PNL all

What is the term used to identify the omission of doing something that a reasonable person would do, guided by the considerations that ordinarily regulate human affairs?

Negligence

The nurse is caring for a patient whose vital signs are not stable and who seems to be nearing the end of life. The provider orders the patient to be placed on life-sustaining treatments, but the nurse questions this order. The nurse is operating within which type of ethical framework?

Rights based—deontological

During a staff meeting, a nurse manager identifies interpersonal conflict occurring between two RNs about how best to schedule new graduate nurses. The manager responds, "You both agree that the schedule for the new graduates is critical to their success, so let's start there." Which conflict resolution strategy is the manager using?

Smoothing

Goleman in his best seller Emotional Intelligence built upon work in his identification of five components of emotional intelligence. Which component of emotional intelligence is occurring when a person is proficiently handling relationships and building networks?

Social skills

Intentional Torts (Cont.)

Don't communicate patient information without the patient's consent Confidentiality Keep information about patients to yourself; share only with other health care workers as needed Invasion of privacy Photographing procedures Going through patient's belongings Talking about patient's private life publicly

List 3 levels of criminal law offenses

Felony, Misdemeanor, Juvenile

Interpersonal Roles

Figurehead, leaders and liaison to manage relationships with people -Used to manage relationships with people

Which is a characteristic of Theory Z?

Fitting employees to their jobs

Fire Class B

Flammable liquids and gas fires

Steps to solving a problem

Gather data, analyze data, establish outcome, implement, evaluate

This is the negative phenomenon that occurs in highly cohesive groups similar prejudices suppress open discussion. It often interferes with critical thinking and increases pressure to conform.

Group Think

What effect of organizational power on decision making is often reflected in the tendency of staff?

Having private beliefs that are separate from corporate ones

What are the differences between mission statement, vision and philosophy of an organization

Mission - reason for existence, Vision-goals/ambitions for future, Philosophy-value of principles/beliefs/behaviors

Five stages of nursing ability

Novice nurse, advanced beginner, competent nurse, proficient nurse, expert

Laws Governing Nursing

Nurse Practice Acts

Legal Control Over Nursing Practice

Nurse Practice Act—statute and rules governing nurses in your state Board of Nursing—agency designated to apply laws to individuals

The nurse witnesses a patient sign an operative permit form. Legally, what does the nurse's signature imply?

Observed the client sign the consent form

There are many terms used to describe moral issues faced by nurses, including moral uncertainty, moral conflict, moral distress, moral outrage, and ethical dilemmas. Which statement describes how moral uncertainty occurs?

Occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is

HESI Hint #2

Often questions are asked regarding the Good Samaritan Act, which is the means of protecting a nurse when she or he is performing emergency care.

This budget used by businesses is used for day to day expenses

Operating Budget

What are some common areas for Functional nursing delivery?

Operating Room

To make appropriate ethical decisions the nurse-manager must have knowledge of what items to assist in making decisions? Select all that apply:

Organizational processes 1, 2 Proven decision-making models 1, 2, and 3 Professional approach that eliminates trial and error Ethical principles and frameworks

A staff nurse is having difficulty with problem solving in patient care and the nurse manager is counseling the nurse. What suggestions by the nurse manager may assist the staff nurse in improving problem solving skills? (Select all that apply.)

Override bias Systematize data collection Slow down thinking

This managed healthcare organization type allows choice of providers but cost may be higher

POS

This managed healthcare organization is when the physician and health services are contracted with the insurance company to provide services at discounted fees

PPO

To keep a current license RN's complete CEU's. At least one of these CEU's must be about _________________.

Pain or pain management

This type of resistance to change avoids discussion, ignores the change, refuses to commit, and agress but doesn't act on the change

Passive resistance

The only treatment alternative left for a patient diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. The insurance company refuses to authorize payment for the $200,000 procedure, arguing that the money could be better spent providing well-baby screening for 2,000 residents in the service area. What does this decision by the insurance company reflect?

Utility

The nurse asks the client's spouse, "Mrs. Smith, your husband told me that for the past week he has not been eating the meals you prepare. Do you agree?" This is an example of __________________ of assessment data.

Validation

This research method asks "Does the tool really measure what it is supposed to?"

Validity

Shirey suggests there are five distinguishing characteristics of authentic leaders. Which characteristic is occurring when authentic leaders link between purpose and passion by having congruence in beliefs and actions?

Values

Collaborative health care teams require;

1. Shared goals, commitment, and accountability. 2. Open and clear communication. 3. Respect for the expertise of all team members.

Legal and civil rights of hospitalized clients

1. The right to wear their own clothes and to keep personal items and a reasonable amount of cash for small purchases. 2. The right to have individual storage space for one's own use. 3. The right to see visitors daily. 4. The right to have reasonable access to a telephone and the opportunity to have private conversations by telephone. 5. The right to receive and send mail (unopened). 6. The right to refuse shock treatments and lobotomy.

This is a health care initiative by the institute of medicine that states the gaps in actual care and high quality care can be attributed to key inter-related areas within healthcare

"Crossing the quality chasm"

Which response is characteristic of a servant leader?

"Let me think about that request for 24 hours."

Which statement by a subordinate demonstrates the greatest problem for the leader?

"Your plans for the changes will be difficult to implement."

Practice Questions Care Final

-

A nurse explains the informed consent form to a patient who is scheduled for heart bypass surgery. Which elements are considered essential to the effective establishment of informed consent? (Select all that apply.)

- Competence of the patient must be determined prior to consent - Comprehension of the information by the patient or guardian - Full disclosure of information regarding the procedure

Staff development activities on a nursing unit occur for a variety of reasons, including to establish or improve competence in an area, or to provide annual training for mandatory competencies. Which topics would be covered in an annual in-service of the mandatory child abuse reporting process for all nursing staff? (Select all that apply.)

- Discussion of actual case studies of child abuse to review obvious and concealed circumstances. - Demonstration of the electronic Child Protective Services (CPS) form that must be completed by a CPS staff member on every report made. - Review of the state statute on mandatory child abuse reporting. - Review and discussion of recent journal articles on child abuse detection and prevention.

Which steps will help the nurse minimize the risk of nursing malpractice? (Select all that apply.)

- Periodically reviewing the scope of practice for nurses - Observing all facility policies and procedures when providing care - Maintaining liability insurance independent of that provided by the facility - Attending relevant continuing education programs to upgrade clinical skills

Which behaviors by a nurse can result in the suspension or revocation of the nursing license? (Select all that apply.)

- Practicing on an expired nursing license - Failing to report an incident of substandard nursing care - A felony conviction for drug use - Being convicted of professional negligence

Strategic Management

-Emphasizes fit or alignment between the organization's strategy, external environment, and internal structure and capability -Links quality improvement efforts to core strategies and capabilities of the organization to meet organizational needs

Managerial Resources

-Human resources -Financial resources -Physical resources -Information resources

Theory Z

-Organizations invest in their employees and address BOTH home and work issues creating a path for career development -Mixed results from studies on it's effectiveness on company's performance -Embraced by Fortune 500 Companies -Participative management -Decreases amount of turnovers

Chaos Theory

-Prevalent in healthcare organizations -Organizations must be able to organize and implement change quickly and forcefully -Little time for orderly linear change Ex: Changing to 12 hour shifts at the hospitals

Plan the Change

-Select people to carry out the change plan -Design a method to evaluate the outcome -Anticipate resistance to the change -Develop strategies to manage resistance -Design a plan to stabilize the change

Empathy

-Sensing what people are feeling -Being able to take their perspectives -Cultivating rapport and being in tune with a broad diversity of people.

What are some possible goals of a health care organization other than "caring for the health and wellbeing of people)

-Survival, Growth, Profit, Status, Dominance

Roger's Diffusion Model

...

Typical steps of the grievance process

1) Formal presentation of the complaint is in the proper chain of command. 2) Formal hearing if the issue is not resolved at a lower level. 3)Professional mediation if a solution is not reached during a formal hearing

Steps in Providing Educational Programs

1) Identify and Respond (identify need for knowledge or skill proficiency) 2)Analyze (Deficiencies and develop learning objectives to meet needs) 3) Research (resources available to address learning objectives) 4) Plan (Program to address objectives using available resources) 5) Implement (Programs at time conductive to staff attendance) 6) Evaluate (material and observations to measure behavior changes secondary to learning objectives)

Maslow's hierarchy

1) Physiological 2) Safety and security 3) love and belonging 4) self-esteem 5) self actualization.

Commission of a crime involves...

1. A person commits a deed contrary to criminal law. 2. A person omits an act when there is a legal obligation to perform such an act (e.g., refusing to assist with the birth of a child if such a refusal results in injury to the child). 3. Criminal conspiracy occurs when two or more persons agree to commit a crime. 4. Assisting or giving aid to a person in the commission of a crime makes that person equally guilty of the offense (awareness must be present that the crime is being committed). 5. Ignoring a law is not usually an adequate defense against the commission of a crime (e.g., a nurse who sees another nurse taking narcotics from the unit supply and ignores this observation is not adequately defended against committing a crime). 6. Assault is justified for self-defense. However, to be justified, only enough force can be used as to maintain self-protection. 7. Search warrants are required prior to searching a person's property. 8. It is a crime not to report suspected child abuse (i.e., the nurse's legal responsibility is to report suspected child abuse)

List 3 qualities a leader must develop

1. Ability to diagnose or understand the situation you want to influence or change 2. Adaptation in order to allow your behaviors to close the gap between the current situation and what needs to be changed 3. Communication

Critical pathways:

1. Are interdisciplinary plans of care. 2. Are used for diagnoses and care that can be standardized. 3. Are guides to track client profess. 4. Do not replace individualized care

Critically thinking model

1. Assessment: What are the needs or problems? 2. Analysis: What has the highest priority? 3. Planning: What outcomes and goals must be accomplished? What are the available resources? (1) Nursing staff (2) Interdisciplinary team members (3) Time (4) Equipment (5) Space (client rooms, home environment, etc.). 4. Implementation: Communication expectations. Is documentation complete? 5. Evaluation: Were the desired outcomes achieved? Was safe, effective care provided?

Follow-up

1. Communication of evaluation findings to the LPN or UAP and other appropriate personnel. 2. Need for teaching or guidance.

The role of the nurse takes place at all three levels of disaster management:

1. Disaster preparedness. 2. Disaster response. 3. Disaster recovery

Two things (Forces) that can happen during change (according to Lewin)

1. Driving forces and 2. Resisting forces

Evaluation/monitoring

1. Frequent check-in. 2. Open communication lines. 3. Achievement of outcome

Consent of minors

1. Minors 14 years of age and older must agree to treatment along with their parents or guardians. 2. Emancipated minors can consent to treatment themselves. Be aware that the definition of an emancipated minor may change from state to state.

To achieve effective disaster management:

1. Organization is the key. 2. All personnel must be trained. 3. All personnel must know their roles.

Primary prevention in Disaster Management

1. Participate in the development of a disaster plan. 2. Train rescue workers in triage and basic first aid. 3. Educate personnel about shelter management. 4. Educate the public about the disaster plan and personal preparation for disaster

Secondary prevention in Disaster Management

1. Triage. 2. Treatment of injuries. 3. Treatment of other conditions, including mental health. 4. Shelter supervision.

What are 4 things that the Institute of Medicine states about quality of care

1. quality can be defined and measured 2. quality problems are serious and extensive 3. current approaches are inadequate to improve quality 4. there is an urgent need for rapid change

How much actual time does an RN spend on pt care?

35%

What component of professional negligence is represented when a patient experiences a seizure resulting from a medication error?

A causal relationship

High Position Power

A favorable leader

Code of Ethics

A set of principles that all members of a profession generally accept. Guidelines to assist nurses and other professionals when conflict or disagreements arise about correct practice and /or behavior.

What is an ethical dilemma?

