, and try to be understanding. This type of leadership is based off of the leader having the motivation to serve her employees first.
The charge nurse is planning the assignment for the day. Which factors should the nurse remain mindful of when planning the assignment? Select all that apply. The acuity level of the clients Specific requests from staff The clustering of the rooms on the unit The number of anticipated client discharges Client needs and workers' needs and abilities
The acuity level of the clients Client needs and workers' needs and abilities
You are a registered nurse who is performing the role of a Case Manager in your hospital. You have been asked to present a class to the newly employed nurses about your role, your responsibilities and how they can collaborate with you as the Case Manager. Which of the following is a primary case management responsibility associated with reimbursement that you should you include in this class? The case manager's role in terms of organization wide performance improvement activities The case manager's role in terms complete, timely and accurate documentation The case manager's role in terms of the clients' being at the appropriate level of care The case manager's role in terms of contesting denied reimbursements
The case manager's role in terms of the clients' being at the appropriate level of care Rationale: Registered nurse case managers have a primary case management responsibility associated with reimbursement because they are responsible for ensuring that the client is being cared for at the appropriate level of care along the continuum of care that is consistent with medical necessity and the client's current needs. A failure to ensure the appropriate level of care jeopardizes reimbursement. For example, care in an acute care facility will not be reimbursed when the client's current needs can be met in a subacute or long-term care setting. Nurse case managers do not have organization wide performance improvement activities, the supervision of complete, timely and accurate documentation or challenging denied reimbursements in their role. These roles and responsibilities are typically assumed by quality assurance/performance improvement, supervisory staff and medical billers, respectively.
A widowed woman is being admitted for emergency cardiac surgery by the nurse. She is asking the nurse questions about who will make decisions for her if something goes wrong during her surgery. Which of these is the correct course of action for the nurse? The nurse should inform and educate this client that the nurse will act as a healthcare proxy for the patient, should the client be rendered incapable of making medical decisions for herself. The nurse is not involved with advance directives. She should alert a social worker that the patient needs help establishing advance directives. The nurse should inform the physician and advocate for the delay of surgery until the patient seeks legal counsel. The nurse should inform and educate this client about advanced directives, help coordinate their creation, and ensure they are in the client's medical record.
The nurse should inform and educate this client about advanced directives, help coordinate their creation, and ensure they are in the client's medical record. Rationale : According to the Patient Self Determination Act of 1990, it is the nurse's legal duty to inform and educate clients on advance directives upon admission to any healthcare facility. This includes assessment of whether or not the client requires advance directives, facilitating the creation of the documents, and ensuring they are part of the medical record. The nurse may not act as a healthcare proxy for the client.
A patient with a pulmonary embolus is receiving anticoagulation with IV heparin. What instructions would you give the nursing assistant (UAP) who will help the patient with activities of daily living? Select all that apply. Use a lift sheet when moving and positioning a patient in bed Use an electric razor when shaving the patient each day Use a rectal thermometer to obtain a more accurate body temperature Use a soft-bristle toothbrush or tooth sponge for oral care Yes! Be sure the patient's footwear has a firm sole or a "no-slip" guard when the patient ambulates
Use a lift sheet when moving and positioning a patient in bed Use an electric razor when shaving the patient each day Use a soft-bristle toothbrush or tooth sponge for oral care Yes! Be sure the patient's footwear has a firm sole or a "no-slip" guard when the patient ambulates
A nurse is assigned five patients on a medical surgery floor. There are two LPNs and one nursing assistant also working the shift. Which of the following interventions are appropriate to delegate to the supportive nursing staff? Select all that apply. auscultating breath sounds on a 70-year-old client with emphysema changing bed linens on a 44-year-old client while he is in radiology for an MRI Correct assisting a 83-year-old client with history of unstable gait to the restroom administering IV Toradol (Ketorolac tromenthamine) to a 56-year-old recovering from a stroke taking vital signs on a 65-year-old client whose blood pressure was last 80/46
changing bed linens on a 44-year-old client while he is in radiology for an MRI Correct assisting a 83-year-old client with history of unstable gait to the restroom Rationale : Nurses frequently delegate tasks to ensure proper care of their patients. The key to proper delegation is to consider the five "rights": right task, right person, right circumstance, right communication, and right supervision. These remind the nurse to only delegate activities for stablepatients to staff that are properly trained to perform them. In the delegation tasks above, a nurse must not delegate assessment or administration of intravenous medications, as these are tasks outside of the LPNs' and medical assistant's scopes of practice. The client with the low blood pressure would be considered unstable and should be assessed directly by the nurse. Assisting the client with unsteady gait to the restroom and changing bed linens are appropriate actions to delegate to the assistive staff.