A situation that requires choosing between two or more undesirable alternatives

A nurse is caring for an older adult client who has left the unit for a radiology procedure. The client's son asks the nurse what med is being given to the client. Which of the following is an appropriate response by the nurse? A. "I am sorry, but that is information you will need to ask your mother or her doctor." B. "Your mother is taking famotidine (Pepcid) for the ulcer & lorazepam (Ativan) for anxiety." C. "You will need to ask the charge nurse for that info." D. "Don't worry. We will give your mother all pertinent info before discharge."

A.

When considering the MORAL decision-making model, what step is the nurse engaging in when developing the plan of care?

Affirming

Torts

An act involving injury or damage to another (except breach of contract) resulting in civil liability (i.e., the victim can sue) instead of criminal liability

Low Position Power

An unfavorable leader.

What is a characteristic of a left-brain thinker?

Analytical

HESI Hint#5

Assertive communication starts with "I need" rather than with "You must"

Which leadership style maintains strong control over the work group and uses coercion to motivate others?

Authoritarian

Name the three types of leadership styles

Authoritarian/autocratic, Democratic, laissez fare

interprofessional conference for a client 3 days post-op following ORIF right hip. Which concern is the priority ?

B. The client refuses to attend physical therapy sessions.

A nurse is observing a new nurse perform a sterile dressing change on a client who has a central venous catheter. Which is an appropriate action by the new nurse?

C. Picks up first sterile glove by grasping the folded cuff edge.

8. Before performing a procedure for the first time at a new agency, the travel nurse: A) Refuses to perform the procedure B) Asks the charge nurse how to perform the procedure C) Reads about the procedure in the policy and procedure manual D) Performs the procedure as at the agency where the nurse previously worked

C. Reads about the procedure in the policy and procedure manual Every agency has its own policies and way of performing procedures. The charge nurse may not know how the procedure should be performed or may explain it incorrectly. The procedure may be performed differently than in the previous agency. If the nurse refuses to perform procedures that are covered by the Nurse Practice Act, the nurse could be fired.

A nurse is presenting information on health care law to a group of newly licensed nurses. Which of the following information should the nurse include?

C. The Patient Self-Determination Act requires a nurse to give clients information about end-of life options.

Delegation to LPN

Cannot delegate any patient who requires blood transfusion, IV push meds, critical ptns

Leadership Values

Caring, integrity, diversity, excellence.

According to JCAHO what is the reason for a large number of sentinel events that occur?

Communication deficits among health care providers

State Laws

Core nursing practice is regulated by state law

Invasion of Privacy

Covers the right to be left alone, to chose care based on one's personal beliefs.

Causes of reality shock

Culture shock (expectations distorted with reality), incongruent school values and work values, lack of support, lack of a mentor

A nurse is caring for a client who has recently been prescribed lithium carbonate (Eskalith). Which of the following is the priority assessment finding for this client? A. Fine hand tremors B. Weight gain of 2.7 kg (6 lb) C. Report of nausea D. Poor motor coordination

D

A nurse in ED is admitting clients following an earthquake. Emergency disaster plan has been implemented due to large # of anticipated casualties. Which clients should nurse recommend provider see first?

D. A client who has a sucking chest wound.

Charge nurse conducting in-service with staff about infection control precautions. RN should instruct staff that which client requires droplet precautions?

D. A client who has pertussis.

Which of the following is an example of an expected outcome statement in measurable terms? A) Client will be pain free. B) Client will have less pain. C) Client will take pain medication every 4 hours. D) Client will report pain intensity of less than 4 on a scale of 0 to 10.

D. Client will report pain intensity of less than 4 on a scale of 0 to 10 Reporting the level of pain on a numbered scale is a measurable, objective goal. The other options do not specify measurable outcomes.

The purpose of assessment is to: A) Make a diagnostic conclusion. B) Delegate nursing responsibility. C) Teach the client about his or her health. D) Establish a database concerning the client.

D. Establish a database concerning the client The purpose of assessment is to establish a database about the client's perceived needs, health problems, and responses to these problems. The data also reveal related experiences, health practices, goals, values, and expectations. The other options are not purposes of assessment.

A nurse preparing to administer medication to a client who has Crohn's. Client states, " I want to skip this dose of medication. I'm too tired to take it." Which actions should nurse take?

D. Inform client of consequences of refusing medication.

A client presents to an ED and reports weakness, vomiting, and diarrhea for the past 3 days. Which of the following is the priority assessment for this client?

D. Serum potassium levels

Phases of decision making

Define objectives, generate options, identify advantages and disadvantages, rank options and select one, implement option selected, evaluate the results

What does traditional management science focuses upon?

Delineating barriers to productivity

list the 4 phases of unplanned change?

Design the change, plan implementation, implement the change, integrate the change

Malpractice Elements (Cont.)

Did the breach of duty cause the injury? Causation must be proven. Good documentation usually makes proof impossible.

Which ethical framework would most likely be used to arrive at the nurse's decision to work overtime in spite of previous social plans?

Duty based

Fourth Infraction

Employee termination

How Can I Avoid a Malpractice Claim? (Cont.)

Equipment failure Know standard of care connected with equipment Use as directed Properly maintained? Working properly? Remove from service if necessary

Controversial Ethical Issues Confronting Nursing (Cont.)

Euthanasia Commonly referred to as mercy killing, good death, or right to die Classified as active, passive, or voluntary Durable power of attorney for health care, living wills, advance medical directives

Structure audits

Evaluate the influence of elements that exist separate from our outside of the client - staff interaction.

Controlling

Evaluation of staff performance and evaluation of unit goals to ensure identified outcomes are being met

True or False, good management skills ensure good leadership skills?

False

True or false, effective leadership ensures good management skills

False

This ethical principle is loyalty and a promise to fulfill all commitments. (accountability)

Fidelity

Vroom's Expectancy Equation

Force= Valence x Expectancy

This is a type of leadership in which the nurse is acting in an approved/appointed management role

Formal leadership

Felony

Fraud that is deliberate and results in personal gains

What About the Impaired Nurse?

Impaired nurses are unable to function effectively because of some type of substance abuse Heightened awareness of this problem Significant impact on rendering safe, effective patient care High stress and easy access to drugs seem to contribute to this common problem Many states have taken a rehabilitative approach to this problem

First Infraction

Informal reprimand. Manager and employee meet to discuss issue and suggest improvement

These types of values sustain life - (food/water)

Intrinsic values

Which ethical framework involves an individualized decision-making framework?

Intuitionist

What is a weakness of the traditional problem-solving model?

Its need for implementation time

Fidelity

Keeping one's promised to the client about care that was offered.

What is the basic premise of the interactional theory?

Leadership behavior is generally determined by the relationship between the is the basic premise of the interactional theory? leader's personality and the specific situation

Which statement is correct regarding the distinction between legal and ethical obligations in decision making?

Legal controls are clearer and philosophically impartial

What is a distinguishing trait of integrated leader-managers? Select all that apply.

Long-term thinkers Concerned with employee motivation Possess influence beyond their own group

This type of error event is when no harm or minimal harm is done

Near miss

Malpratice

Negligence ( professional misconduct or unreasonable lack of skill) by a professional person with a license. (Can be sued for this once you have your LPN license) Client also must accrue damages as a result of the injury.

Handling Change

Object is to gain control of the forces of change in your organization, work environment and life.

What is the idea that workers should be hired, trained, and promoted based on their competence and abilities related to?

One of the four overriding principles of scientific management

Competing/coercing

One party pursues a desired solution at the expense of others. win-lose

Cooperating/Accommodating

One party sacrifices something, allowing the other party to get what it wants. Lose-win

What is the best definition of decision making?

One step in the problem-solving process

What type of management was emphasized in the human relations era of management?

Participatory

3 types of liability

Personal, vicarious, employer/corporate

This research is objective, numbers are used as analysis

Quantitative

Incident Reports

Records made of unexpected or unusual incidents that affected a client, employee, volunteer, or visitor in a health care facility. Cannot be used as evidence in lawsuits. Should be completed w/in 24 hrs of incident, considered confidential,

This approach to error resolution addresses a problem and goes deeper, and deeper and deeper to find out "why"

Root cause analysis

This type of error event is when serious injury occurs, very concerning, major mistake

Sentinel event

Which principle will help increase the likelihood that followers do not mislead their leader?

Support the followers' right to disagree

TRUE OR FALSE: A nurse can have his or her license revoked if he or she is providing patient care while under the influence of drugs or alcohol.

TRUE

What law protects the nurse who provides care or gives aid in an emergency situation?

The Good Samaritan Act

According to the ANA Code of Ethics for Nurses, what is the nurse's primary commitment?

The application of ethical standards to the delivery of patient care

Beneficence

The care that is in the best interest of the client.

State Board of Nursing

The power organization regarding nursing in every state. Has the right to refuse to allow students to sit for NCLEX.

The nurse manager has an obligation to act as advocate for which entities? (Select all that apply.)

The staff The patient The profession Themselves

Hierarchical

The team uses a large amount of data and generates one option.

Integrative

The team uses a large amount of data and generates several options

McGregor has two theories of workers name them

Theory X and Theory Y

Which statement regarding the characteristics of a good leader is true?

They may have character flaws

How many primary leadership styles have been identified?

Three

What concept is servant leadership based upon?

Trusting and valuing employees

HESI Hint #10

UAPs generally do not perform invasive or sterile procedures

Choose one of the following words to complete this statement: "Effective leadership in nursing requires the individual to be self-aware in order to ________ the motivation of others."

Understand

What are some fiscal responsibilities of RN's?

Understand that budgeting drives healthcare, achieve patient outcomes in a safe/cost efficient manner, judicious use of equipment and supplies

3 stages of lewins theory of change

Unfreeze(take out of comfort zone), Change(discomfort), Refreeze(new comfort zone)

Rights of a person participating in research/experimentation?

Voluntary consent, if the subject of the research is human - they can stop at any time they choose, patients are adequately informed

Moral and Ethical Principles

What is the best decision? How will I know? Autonomy Beneficence Nonmaleficence Fidelity Justice Veracity

Which statement best describes ethics?

What our conduct and actions should be regarding what is right and good.

What needs to be considered in evaluating the quality of one's decisions?

Will the evaluation be helpful in increasing one's decision-making skills?

Mandatory Nurse Practice Acts

authorize that, under the law, only licensed professionals an practice nursing.

Hygiene-Maintenance Factors:Absent

can be sources of job dissatisfaction,

Four elements necessary to prove negligence or malpractice

duty, breach of duty, injury/damages, causation

Best Leadership Style

high initiating structure and high consideration leadership behaviors

According to Rogers what are typical responses to change?

innovators, early adapters, early majority, late majority, laggards and rejectors.

Caring

promoting health, healing, and hope in response to the human condition

Delegation

the process by which responsibility and authority are transferred to another individual

Authority

the right to act or command the actions of others

An LPN can perform ______care.

tracheostomy care

Substitutes for Leadership

variables that may influence followers to the same extent as the leader's behavior.

Practical Advice

"Mother rule": Would you feel comfortable telling your mother about what you are doing or thinking about doing? Fraud or defamation: If something feels dishonest, it is probably wrong Don't do anything outside your scope of practice or anything unsafe for the patient Invasion of privacy or breach of confidentiality: Don't gossip or talk about patients unnecessarily

Which statement demonstrates a characteristic of a critical thinker? Select all that apply.

"Since that didn't work effectively, let's try something different." "The solution has to be something the patient is willing to do." "I'll talk to the patient's primary care giver about the problem."

This finding in research means there is low probability the result was due to just chance

"significant findings" (Not chance - proven probability)

Transformational Leadership Theory

(Burns) A process in which "leaders and followers raise one another to higher levels of motivation and morality." Based on the idea of empowering others to engage in pursing a collective purpose by working together to achieve a vision of a preferred future.

Path-Goal Theory

(Robert House) The leader works to motivate followers and influence goal accomplishment. By using the appropriate leadership style for the situation, the leader makes the path toward the goal easier for the follower.

Client Rights

-Be informed about all aspects of care and be active in decision making process -Accept, refuse, or request modification to the plan of care -Receive care that is delivered by competent individuals who treat the client with respect

Force Field Analysis

-Brainstorm to produce a list of all driving and restraining forces. -Estimate the strength of each force. -Note the most important forces, then research and analyze them. -List and document possible responses or actions that might strengthen each important driving force or weaken each important restraining force.

VIctim of Change

-Bring crises -Undermine morale -Decrease productivity -Create conflict

Lippitt's Phases of Change

-Built on Lewin's model -Emphasizes the participation of key personnel & change agent in designing and planning change -Emphasizes communication 1.Diagnose problem 2.Assess motivation and capacity for change 3.Assess change agent's motivation and resources 4.Select progressive change objectives 5.Choose appropriate role of change agent 6.Maintain change 7.Terminate helping relationship

Vroom's Expectancy Theory

-Centers around what people want and thier prospect of getting it. -Can be demonstrated in the form of an equation. This theory proposes that this equation can help to predict the motivation, or force, of an individual to achieve a goal as negative, neutral, or positive. -Has 3 variables that are subdivided into 3 indicators: -Force, Valence, and Expectancy

Implement the Change

-Clear understanding (and preparation) of the change to take place -What to expect, -The meaning of the change, and -What is required of the client system in adapting to the change. -Pilot study -Iron out problems -Less threatening -"Sell" the rest of the client system on the idea

Social skills

-Handling emotions in relationships well and accurately reading social situations and networks -Interacting smoothly -Using these skills to persuade and lead and negotiate and settle disputes -For cooperation and teamwork

Self-Regulation

-Handling your emotions so that they facilitate rather than interfere with the task at hand -Being conscientious and delaying gratification to peruse goals -Recovering well from emotional distress

Herzberg's Two Factor-Theory

-Hygiene maintenance factors -Motivator factors

Root cause analysis

-Investigates the consequence and possible causes -analyzes the possible causes and relationships that may exist -determines additional influences at each level of relationship -determines the root cause or causes

Theory X

-Leaders must direct and control because motivation results from reward and punishment. -Employees prefer security, direction, and minimal responsibility and they need coercion and threats to get the job done. -Employees are unable to offer creative solutions to help the organization advance.

List 3 types of healthcare organizations

-Private/nonprofit, publicly supported, private/for profit

The Patient Protection & Affordable Care Act

-Protects client from annual & lifetime coverage limits. -Allows parents to insure dependents until age 26. -An insurance provider cannot deny coverage due to preexisting conditions. -protects client from cancellation of insurance due to illness.

Planned Change Model

-Recognize Symptoms -Diagnoise Need -Look for Alternative Solutions (Listen to nay-sayers) -Select Change -Plan Change -Implement Change -Evaluate Change

Theory Z

-Uses collective decision making, long-term employment, mentoring, holistic concern, and use of quality circles to manage service and equality -This is a humanistic style of motivation based on the study of Japanese organizations.

Motivation

-Whatever influences peoples' choices and creates direction, intensity, and persistence in behavior -Process that occurs internally to influence and direct behavior in order to satisfy needs -Help leaders to lead efficiently

Motivation Theories

-Worker output is greater when the worker is treated humanistically. -Helpful to explain why people act the way they do and how nurse managers can relate to individuals as human beings and workers -Considered alongside management theories

How nurses use knowledge

-recognize even subtle changes in patient's conditions -anticipate patient care problems -intervene appropriately to minimize/avoid complications

Importance of the Change Agent

-the person who leads and manages the change -Ultimately responsible for the success (or failure) of the change project -Manage the dynamics of the change process -MUST maintain communication, momentum and enthusiasm while still managing the process

Havelock's Six-Step Change Model

...

5 Elements necessary to Prove Negligence

1) DUTY to provide care as defined by a standard: what a reasonably prudent nurse would do 2) BREACH of duty by failure to meet the standard: failure to meet the standard of care that should have been given 3) FORSEEABLEHARM: that knowledge that not providing the care may cause harm to the ptn 4) Breach of duty has POTENTIAL TO CAUSE HARM 5) HARM OCCURS: the actual harm

Steps of the problem-solving process

1) Identify the problem - stayed it in objective terms, minimizing emotional overlay. 2) Discuss possible solutions - brainstorming solutions as a group may stimulate new solutions to the old problems. Encourage individuals to think outside the box. 3) Analyze identified solutions - the potential pros and cons of each possible solution should be discussed and attempt to narrow down the number of viable solutions. 4) Select a solution - based on this analysis, select a solution for implementation. 5) Implement the selected solution - a procedure and timeline for implementation check off me the implementation of the selected solution. 6) Evaluate the solutions ability to resolve the original problem. The outcome surrounding the new solution should be evaluated according to the predetermined time line. The solution should be given adequate time to become established as a new routine before is evaluated. If the solution is deemed unsuccessful, the problem-solving process will need to be reinstituted and the problem discussed again

A nurse discovers that a client was administered an antihypertensive med in error. Number the following actions in the appropriate sequence that the nurse should follow. ___A. Call the client's provider ___B. Monitor the client's vitals ___C. Notify the risk manager ___D. Complete an incident report ___E. Instruct the client to remain in bed until further notice

1. B 2. E 3. A 4. D 5. C

Examples of negligence or malpractice

1. Burning a client with a heating pad. 2. Leaving sponges or instruments in a client's body after surgery. 3. Performing incompetent assessments. 4. Failing to heed warning signs of shock or impending MI. 5. Ignoring signs and symptoms of bleeding. 6. Forgetting to give a med or giving the wrong med

Direction/guidance

1. Clear, concise directions. 2. Expected outcome. 3. Time frame. 4. Limitations. 5. Verification of assignment

Tertiary prevention in Disaster Management

1. Follow-up care for injuries. 2. Follow-up care for psychological problems. 3. Recovery assistance. 4. Prevention of future disasters and their consequences

If the nurse believes that a HCP's prescription was made with poor judgment:

1. Record that the HCP was notified and that the prescription was questions. 2. Carry out the prescription because nursing judgment cannot be substituted for a HCP's judgment.

Five Rights of Delegation

1. Right task: Is this a task that can be delegated by a nurse? 2. Right circumstance: Considering the setting and available resources, should delegation take place? 3. Right person: Is the task being delegate by the right person to the right person? 4. Right direction/communication: Is the nurse providing a clear, concise description of the task, including limits and expectations? 5. Right supervision: Once the task has been delegate, is appropriate supervision maintained/

Top 3 types of quality errors that can happen in an institution

1. Service occurrences 2. serious incident 3. sentinel event

Nursing responsibilities with regard to restraints

1. The nurse must notify the HCP immediately that the client has been restrained. 2. The nurse should document the facts regarding the rationale for restraining the client.

What three traits are necessary in a person to prevent burnout

1. a sense of personal control rather than powerlessness 2. commitment to work and lifes activities rather than alienation 3. seeing lifes demands and changes as a challenge rather than a threat (THINK POSITIVE)

The CQI program evaluates what 3 things?

1.Structure within which care is given, 2. the process of giving the care 3. the outcome of that care

Much of the difficulty people have in making ethical decisions results from a lack of formal education about problem solving. Research at the University of Pennsylvania found what percentage of the nurses and social workers reported having no ethics training?

25

A new charge nurse on a busy surgical unit notes a high degree of tension among the nursing staff. Which of the following should be the initial method used for resolving this issue? A. Work w/the nurses to identify stressors B. Hire additional staff to decrease the work load C. Make relaxation tapes available to staff to help decrease stress D. Reassess the situation after the nurses have become accustomed to the new charge nurse

A

A nurse manager is making a decision based on a problem with a staff member. What would be the optimal end product of the decision?

A chosen course of action

If decision making is triggered by a problem with what does it end?

A chosen course of action

What best describes someone who is an informal nursing leader

A well-respected nurse with years of experience on the unit becomes a team leader.

Grievance

A wrong perceived by an employee based on a feeling of unfair treatment that is considered grounds for a formal complaint.

In infectious diseases such as hepatitis B and C, a reservoir for pathogens is: A) The blood B) The urinary tract C) The respiratory tract D) The reproductive tract

A) The blood The blood is a reservoir for pathogens in hepatitis B and C. Neither organism can survive in the urinary, reproductive, or respiratory tract

A nurse is caring for a group of clients on a med surg unit. Which of the following tasks should the nurse delegate to the assistive personnel (AP)? Select all that apply. A. Collecting a stool specimen B. Providing instructions about using a spirometer C. Measuring oral intake D. Providing postmortem care E. Changing a dressing

A, C, D

Which of the following is an example of assertive communication? A. "You need to improve the way you spend your time so that all of your care gets performed." B. "I've noticed that many of your clients did not get their care today."

A. Aggressive communication, which causes anger, hostility, and defensive attitude. B. Assertive communication begins with "I" rather than "you" and clearly states the problem.

Biologic agents

A. Anthrax. B. Pneumonic plague. C. Botulism. D. Smallpox. E. Inhalation tularemia. F. Viral hemorrhagic fever

Chemical agents

A. Biotoxin agents: ricin. B. Nerver agents: sarin

Nursing Assessment Disaster

A. Community-disaster risk assessment. B. Measures to mitigate disaster effect. C. Exposure symptom identification.

A staff nurse detects alcohol on the breath of another nurse working on unit. He observes that her gait seems unsteady, and she slurs her speech. Which actions should nurse take if he suspects his colleague is under influence ?

A. Notify the charge nurse of his suspicions.

During your clinical experience, in which areas have you observed or thought there were violations of ethical principles?

A. Older adult care B. Obstetrics C. Terminally ill patients D. Confidentiality E. Treatments or surgery

Nursing Plans and Interventions Disasters

A. Participate in development of disaster plan. B. Educate the public on disaster plan and personal preparation for disaster. C. Train rescue workers in triage and basic first aid. D. Educate personnel for shelter management. E. Practice triage. F. Treat injuries and illness. G. Treat other conditions, including mental health. H. Supervise shelters. I. Arrange for follow-up care for injuries. J. Arrange for follow-up care for psychological problems. K. Assist in recovery. L. Work to prevent future disasters and their consequences.

Skills Needed by Change Agents

A. Problem-solving B. Decision-making C. Interpersonal relationships

A client who is having chest pain is to undergo emergency cardiac catheterization. Which of the following is the most appropriate teaching approach in this situation? A) Telling approach B) Entrusting approach C) Reinforcing approach D) Participating approach

A. Telling approach The telling approach is used when teaching limited information, such as in an emergent situation. The entrusting approach provides the client the opportunity to manage self-care. In the participating approach, the nurse and client set objectives and become involved in the learning process together. Reinforcement requires the delivery of a stimulus that increases the probability of a response.

A client was in pain following surgery. The nurse administered the prescribed analgesics, but the client's pain rating stayed the same (8 out of 10). What should the nurse recognize? A) The pain plan needs changing. B) The client is overrating the pain. C) Complications from surgery are occurring. D) Nonpharmacological pain-relieving strategies are now appropriate.

A. The pain plan needs changing The current pain medications are not effectively relieving the pain. The nurse needs to call the physician and discuss changing the medication is some way (type, dose, frequency, formulation). Pain is what the client says it is. There is no objective way to measure pain. The clinician must accept the client's report of pain. Nonpharmacological strategies are adjuncts to the pain plan. They are not to be used in place of pain medications. Pain following surgery is an expectation.

Nursing Interventions and Roles in Triage

A. Triage duties using a systematic approach such as the START method. B. Treatment of injuries. 1. Render first aid for injuries. 2. Provide additional treatment as needed in definitive care areas. C. Treatment of other conditions, including mental health. 1. Determine health needs other than injury. 2. Refer for medical treatment as required. 3. Provide treatment for other conditions based on medically approved protocols.

The nurse asks a client, "Ms. Neil, describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?" This series of questions would likely occur during which phase of a client interview? A) Working B) Orientation C) Termination

A. Working The nurse's questions exemplify the working phase of the interview.

A nurse teaching client about Patient Protection & Affordable Care Act & his rights regarding insurance coverage. Which statement by client indicates understanding of teaching?

A."My insurance coverage no longer has lifetime coverage limits."

Which of the following competencies are important for the nurse leader to develop?

Ability to diagnose a situation, adapt, and communicate

2 types of resistance to change

Active resistance and passive resistance

Which behavior will best minimize a nurse's risk for a malpractice claim?

Always function with the state's nursing practice act

Crime

An act contrary to a criminal statute. Wrongs punishable by the state, committed against the state, with intent usually present. The nurse remains bound by all criminal laws.

When the care required of a patient comes into conflict with the nurse's personal beliefs, what situation exists?

An ethical dilemma

Assault

An intentional threat of unlawful touching of another, giving the person a reasonable fear of harmful conduct. (No actual contact is required for this to occur) ex: threaten to restrain a person for refusing consent.

Emergency admission

Any adult may apply for emergency detention of another. However, medical or judicial approval is required to detain anyone beyond 24 hours. 1. A person held against his or her will can file a writ of habeas corpus to try to get the court to hear the case and release the person. 2. The court determines the sanity and alleged unlawful restraint of a person.

Describe nursing care of the restrained client

Apply restraints properly; check restraints frequently to see that they are not causing injury and record such monitoring; remove restraints as soon as possible; use restraints only as a last resort.

A charge nurse on a med surg unit is assigning client care to an RN and an LPN. Which of the following tasks should the nurse assign to the RN? Select all that apply. A. Performing colostomy care B. Administering blood to a client C. Developing a plan of care for a client D. Calculating a TPN flow rate E. Checking nasogastric tube patency

B, C, D

A client needs to learn how to administer a subcutaneous injection. The nurse knows the client is ready to learn when the client: A) Has walked 400 feet B) Expresses the importance of learning the skill C) Can see and understand the markings on the syringe D) Has the dexterity needed to prepare and inject the medication

B. Expresses the importance of learning the skill When the client can verbalize the need to learn, the client is ready to learn to read the markings on the syringe, and the nurse can assess whether the client has the dexterity to perform the injection. The ability to walk 400 feet is not a prerequisite for learning about subcutaneous injection.

When teaching is viewed as communication, then a specific learning objective can be said to be developed from: A) The message B) The referent C) Feedback D) Intrapersonal variables

B. The referent The referent is the perceived need for information. This provides the basis for the learning objective. The message refers to the information taught. Feedback is used to determine whether or not the learning objective was achieved. Intrapersonal variables are assessed to determine willingness and ability to learn.

What impact do ineffective nurse managers have on others?

Can harm employees, clients and the organization for which they work

Delegation to AP

Cannot delegate the nursing process, Client education, or tasks that require clinical judgment to LPN or AP.

What are some disadvantages of functional nursing care?

Care can be fragmented, Pt may become confused with so many different care providers, caregivers feel unchallenged

What are some advantages of functional nursing care

Care is provided economically and efficiently, minimum number of RNs required, tasks are completed quickly

Quality Improvement

Care- related and organizational processes that involve the development and implementation of a plan to improve healthcare services and better meet clients needs.

A nurse educator determines that the present classroom environment is ineffective in promoting critical thinking. What methods could the educator employ in the classroom to improve critical thinking? (Select all that apply.)

Case studies Problem-based learning exercises Simulation

This budget is a plan for monthly bills and receipts

Cash Budget (Petty cash)

What is a focus of thought leadership?

Challenging the status quo

_______________ are influenced by values

Choices

Which type of law regulates the practice of nursing?

Civil law

Which action is associated with relationship age leadership? Select all that apply.

Communicates regularly with subordinates Encourages teamwork to achieve problem solving Includes committee representatives from all areas that will be affected by the change Recognizes staff members who have contributed plausible problem-solving solutions

Skills of the Nurse Manager

Communication, Act as a liaison between clients and others, Engage in conflict resolution as needed with staff. Organization, Plan overall strategies to address client problems, Review management outcomes. Delegation, Identify roles/responsibilities of health care team members. Supervision, Supervise care provided by others. Critical thinking, Serve as resource person to other staff

Controlling

Comparing actual performance to a standard ad revising the original plan as needed to achieve the goals

What is the nurse's best safeguard against legal prosecution?

Competent practice

What are some potential conflict generators in the workplace?

Competition, increased workload, multiple role demands, threats to safety/security, scarce resources, cultural differences, invasion of personal space

Steps of a lawsuit

Complaint, discovery, deposition, and trial

Define an intentional tort, and give one example

Conduct causing damage to another person in a willful or intentional way without just cause. Example: Hitting a client out of anger, not in a manner of self-protection

Surgical Permit

Consent to operate (surgical permit) must be obtained prior to any surgical procedure, however minor it might be. Must be 1. written. 2. obtained voluntarily. 3. explained to the client (i.e., informed consent must be obtained).

Max Weber, a well-known German sociologist, began to study large-scale organizations to determine what made some more efficient than others. What was his conclusion?

Consistent rules and regulations for workers increased efficiency

Mishel's theory of uncertainty in illness focuses on the experience of clients with cancer who live with continual uncertainty. The theory provides a basis for nurses to assist clients in appraising and adapting to the uncertainty and illness response and can be described as: A) A grand theory B) A descriptive theory C) A prescriptive theory D) A middle-range theory

D. A middle-range theory Middle-range theories are limited in scope, less abstract than grand theories, address specific phenomena or concepts, and reflect practice. Grand theories are described as broad and complex. Prescriptive theories address nursing interventions and predict the consequence of a specific nursing intervention. Descriptive theories describe phenomena, speculate as to why the phenomena occur, and describe the consequences of phenomena

The type of theory that tests the validity and predictability of nursing interventions is: A) A grand theory B) A descriptive theory C) A prescriptive theory D) A middle-range theory

D. A middle-range theory Prescriptive theory addresses nursing interventions and predicts the consequence of a specific nursing intervention. Middle-range theories are limited in scope, less abstract than grand theories, address specific phenomena or concepts, and reflect practice. Descriptive theories describe phenomena, speculate as to why the phenomena occur, and describe the consequences of phenomena. Grand theories are broad and complex.

During the change-of-shift report the night nurse states that a client mentioned having a bad experience with surgery in the past. The nurse was called away and was unable to continue the conversation with the client. The nurse tells the day shift nurse about the comment and notes that the client appears anxious. When the day shift nurse visits the client to clarify the client's bad experience with surgery, the nurse is exhibiting which aspect of critical thinking? A) Integrity B) Discipline C) Confidence D) Perseverance

D. Discipline Discipline includes completing the task at hand, including assessments (which were not completed on the previous shift). Integrity includes recognizing when one's opinions conflict with those of others and finding a mutually satisfying solution. Confidence is demonstrated in one's presentation and belief in one's knowledge and abilities. Perseverance helps the critical thinker to find effective solutions to client care problems, especially when they have been previously unresolved.

2 nurses on unit each say the other not doing fair share of work. Conflict is affecting unit. charge nurse should recognize which is an appropriate approach to conflict?

D. Explore alternative solutions to address unit workflow with the nurses.

In order to determine whether an intervention was successful, the nurse evaluates the success of attaining a goal. Which of the following is an example of an evaluation? A) Dressing changed every 8 hours using sterile technique. B) Client will ambulate 500 feet 4 times a day with minimal assistance. C) Client performed quadriceps-setting exercises to right leg every 4 hours. D) Wound filling in with granulation tissue is red to pink without signs of infection.

D. Wound filling in with granulation tissue is red to pink without signs of infection Evaluation occurs after an intervention and indicates degree of achievement of goal attainment. The qualifier "will" indicates that this is a future event and does not evaluate current attainment of goal. Doing an intervention is not evaluating whether it was effective or not.

1. Management is a process that is used today by nurses or nurse managers in health care organizations and is best described as A. scientific management B. decision making C. commanding and controlling others using hierarchical authority D. planning, organizing, coordinating, and controlling

D. planning, organizing, coordinating, and controlling

This type of organization gives power to those who are affected by decisions

Decentralized/Non-traditional/Innovative

A nursing staff is presently using disposable biopsy forceps in the endoscopy suite, and the nurse manager is questioning the cost-effectiveness of this practice. What would be an appropriate decision-making model to find a cost-efficient solution?

Decision grid

A nurse manager is mentoring a new facilitator. What decision-making models can the manager suggest to the facilitator that will help minimize the impact of an unskilled facilitator?

Decision tree Consequence table Decision grid Payoff table

Decision Making Styles

Decisive, Flexible, Hierarchal, Integrative

What are some types of errors that can occur in healthcare delivery

Diagnostic, treatment, preventative

Name four types of costs incurred by businesses

Direct, indirect, fixed and variable

List the three levels of disaster management

Disaster preparedness, disaster response, disaster recovery.

Do's and Don'ts for managing diversity

Do - recognize it, value it and develop support for it, Ensure fairness, make all of the above part of your philosophy. Don't- pretend all are alike, expect everyone to conform, seek quick solutions, develop different performance standards, expect one workshop/meeting to solve it.

A nurse is travelling to work on the highway. The nurse sees a car get hit from the rear. The car spins out of control and hits the median. The nurse stops to help at the scene. Legally, the nurse may do this based on the Good Samaritan Law. What ethical framework is the Good Samaritan Law based upon?

Duty based

List some examples of professional negligence

Duty owed, duty breached, forseeability(Knowingly fails to meet standards), causation, injury, damages

List the four elements that are necessary to prove negligence

Duty. Breach of duty. Causation. Damages

Compromising/ Negotiating

Each party gives up something. win-lose

How do managed healthcare organizations promote health?

Education, early diagnosis, self-care, prevention, reduce duplication

A manager demonstrating an understanding of the principles of Human Capital theory will schedule which staff in-service? Select all that apply.

Effective communication skills Advanced cardiopulmonary resuscitation Meeting the needs of the patient's family

What does knowledge about good decision making lead one to believe?

Effective decision makers are sensitive to the situation and to others

Employee-Centered Leadership

Effective leadership described as having focus on the human needs of subordinates

HESI Hint #8

Effective leadership involves assertive management skills. Look for responses that demonstrate that the nurse is using assertive communication skills

Human Resources

Ex: Having the right staff on the healthcare team to complete various assignments.

Physical Resources

Ex: Patient care equipment used to complete work.

What does a decision grid allow the decision maker to do?

Examine alternatives visually and compare each against the same criteria

Nurses

Example of someone who is a servant and a leader

Good Leader-Member Relations

Exists when followers respect, trust, and have confidence in the leader.

True

Experience may serve as a substitute for leadership. True or False?

Exposure of a person

Exposure or discussion of a client's case. After death, a client has the right to be unobserved, excluded from unwarranted operations, and protected from unauthorized touching of the body.

These are non life essential values (things, people, ideas, kindness, and understanding)

Extrinsic values

Behaviors at risk for violence

History of violent behavior, delusions paranoia suspicion, aggression, threats, rapid speech, anger, stiff posture, clenched fists, ETOH/drug use, male or youth, unrealistic policies/procedures

Phases of reality shock

Honeymoon, shock, recovery and resolution

What are some common areas for primary care nursing delivery?

Hospice, Home Health, Long Term Care, (my sub-acute detox facility I work on)

A nursing instructor is discussing ways to improve critical thinking during a clinical rotation with a student. The student asks the nurse what critical thinking is. What is the best response by the nursing instructor

It requires reasoning and creative analysis.

An elderly patient is admitted to the cardiac floor for worsening congestive heart failure. As the nurse is obtaining baseline vital signs, the patient states, "My neighbor is in the ICU on one of those machines that keep people breathing forever. I never want to end up like that." Which response by the nurse is best?

It sounds likes you have given this a lot of thought. Would you like me to arrange for you to complete an advance directive and share this with your family?

A nurse manager is reviewing the stages of conflict resolution with the nursing staff. The nurse manager should instruct the staff to expect the stages of conflict to occur in what order?

Latent Conflict. Percieved Conflict. Felt Conflict. Manifest Conflict. Conflict Aftermath.

What is the best reason that nurse-managers have an ongoing responsibility to be aware of legislation affecting nursing practice?

Laws are fluid and subject to change

Good _______________ empowers others

Leadership

This is created as an attempt to demand lower health care prices by consumers and employers. (the strongest movement in healthcare)

Managed Health Care organizations

This is the act of getting work done through others by planning, organizing and commanding employees

Management

Explain the differences between management and leadership

Management-Assigned formal position, budgets, hires/fires. Leadership -Achieved informal position, part of every RN's responsibility

Financial Resources

Managers must use these wisely to achieve organizational goals

Collecting data about the ethical problem and identifying who should be involved in the decision-making process is accomplished in which phase of the MORAL decision- making model?

Massage the dilemma

These are established guidelines for the nursing profession to ensure quality of care

Nursing Standards

How Can I Avoid a Malpractice Claim? (Cont.)

Patient falls Implement a fall reduction program Primary risk, second only to drug errors Source of physical and psychological injury to older patients First duty to patient Notify physician to assess and treat Make sure patient is protected from another fall Notify family Document what occurred

Motivator Factors: Present

People are motivated and satisfied with their job

Motivator Factor: Absent

People have neutral attitudes about their jobs or organizations

This liability is your individual responsibility for action or inaction

Personal liability

Five major of management functions

Planning, organizing, staffing, directing, and controlling.

Nurse overheard staff discussing a client's care. Which intervention should nurse take?

Report incident to nurse manager.

AKA - Bottling emotions (inappropriate way of dealing reality shock)

Rutter

A new nurse manager is interested in a transformational leadership style. Which statement best describes this type of leadership?

Seeks input from all staff for joint problem solving with a focus on team building

List some ways RNs organize their work

Set long and short term goals, use lists, ticker files, time blocks, filing systems

In this nursing care delivery model the RN acts as a leader and coordinates all care for a group of patients. Was formed in the 50's to improve pt satisfaction and reduce fragmented care

Team Nursing (RN team A LPN team A PCA team A delivers care for the group of pts assigned to team A; RN teamb, LPN team B PCA team B delivers care for the group of pts assigned to team B)

List four types of nursing care delivery methods

Team nursing, Functional nursing, Primary nursing, total care nursing

Flexible

Team uses a limited amount of data and generates several options.

What defines the legal boundaries of nursing at the state level?

The Nurse Practice Act

HESI Hint #11

The RN is accountable for adhering to the 3 basic aspects of supervision when delegation to other health care personnel, such as LPNs, graduate nurses, inexperienced nurses, student nurses, and UAPs.

Emotional Intelligence

The ability of an individual to perceive and manage the emotions of self and others. Also important characteristic of the successful nurse leader. Has insight into their emotions of members of the team, understands the perspective of others, encourages a constructive criticism and is open to new ideas, is able to maintain focus while multitasking, manage his emotions and channels them in a positive direction which in turn helps the team accomplish its goals, Is committed to the delivery of high-quality client care, and refrains from judgment and controversial or emotionally charged situations until facts are gathered.

Autonomy

The ability of the client to make personal decisions, even when those decisions may not be in the clients own best interest.

Goleman in his best seller Emotional Intelligence identifies self-awareness as one of the five components of emotional intelligence. What is self-awareness?

The ability to recognize and understand one's moods, emotions, and drives as well as their effects on others

Staffing

The acquisition and management of adequate staff and staffing mix.

Delegation skills

The authority, accountability, and responsibility of the RN are based on the state Nurse Practice Act, standards of professional practice, the policies of the health care organization, and ethical-legal models of behavior. The nurse transfers responsibility and authority for the completion of delegated tasks, but the nurse retains accountability for the delegation process. This accountability involves ensuring that the five rights of delegation have been achieved

While focusing on preparing for an upcoming accreditation visit, a new charge nurse becomes aware of an interpersonal conflict between two nurses occurring on her shift. Given the pending accreditation visit, she decides to disregard the conflict. The nurse manager explains that which outcome may result from this avoidance approach?

The conflict will remain and reemerge at a later time in a more exaggerated way

Critical judgment

The decision made regarding a course of action based on a critical analysis of data when using knowledge is applied to clinical situation. The nurse uses this to analyze data and related evidence, ascertain the meeting of the data and evidence, determine a client outcomes desired and/or achieved as indicated by evidence-based practices.

Position Power

The degree of formal authority and influence associated with the leader.

Teamwork and Collaboration

The delivery of client care in partnership with multi-disciplinary members of the healthcare team to achieve continuity of care and positive client outcomes.

What statement describes the concept of quantum leadership?

The environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity

How is the question of whether a nurse acted with reasonable care generally proven?

The expert testimony of nursing witnesses

Leader-Member Relations

The feelings and attitudes of the followers regarding acceptance, trust, and credibility of the leader.

Which situation is characteristic of the weakness of the nursing process?

The frequent absence of well-written patience-focused objectives

Consent

The law does not require written consent to perform medical treatment. 1. Treatment can be performed if the client has been fully informed about the procedure. 2. Treatment can be performed if the client voluntarily consents to the procedure. 3. If informed consent cannot be obtained (e.g., client is unconscious) and immediate treatment is required to save life or limb, the emergency laws can be applied

During a home visit to a family of three—a mother, father, and child—the mother shares with the community health nurse that the father (who is not present) has hit the child on several occasions when he was drinking. The mother further explains that she has talked her husband into attending Alcoholics Anonymous and asks the nurse not to interfere, so her husband won't get angry and refuse treatment. What is the best response by the nurse?

The nurse commends the mother's efforts and also contacts Child Protective Services.

Veracity

The nurses duty to tell the truth

Non-maleficence

The nurses obligation to avoid causing harm to the client

Leadership succession planning is defined as:

The organization has ensured that there are competent, qualified, well-prepared people available for future positions

Organizing

The organizational structure that determines the lines of authority, channels of communication, and where decisions are made.

Hawthorne Effect

The phenomena of being observed or studied, resulting in changes in behavior -"Social facilitation" -the idea that people increase their work output in the presence of others

Decisive

The team uses a minimum amount of data and generate one option.

What is the purpose of belief systems

To explain concepts such as life and health, good and evil, and health and illness

What is the purpose of peer review?

To provide the individual with feedback from those best acquainted with the requirements and demands of the position.

Define triage

To sort or categorize

This type of civil law is a legal duty of care (Duty to not harm)

Tort

What type of law states that nurses have a duty to deliver care in such a manner that pts will not be harmed? (civil law)

Tort

What term is used to identify the type of law that covers most incidences of malpractice?

Tort laws

What type of manager is concerned with the day-to-day operations?

Transactional

How is the nursing process used while delegating care?

Use Assessment to assess needs of pts, set specific goals, match the right personnel with the appropriate skills care for the pt, Use Planning to mentally identify who is best suited for the task, and prevent later problems, Use implementation to assign appropriate personnel who have the right level of expertise for the pt to deliver the care, and use Evaluation to oversee the care and determine if the pt care needs have been met and allow for feedback.

Controversial Ethical Issues Confronting Nursing (Cont.)

What is the ethical issue regarding the use of fetal tissue? Proponents argue that it is available tissue that can be put to some beneficial use in patients who do not have any other hope of significant improvement or cure Individual states also have the authority to pass laws to permit human embryonic cell research using state funding

Controversial Ethical Issues Confronting Nursing (Cont.)

What is the nurse's role in this area? Nurses provide education to patients about genetic and genomic testing, research, and treatment. One of the fastest growing areas of health care research

Moral and Ethical Principles (Cont.)

What other resources are available to help resolve ethical dilemmas? ANA Code of Ethics for Nurses ICN Code for Nurses Your rights as a hospital patient Home Care Bill of Rights for Patients Nuremberg Code

Malpractice Insurance (Cont.)

What should I ask about institutional coverage? Name of carrier, policy limits, and rating of carrier Covered for all acts occurring? Acts not covered? Covered if you need to appear before State Board of Nursing? Independent practitioners must know how they are covered by employers Limited coverage if working in physician's office If self-employed, need to purchase coverage

The nurse must get a consent signed by the patient regarding their upcoming surgery. She notes in the chart that the patient was medicated for pain one hour ago with hydromorphone. Ethically, what should the nurse do?

Withhold the consent until another time.

Responsibilities of a Nurse for Informed Consent

Witnesses informed consent which includes: ensuring that the provider gave the client information needed, ensuring the client understood the info given, notifying the provider if the client has any Q's, watching the client sign

What assumption about workers does Theory X hold?

Workers need threats to be motivated

Causation

a connection exists between conduct and the resulting injury referred to as "proximate cause" or "remoteness of damage"

This ethical principle means being responsible for your own action to self and other collegues

accountability

Contingency Theory

acknowledges that other factors in the environment influence outcomes as much a leadership style and that leader effectiveness depends upon something other than the leader's behavior.

Incivility

action that is rude, intimidating, and insulting. Includes teasing, joking, dirty looks, and uninvited touching

Voluntary admission

client admits himself or herself to an institution for treatment and retains civil rights

False imprisonment

confinement without authorization

Excellence

creating and implementing transformative strategies with daring ingenuity

Force

describes the amount of effort one will exert to reach one's goal

Organizational Skills

encompass management of: A. people. B. time. C. supplies

Samantha recognizes the need to adhere to the ethical principle of beneficence when addressing this challenge in Mary's care. Samantha can best promote beneficence in Mary's care by:

ensuring that Mary's best interests inform any decisions that are made.

Injury/damages

failure to meet standard of care, which causes actual injury or damage to the client, either physical or mental.

Breach of duty

failure to perform according to the established standard of conduct in providing nursing care

True or False, it is more difficult to provide positive feedback than to provide negative feedback?

false, it is more difficult to provide "good negative feedback" Than positive feedback.

Nurse's Responsibility in making assignments

governed by Nurse Practice Acts. 1. Assignments should be commensurate with the nursing personnel's educational preparation, experience, and knowledge. 2. The nurse should supervise the care provided by nursing personnel for which he or she is administratively responsible. 3. Sterile or invasive procedures should be assigned to or supervised by a professional nurse (RN).

Country Club Leader

high people concern and low production concern

Team Leader

high production concern and high people concern

Authority Compliance Leader

high production concern and low people concern

Lateral Violence

horizontal abuse or hostility. Occurs between individuals who are at the same level within the organization. For example, a more experienced staff nurse may be abusive to a newly licensed nurse. Behaviors include verbal abuse, undermining activities, sabotage, gossip, withholding information, and ostracism

Motivator Factors

include satisfying and meaningful work, development and advancement opportunities, and responsibility and recognition. -Important to recognize that not al lpeople respond to the same ones.

Stewardship

includes the management of something entrusted to one's care

Leading

influencing others to achieve the organization's goals and involves energizing, directing, and persuading others to achieve those goals

Consideration

involves activities that focus on the employee and emphasize relating and getting along with people.

Autocratic Leadership

involves centralized decision making, with the leader making decisions and using power to command and control others. Associated with high-performing groups, but close supervision necessary, and feelings of hostility often present.

Initiating Structure

involves emphasis on the work to be done, a focus on the task, and production.

Planning

involves setting goals and identifying ways to meet them

Civil procedures

methods used to protect the rights of psychiatric clients

Inability to stand trial

person accused of committing a crime is not mentally capable of standing trial. He or she: 1. Cannot understand the charge against himself or herself. 2. Must be sent to psychiatric unit until legally determined to be competent for trial. 3. Once mentally fit, must stand trial and serve any sentence, if convicted

Civil Laws

protect the individual rights of people

The unit policy and procedure manual states that, for all clients admitted to the cardiac unit, if the client experiences chest pain, 1/150 grain nitroglycerin should be administered sublingually and an electrocardiogram should be obtained immediately. This is an example of a(n) _____________.

protocol

Hospital policies

provide a guide for nursing actions. They are not laws, but courts generally rule against nurses who have violated the employer's policies. Hospital can be liable for poorly formulated or poorly implemented policies

Good Samaritan laws

provide protection to health care professionals; however, health care professionals are still accountable for maintaining a reasonable standard of care.

Nurse Practice Acts

provide the laws that control the practice of nursing in each state.

Achievement-Oriented Style of Leadership

provides high structure and direction as well as high support through consideration behavior.

Verbal telephone prescriptions

should be avoided, the nurse should follow the agency's policy and procedures. Failure to follow such rules could be considered negligence. The Joint Commission requires that organizations implement a process for taking verbal or telephone orders that includes a read-back of critical values. The employee receiving the prescription should write the verbal order or critical value on the chart or record it in the computer and then read back the order or value to the HCP.

involuntary admission

someone other than the client applies for the client's admission to an institution. 1. This requires certification by a health care provider that the person is a danger to self or others (Depending on the state, one or two health care provider certifications are required). 2. Individuals have the right to a legal hearing within a certain number of hours or days. 3. Most states limit commitment to 90 days. 4. Extended commitment is usually no longer than 1 year.

These types of tests determine probability (likelihood something will happen)

statistical tests

Transformational Leader

the leader who is committed to a vision that empowers others. Motivates others by behaving in accordance with values, providing a vision that reflects mutual values, and empowering others to contribute. "Commits people to action, who converts followers into leaders, and who converts leaders into agents of change."

List five activities a person who is declared incompetent cannot perform

vote, make contracts or wills, drive a car, sue or be sued, hold a professional license.

Can an RN delegate to an AP to feed a client not on swallow precautions?

yes

Can an RN delegate to an LPN to perform suctioning?

yes

TRUE OR FALSE: Using first impressions to guide the decision-making process is a common flaw and considered a pitfall in using decision-making tools.

TRUE

Describe the traditional organizational structure

Tall and narrow chain of command - Employees ranked top to bottom with the number on bottom greater than the top, authority is at the top only, power is distributed, communication is a challenge because of all of the layers of power

A nurse is assigning care for four clients. Which of the following tasks should the nurse plan to delegate to an AP?

C. Record a client's meal intake.

What are the five rights of delegation?

Right task, right circumstance, right person, right direction or communication, and right supervision.

What document permits a registered nurse to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful?

A state nursing license

A nurse delegates to an AP to assist in obtaining vital signs from a postop patient who required naloxone (narcan) for depressed respirations. Is this an appropriate task for the AP?

no

This is "do no harm" ethical principle

nonmaleficence

Requirements for informed consent

Mentally competent adult - voluntary, client understands exactly what they are consenting to, Consent includes risks alternative treatments available and outcomes, consent is written

This is a measure of the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current and professional knowledge

Quality

Consent

Individuals authorized to grant consent for another person include parent of a minor, legal guardian, court specified representative, spouse or closest available individual who has durable power of attorney for healthcare, emancipated minors.

2 out of 3 people leave a job because of this

Ineffective/incompetent management

User-Driven Practices

the individual, at a time when digital mediums have given us more access to information and therefore more choices, acts more independently and is increasingly accountable for for those choices and actions.

Responsibility

the obligation to complete a task

Transactional Leader

the traditional manager concerned with day-to-day operations

Which approach resonates with you regarding ethical decision making?

A. Deontology B. Teleology C. Situational D. All of them E. None of them

This type of leader is directive an controlling and can damped the creativity and inhibit motivation of the group (Very efficient)

Autocratic/ authoritarian

This type of leader tries to move the group toward their own (the leaders) goals

Autocratic/authoritarian

This is the freedom to make ones own decisions

Autonomy

Ethical Principles of Nursing

Autonomy Beneficence Fidelity Justice Non-maleficence Veracity

Name some ethical principles

Autonomy, nonmaleficence, beneficence, justice, fidelity, confidentiality, veracity, accountablity

Which characteristics are required of a reasonable and prudent nurse?

Average nursing judgment and skills

Choices to resolve conflict

Avoid it, accommodate, compete, compromise, collaborate

Describe the nurse's legal responsibility when asked to perform a task for which he or she is unprepared.

Inform the HCP or person asking the nurse to perform the task that he or she is unprepared to carry out the task; refuse to perform the task.

A client is prescribed morphine sulfate IM. Which of the following should the nurse recognize as a requirement for governing controlled substances? A. Delegate med admin to a RN B. Ask another nurse to observe disposal of unused med C. Request another nurse to validate admin of the med D. Observe the LPN admin the med

B

What are the skills needs of a novice RN?

Interpersonal skills, Clinical skills, organizational skills, delegation skills, prioritization skills, improved social skills

3 quality behaviors of effective nurse managers?

Interpersonal, decisional and informational behaviors along with leadership, business sense and clinical expertise

A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the following actions should the nurse plan to take?

B. Inform the assistive personnel of the client's weight bearing status.

Types of ethical values

Intrinsic, extrinsic, personal and professional

Battery

touching, with or without the intent to do harm (e.g., hitting or striking a client). If a mentally competent adult is forced to have a treatment he or she has refused, battery occurs.

Name three legal requirements of a surgical permit

voluntary, informed, written

Hygiene-Maintenance Factors

Include adequate salary status, job security, quality of supervision, safe and tolerable work conditions, and relationships with others

Do's of feedback

Include positive comments, be objective, be specific, treat everyone the same, correct people privately

Managerial Roles

Includes behaviors, expectations, and recurrent activities within a pattern that is part of the organization's structure -Information processing -Interpersonal -Decisional

What rights do patients have? (Select all that apply.)

- The right to protection of their privacy - The right to end treatment without physician consent -- The right to informed consent -The right to respectful care free of discrimination

This was a group of recommendations by the institute of medicine to enhance safety, encourage learning from errors, sets standards for safety and safety systems

"To Err is Human" recommendation

What are the requirements of the patient self determination act

Advanced directives - (Each person must be provided with information regarding them, documentation must be made, education necessary, respect pts rights, demonstrate cultural humility)

A nurse manager is holding a meeting to discuss a sensitive issue with the staff. A previous meeting was held regarding the same issue and it ended in a negative manner. What action can the manager take in order to minimize the impact of leader/group style mismatch?

Appoint a leader as a participant.

Infants and Toddlers Home Risks

Aspiration, burns, suffocation (crib slats no more than 2.5 inches, "Back to sleep"), poisoning, falls, Motors vehicle/ injury (rear-facing car seat until 2 yrs or exceed ht and wt)

List 3 sources that laws come from

Constitution, statutes, Administrative

Which of the following statements is true regarding decision making?

Decisions are greatly influenced by each person's value system

Selling Leadership Style

High task behavior and high relationship style

This is leadership exercised by a person with no official power but influences others (can be positive or negative influence)

Informal leadership

A nurse manager schedules a meeting with the staff to discuss policy changes. What does the manager hope to achieve by having some upper left-brain dominant staff members lend their input?

Logical and rational analysis

Who Might Have Liability (Responsibility) in a Claim?

Personal liability Each individual accountable for own actions You are held to professional standard of care Physician and other practitioner liability NOT ultimately responsible for everything that happens to the patient Nurses follow orders, but not those unsafe for patients or out of scope of practice—thus, nurses bear responsibility for their own actions.

2 types of change

Planned/Managed, Unplanned/Reactive

Which action demonstrates appropriate management regarding legal issues? Select all that apply.

Remains current on all institutional policies and procedures Delegates with consideration to appropriate scopes of practice Requires physical proof of appropriate professional licensure each year

Job-Centered Leadership

Seen as less effective leadership because of their focus on schedules, cost, and efficiency resulting in lack of attention to developing work groups and high performance goals.

Delegating

The process of transferring the authority and responsibility to another team member to complete a task, while retaining the accountability.

Why should nurses be aware of the rights and duties of legal matters?

They are better able to protect themselves

Why are clinical pathways used?

To decrease cost (save money)

Types of Civil Law

Tort, Quasi-Intentional Tort, Negligence, Malpractice

Driving forces

What will cause change to happen

Contemporary Approaches to Leadership

address the leadership functions necessary to develop learning organizations.

Diversity

affirming the uniqueness of and differences among persons, ideas, values, and ethnicities

Negligence

performing an act that a reasonable and prudent person would not perform. The measure of negligence is "reasonableness" (i.e., would a reasonable and prudent nurse act in the same manner under the same circumstances?)

Directive Style of Leadership

provides structure through direction and authority, with the leader focusing on the task and getting the job done

Phenomenology is a

qualitative research method that provides additional understanding of participants' experiences with emotional variances, such as grief and hope.

Meta-analysis is a

quantitative research method that provides a statistical analysis of multiple studies conducted on the same topic.

Experimental study is a

quantitative research method that uses control and treatment groups to test at least one independent variable.

Secondary analysis is a

quantitative research method that uses previously collected data to answer newly formed hypotheses.

Mobility

refers to the ability to change skill sets as well as having the work dispersed among a variety of work locations, rather than work occurring at fixed sites.

An RN has to teach the client initially but can delegate ________to an LPN.

reinforcing the teaching

Supportive Style of Leadership

relationship oriented, with the leader providing encouragement, interest, and attention.

Integrity

respecting the dignity and moral wholeness of every person without conditions or limitation

Smoothing

one party attempts to "smooth" another party by trying to satisfy the other party. lose-lose

Informed consent

operation has been fully explained to the client including: 1. Possible complications and disfigurements 2. Removal of any organs or parts of the body.

Fire Class A

paper, wood, upholstery, rags, or other types of trash fires

Knowledge Workers

people who bring specialized, expert knowledge to an organization. They are valued for what they know.

Protecting patient confidentiality respects the client's right to

self-determination

Fraud

willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Examples of fraud include: 1. Presenting false credential for the purpose of entering nursing school, obtaining a license, or obtaining employment. 2. Describing a myth regarding a treatment (e.g., telling a client that a placebo has not side effects and will cure the disease or telling a client that a treatment or diagnostic test will not hurt, when indeed pain is involved in the procedure)

When must the NCLEX be taken

within two years of graduation

Can an RN delegate to an LPN to put in a urinary catheter?

yes

Is an RN allowed to delegate to an AP to collect a urine sample?

yes

Stabilize the Change

-Reinforcement -Two-way communication -Follow-up

Possible agents.

Biologic agents. Chemical agents. Radiation.

Adolescents Home Risks

Motor Vehicle/ Injury, burns

Who has the code of ethics for LPN's and LVN's?

(NAPES) National Association for Practical Nurse Education and Service. This is the World's oldest association.

Transactional Leader

-Focuses on management tasks -Is a caretaker -Uses trade-offs to meet goals -Does not identify shared values -Examines causes -Uses contingency reward -Task oriented -Concerned with the day to day operation

Which situations are necessary components for malpractice to occur? (Select all that apply.)

- A direct connection between care given and injury must be present. - A standard of care must be in place whereby the provider has accepted duty for the patient. - The practitioner has failed to meet a standard of care, also called a "breach of duty." - Foreseeability of harm must exist.

Which statement is true about an incident report? (Select all that apply.)

- A disclosed incidence report can be subpoenaed in court. - The document is generally considered confidential. - The chart should contain all the variables related to the incident.

One of the first actions a new nurse manager must address is the unit practice of posting photographs on social media of staff with favorite patients without the patient's permission. When planning communication about this topic, the nurse manager intends to use which communication techniques? (Select all that apply.)

- Differentiating between information and communication, ensuring that the unit staff receive both types of communication - Ensuring congruence in verbal and nonverbal communication with the staff - Preparing written communication with clear and specific language

What must a person giving informed consent for surgery or a procedure fully comprehend in order to give informed consent? Select all that apply

- Expected complications or potential side effects that may occur as a result of the treatment. - The risks involved - Expected or desired outcomes - The procedure to be performed

The Health Insurance Portability and Accountability Act ensures strong privacy protections for the patient without threatening access to which areas of care? (Select all that apply.)

- Health care plans - Health care clearinghouses - Exchange of patient information among appropriate health care providers

Which statement is true regarding the Good Samaritan law? Select all that apply.

- Protection provided is generally limited to emergency situations. -The provider may not exceed scope of practice limits.

A nurse manager must be aware of what is happening on the unit to prevent injury to the patient and exposing the staff to a potential malpractice situation. What steps would the nurse manager take to accomplish this? (Select all that apply.)

- Providing disciplining those who provide inappropriate care - Assuring adequate staffing - Regularly checking the credentials of current nursing staff - Arranging for relevant staff in-services regarding the operation of equipment

What information is accurate when describing the Nurse Practice Acts? (Select all that apply.)

- They need to be consistent with applicable federal statures - They identify actions that fall outside of the nurse's scope of practice - When considering the law, they are an example of a statute - They focus on the practice of the professional nurse

Management Theories

-*Scientific Management -*Bureaucratic Management -*Human Relations -Contingency -Resource Dependence -*Strategic Management -Population Ecology -Institutional -Social Network -Complex Adaptive Systems

Servant Leadership

-1970's, Robert Greenleaf -Wanting to put needs of others above all else as #1 priority -Characteristics: listening, empathy, healing, awareness, persuasion, foresight, stewardship, growth, and building community -Demotes self for the benefit of others -Not a weak form of leadership -Ex: Woody from Toy Story

Steps in the quality improvement process

-A standard is developed and approved by facility committee. -Standards are made available to employees by way of policies and procedures. -Quality issues or get a five by staff, management, or risk management department. -An interprofessional team is developed to review the issue. -The current state of structure and process related to the issue was analyzed.

Tasks that can be delegated to APs

-Activities of daily living -bathing -grooming -dressing -toileting -ambulating -feeding (without swallowing precautions) -positioning -bed making -specimen collection -intake and output -vital signs for stable clients

Evaluate the Change

-Analyze each objective -Was it met? -What evidence shows that it was met? -Was the best means used to accomplish it, or would another method have worked better? -Adjustments are made if needed

Managerial Process

-Art of accomplishing things through people -Includes planning, organizing, coordinating, and controlling -How managers spend their time on particular roles or functions varies by the level of their positions in the organizations -First-level -Mid-level -Executive level

Transformational Leader

-Committed to a vision that inspires others -Long-term vision that reflects mutual values -Empowers & motivates others to contribute -Change agent, courageous, believes in people, value driven, ability to deal with complexity, ambiguity and uncertainty -Not defined by a position -Empowers others -Needed to cause change

Categories of Triage during Mass Casualty Events

-Emergent (class 1): life-threatening injuries, but high possible survival rate once stabilized -Urgent (class 2): major injuries that are not yet life threatening. Can wait 45-60 min for trtment -Nonurgent (class 3): minor injuries that are not life-threatening and do not need immediate attention -Expectant (class 4): not expected to live and will be allowed to die naturally.

Decisional Roles

-Entrepreneur, disturbance handler, allocator of resources, and negotiator -Use by managers to take action when making decisions

Scientific Management

-Fredrick Taylor considered the "father" of this -Principles of Scientific Management (1911) -Used the scientific method -Focused his activity on the on the operations within an organization by exploring production at the worker level -Focused on productivity and goals -Viewed the organization as a machine to be run efficiently to increase production -Selects the right person to do job; provides the proper tools, training, and equipment to work efficiently -Uses time and motion studies to make work efficient

Executive level

-Highest level of the organization -Planning and being a generalist are greatly expanded role functions -Direct supervision is not a major job assignment -Chief Nurse Executive or Vice President of Patient Care Services

Manager of Change

-Improvement -Raise morale -Increase productivity -Meet patient and employee needs effectively

Communities of Practice

-Informal, self-organized communities that use a group process of organizing, principles of learning, and sharing information -Allows the creation of meaning from information or the exchange of knowledge -A way to develop new leaders -Emerge from shared activity, shared knowledge, and ways of knowing that create meaning and thus a culture of engagement, participation, and and relationships.

Traditional Change Theories

-Lewin's Force-Field Model (1951) -Lippitt's Phases of Change (1958) -Havelock's Six-Step Change Model (1973) -Roger's Diffusion Model (1983)

The New Leadership

-Margaret Wheatly (1999) -The leader's function is to guide an organization using vision, to make choices based on mutual values, and to engage in the culture to provide meaning and coherence. -This type of leadership fosters growth within each of us as individuals and as a member of the group. -Humans learn best when they are engaged in relationships with others and can exchange knowledge and expertise through informal, self organized communities. -Communities of Practice

Bureaucratic Management

-Max Weber -Hierarchical superior subordinate communication transmitted from top to bottom via clear chain of command -Merit/skill as basis for promotion and/or reward -Uses rules and regulations -Focuses on technical competence -Limits personal freedom -Emphasizes career service, salaried managers.

Information Processing Roles

-Monitor, disseminator and acting as spokesperson -Each of which is used to mange the information needs that people have

Tasks that can be delegated to LPNs

-Monitoring client findings as input to the RNs ongoing assessment of the client -reinforcement of client teaching from a standard care plan -tracheostomy care -suctioning -checking nasogastric tube patency -administration of enteral feedings -insertion of urinary catheter -medication administration (excluding IV medications in several states.)

Mid-Level

-Often called nursing unit managers or directors -Spend less time in direct supervision and more tim ein managerial roles or functions, particularly planning and coordinating

Management

-Planning, organizing & staffing, leading and controlling actions to achieve goals -Daily activities are diverse, fast-paced, and full of interruptions -Ability to set priorities, make decisions and interact with others is key -Very operational

Prioritization principles

-Prioritize system before local ("life before limb"). -Prioritize acute (less opportunity for physical adaption) before chronic (greater opportunity for physical adaption). -Actual problems before potential future problems. -Listen carefully to clients and don't assume. -Recognize and respond to trends vs transient findings. -Recognize signs of medical emergencies and complications vs "expected client findings". -Apply clinical knowledge to procedural standards to determine the priority action

What are the different types of nursing practice models

-Professional practice model, - Clinical practice model

Planned Change

-Purposeful and intentional. -There are specific reasons or goals prompting change. -To solve a problem -To improve efficiency -To reduce unnecessary workload for some group -The change is by design, not by default.

Emotional Intelligence

-a component of leadership and refers to the capacity to recognize your own feelings and those of others, for motivating yourself, and for managing emotions well in yourself and in your relationships. -Complementary to academic intelligence. -Includes 5 basic emotional and social competencies: -Self-awareness -Self-regulation -Motivation -Empathy -Social skills -Important component used to guide decision making

What are some methods used to organize nursing care?

-critical pathways, computerized information sheets, personalized worksheets, delegation trees

Self-Awareness

-knowing what you are feeling in the moment and using your preferences to guide your decision making -having a realistic assessment of your own abilities and a well grounded sense of self-confidence.

Valence

-speaks to the level of attractiveness or unattractiveness of the goal (+1= highly attractive, -1=highly unattractive, 0= goal does not interest the individual)

Discharge instructions should include:

-step by step instructions for procedures to be done at home -Medication Regimen -Precautions -Indications of medication adverse effects or complications -Names and numbers of health care providers -Plans for follow up care

First-Level

-the nurse-manager at the clinical bedside -spend the majority of the time directly managing patient care and supervising others as they deliver care. the next highest percentage of their time is spent planning and the remainder of their functions take 10% or less of their time. -charge nurse

Expectancy

-the perceived possibility that that the goal can be achieved. (1= assurance goals will be achieved, 0=individual sees the goal as impossible to achieve)

Informed Consent includes

-the reason the treatment or procedure -risks involved -other options to treat the problem -the risk involved if the client chooses no treatment

Five rights of delegation

1) Right TASK (what tasks should be delegates) 2) Right CIRCUMSTANCE (under what circumstances), 3) Right PERSON (to whom), 4) right DIRECTION/ COMMUNICATION (what information should be communicated) 5) Right SUPERVISION/ EVALUATION (how to supervise/ evaluate).

QSEN Competencies

1) Safety 2) patient centered care 3) evidence-based practice 4) informatics 5) quality improvement 6) teamwork and collaboration.

Case management:

1. Coordination of care provided by an interdisciplinary team. 2. Manages resources effectively. 3. Uses critical pathways to organize care

If a nurse is asked to perform a task for which he or she has not been prepared educationally or does not have the necessary experience:

1. Inform the HCP that he or she does not have the education or experience necessary to carry out the prescription. 2. Refuse to carry out the prescription

If a nurse questions a HCP's prescription because he or she believes that it is wrong:

1. Inform the HCP. 2. Record that the HCP was informed and record the HCP's response to such information. 3. Inform the nursing supervisor. 4. Refuse to carry out the prescription.

Quality assurance:

1. Involves continuous quality improvement (CQI)/total quality management (TQM). 2. Is an organized approach to the improvement of: Outcome achievement, Quality of care provided.

A nurse on a long-term care unit finds that a client receiving dialysis was administered captopril (capoten), which was not prescribed for the client. In which order should the nurse take the actions listed? ___Complete an incident report. ___Contact the risk manager. ___Instruct the client to call for assistance when getting out of bed. ___Measure the client's vital signs ___Notify the provider

1. Measure the client's vitals 2. Instruct the client to call for assistance when getting out of bed 3. Notify provider 4. Complete an incident report 5. Contact the risk manager

2 ways to be an emotionally stable leader

1. Recognize and understand your own emotions, learn to manage them, stay calm and clear headed. 2. Listen to others, perceive unspoken concerns, acknowledge others perspectives, helpful

Surgery permits must be obtained as follows

1. They must be witnessed by an authorized person, such as the HCP or a nurse. 2. They protect the client against unsanctioned surgery, and they protect the HCP and surgeon, hospital, and hospital staff against possible claims of unauthorized operations. 3. Adults and emancipated minors may sign their own operative permits if they are mentally competent. 4. Permission to operate on a minor child or an incompetent or unconscious adult must be obtained from a legally responsible family member or guardian.

When restraining a client, the nurse should do the following:

1. Use restraints (physical or chemical) after exhausting all reasonable alternatives. 2. Apply the restraints correctly and in accordance with facility procedures. 3. Check frequently to see that the restraints do not impair circulation or cause pressure sores or other injuries. 4. Allow for nutrition, hydration, and stimulation at frequent intervals. 5. Remove restraints as soon as possible. 6. Document the need for and application, monitoring, and removal of restraints.

Ten rules to govern healthcare reform for the 21st century as published/recommended by the institute of medicine

1. care is based on a continuous healing relationship 2. care is provided based on pt needs/values 3. pt is a source of control of care 4. knowledge is shared and free. 5. Evidence based decisions 6. safety as a system is a priority 7. secrecy is harmful, transparency is necessary 8. anticipate pt needs 9. decrease waste continually 10. cooperation needed between the healthcare providers

4 stages of burnout

1. high expectations and idealism, 2. pessimism and early job dissatisfaction, 3. withdrawal and isolation 4. irreversible detachment and loss of interest

How many characteristics such as servant leadership does Tabaka suggest is required of an agile organization today?

10

Generation Veteran

1925-1942. Supports the status quo. Accepts authority. Appreciates hierarchy. Loyal to employer.

Generation baby boomer

1943-1960. Accepts authority. Workaholics. Some struggle with new technology. Loyal to employer.

Generation X

1961-1980. Adapts easily to change. Personal life and family are important. Proficient with technology. Makes frequent job changes.

Generation Y

1981-2000. Optimistic and self-confident. Values achievement. Technology is a way of life. At ease with cultural diversity.

What Happens When I Go to Court?

95% of personal injury lawsuits are dismissed or settled out of court Discovery process Interrogatories—written questions Deposition—recorded oral questioning

A nurse overhears a client talking with an attorney, reporting physical abuse, use of restraints & denial of meals. What action should the nurse take? A. Report the conversation to the nurse manager to allow for follow-up investigation. B. Question the client about the allegations to identify staff who were allegedly involved. C. Ignore the conversation unless the client brings it to the attention of the nurse. D. Recognize this as a privileged communication that cannot be discussed w/anyone.

A

An AP reports that a client's finger-stick blood glucose reading 30 min before lunch is 58 mg/dL. The client's morning finger-stick blood glucose was 285 mg/dL. The client is asymptomatic for hypoglycemia, & his next dose of insulin is scheduled to be administered at this time. Which of the following actions should the nurse take first? A. Recalibrate the glucometer, & recheck the client's blood glucose B. Have the lab draw a stat serum glucose C. Inform the AP to give the client 120 mL of orange juice D. Administer insulin as prescribed

A

An RN on a med-surg unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LPN? A. Obtain vitals for a client who is 2 hr postop following a cardiac cath B. Administering a unit of PRBCs C. Instructing a client in the performance of wound care D. Developing a plan of care for a newly admitted client

A

An RN working w/an LPN is planning client care assignments. Which of the following tasks should the nurse delegate to the LPN? A. Performing tracheostomy suctioning for a stable client B. Performing an admission assessment of a client who is preop C. Initiating the referral of a client to hospice D. Interpreting a client's digoxin level

A

A nurse is writing a goal for a client's reaction following the admin of a med. Which of the following phases of the nursing process should the nurse modify? A. Planning B. Evaluation C. Analyzing D. Assessment

A The actual writing of an expected outcome is done in the planning phase of the nursing care plan.

A nurse is participating in an interprofessional conference for a client who has a recent C6 spinal cord injury. The client worked as a construction worker prior to his injury. Which of the following members of the interprofessional team should also participate in planning care for this client? Select all that apply. A. Physical therapist B. Speech therapist C. Occupational therapist D. Psychologist E. Vocational counselor

A, C, D, E

Triage

A French word meaning "to sort or categorize." Goal: Maximize the number of survivors by sorting the injured according to treatable and untreatable victims. Primary criteria used: Potential for survival, Availability of resources.

ealth care workers who have direct contact with individuals suspected of being contaminated with anthrax should do which of the following? (Choose all that apply.) A) Wear an isolation gown, gloves, and high-efficiency particle arrestor (HEPA) mask B) Prepare the client for transfer to the radiology department for chest radiography C) Instruct the client to wash the hands and exposed areas with soap and water D) Have the client remove clothing and place it in a sealed biohazard bag

A and D Anthrax is caused by a spore-forming, gram-positive bacillus. Humans become infected through skin contact, ingestion, and inhalation. The nurse should wear an isolation gown, gloves, and a high-efficiency particle arrestor (HEPA) mask. The client should remove potentially contaminated clothing for testing and decontamination. The client should remain in isolation until it is certain that the bacteria have been contained, not transferred to radiology. The client should shower thoroughly with soap and water, not just wash hands and exposed areas.

A client is experiencing nausea and abdominal distention postoperatively. The nurse initiates the interventions listed below. Which of the interventions is an example of an independent intervention? (Select all that apply.) A) Provides frequent mouth care B) Maintains intravenous infusion at 100 ml/hr C) Administers prochlorperazine (Compazine) via rectal suppository D) Consults with the dietitian on initial foods to offer the client E) Controls aversive odors and unpleasant visual stimulation that trigger nausea

A and E Providing frequent mouth care and controlling aversive odors and unpleasant visual stimulation that trigger nausea are examples of independent intervention. The other options are dependent interventions.

A nurse is reviewing a client's medication administration record and finds that the client has not received a prescribed dose of warfarin for 2 days. Which of the following actions should the nurse take first?

A. Check client's last INR.

Shelter Supervision

A. Coordinate activities of shelter workers. B. Oversee records of victims admitted and discharged from shelter. C. Promote effective interpersonal and group interactions among victims in shelter. D. Promote independence and involvement of victims housed in the shelter.

A nurse is caring for a client who is comatose. The client has a living will that declines the use of artificial enteral nutrition as a life-sustaining measure, but the client's family has requested that the staff begin tube feedings. Which of the following actions should the nurse take?

A nurse is caring for a client who is comatose. The client has a living will that declines the use of artificial enteral nutrition as a life-sustaining measure, but the client's family has requested that the staff begin tube feedings. Which of the following actions should the nurse take?***D. Review the client's request with the family.

Prescriptions and HCPs

A nurse is required to obtain a prescription (order) to carry out medical procedures from a HCP.

Describe 6 patient rights guaranteed under HIPAA regulations that nurses must be aware of in practice

A patient must give written consent before HCPs can use or disclose personal health information; HCPs must give patients notice about providers' responsibilities regarding patient confidentiality; patients must have access to their medical records; providers who restrict access must explain why and must offer patients a description of the complaint process; patients have the right to request that changes be made in their medical records to correct inaccuracies; HCPs must follow specific tracking procedures for any disclosures made that ensure accountability for maintenance of patient confidentiality; patients have the right to request that HCPs restrict the use and disclosure of their personal health information, though the provider may decline to do so.

What does the morale principle of autonomy govern?

A person's right to make his or her own decision

Management

A process of coordinating actions and allocating resources to achieve organizational goals.

Leadership

A process of influence in which the leader influences others toward goal achievement.

The nurse gathered the following assessment data. Which of these cues form a pattern? (Select all that apply.) A) Client is restless. B) Respirations are 24/min and irregular. C) Client states feeling short of breath. D) Fluid intake for 8 hours is 800 ml. E) Client has drainage from surgical wound. F) Client reports loss of appetite for over 2 weeks.

A, B, and C The data in items 1, 2, and 3—rapid irregular breathing, complaints of shortness of breath, and restlessness—form a pattern indicating that the client may be experiencing hypoxia, because all are signs and symptoms characteristic of this condition. The other information, although important, is not related to hypoxia.

The nurse delegates to an unlicensed assistant the task of removing the restraints from the client's wrists every ________ hours and reporting any abnormalities. A) 2 B) 4 C) 6 D) 8

A) 2 Removal of restraints and inspection of the contact area every 2 hours is a requirement of The Joint Commission. The time periods in the other options are too long. The client could experience a serious complication if restraints are not removed and the area under the restraints inspected frequently.

When a nurse is performing surgical hand hygiene, the nurse must keep the hands: A) Above the elbows B) Below the elbows C) At a 45-degree angle D) In a comfortable position

A) Above the elbows When surgical hand hygiene is performed, the hands should always be kept above the elbows so that the water runs from the hands to the elbows.

A student nurse is designing a health fair project aimed at reducing motor vehicle accidents. For which group of clients would this subject be most appropriate? A) Adolescents B) Older adults C) Middle-aged adults D) School-aged children

A) Adoescents The risk of motor vehicle accidents is higher among teen drivers than in any other age group.

As a member of the hospital's bioterrorism team, the nurse understands the importance of knowing how an organism is transmitted. Smallpox has the potential to spread quickly because it is transmitted via which route? A) Airborne B) Ingestion C) Absorption D) Blood-borne

A) Airborne Organisms with an airborne route of transmission can claim many victims and spread very quickly. Smallpox is not spread via blood. There is no such thing as an absorption or ingestion route of transmission.

The most effective way to break the chain of infection is by: A) Practicing good hand hygiene B) Wearing gloves C) Placing clients in isolation D) Providing private rooms for clients

A) Practicing good hand hygiene Good hand hygiene is the most effective way to break the chain of infection. Wearing gloves can help in decreasing disease transmission, but clean hands are required for it to be truly effective. Placing clients in isolation is costly and often unnecessary, and clients can be psychologically harmed by isolation. Even providing private rooms for clients will not be effective if health care workers do not follow good hand hygiene practices.

A client is brought back to the unit after a total hip arthroplasty. The client is confused, is moving his leg into positions that could dislocate the new hip joint, & repeatedly attempts to get out of bed. Which of the following actions should the nurse take? Select all that apply. A. Apply arm & leg restraints immediately B. Get an order from the provider C. Have a family member sign the consent for restraints D. Use a square knot to secure the restraints to the bed frame E. Ensure that only one finger can be inserted between the restraint and the client

A, B, C

Which of the following are defining characteristics for the nursing diagnosis of Impaired urinary elimination? (Select all that apply.) A) Nocturia B) Frequency C) Urinary retention D) Inadequate urinary output E) Receipt of intravenous fluids F) Sensation of bladder fullness

A, B, and C The defining characteristics for Impaired urinary elimination according to NANDA include nocturia, frequency, and urinary retention. The other options are not defining characteristics from NANDA.

A nurse working at a rehab facility attends an interdisciplinary team meeting for a client who has had a left hemispheric stroke. Which of the following members of the interdisciplinary team should the nurse expect to contribute to the plan of care? Select all that apply. A. Nurse B. Occupational therapist C. Speech therapist D. Physical therapist E. Respiratory therapist

A, B, C, D

7. Which steps do you follow when you are asked to perform a procedure about which you are unfamiliar? Select all that apply. A) Seek necessary knowledge B) Reassess the client's condition C) Collect all equipment necessary D) Have an experienced nurse available to assist E) Consider all possible consequences of the procedure

A, B, C, D, and E Each of the five options is important in performing a new procedure. Be sure to seek all necessary knowledge, consider the possible consequences of the procedure, reassess the patient, collect the appropriate supplies, and ask a nurse experienced in the procedure to help out

A client newly admitted to the hospital begins to have chest pain. Before calling the physician, the nurse should gather what additional data? (Select all that apply.) A) Pain intensity B) Location of pain C) Character of pain D) Radiation of pain E) Meaning of pain to the client F) Family history of myocardial infarctions

A, B, C, D, and E The nurse should gather the data the physician will need to determine whether the chest pain represents a myocardial infarction. Family history is important in comprehensive pain assessment; however, taking time to obtain this information is inappropriate in this critical situation.

A nurse manager is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following statements should the nurse manager include? Select all that apply. A. A description of the incident should be documented in the client's health care record B. Incident reports should not be shared w/the client C. Incident reports include a description of the incident & actions taken D. A copy of the incident report should be placed in the client's health care record E. The risk management dept. investigates the incident

A, B, C, E

A nurse manager is providing info about the audit process to members of the nursing team. Which of the following statements should the nurse manager include? Select all that apply. A. A structure audit evaluates the setting & resources available to provide care B. An outcome audit evaluates the results of the nursing care provided C. A root cause analysis is indicated when a sentinel event occurs D. Retrospective audits are conducted while the client is receiving care E. After data collection is completed, it is compared to a benchmark

A, B, C, E

A nurse is serving as a preceptor to a newly licensed nurse & is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? Select all that apply. A. Verifying that a client understands what is done during a cardiac catheterization B. Discussing treatment options for a terminal diagnosis C. Informing members of the health care team that a client has DNR status D. Reporting that a health team member on the previous shift did not provide care as prescribed E. Assisting a client to make a decision about his care based on the nurse's recommendations

A, C, D

A home health nurse is assessing the safety of a client's home. Which of the following factors may increase the client's risk for falls? Select all that apply. A. History of a previous fall B. Reduced vision C. Impaired memory D. Takes rosuvastatin (Crestor) E. Wears house slippers F. Kyphosis

A, B, C, E, F

What techniques encourage a client to tell his or her full story? (Select all that apply.) A) Active listening B) Back channeling C) Use of open-ended questions D) Use of closed-ended questions

A, B, and C Options 1, 2, and 3 encourage clients to tell their full stories. Closed-ended questions allow clients to answer with one or two words, which makes it more difficult to obtain all the information required for a full story. The other options give clients the opportunity to tell their stories and feel supported. Active listening helps them feel that they, and their stories, are important.

Which of the following are nurse-provided indirect care activities? (Select all that apply.) A) Delegating B) Documenting C) Evaluating new products D) Administering medications E) Providing client counseling

A, B, and C The correct options do not involve direct interaction with the client or family. The other options do require such direct interaction.

When determining a client's ability to perform instrumental activities of daily living, which of the following skills does the nurse assess? (Select all that apply.) A) Ability to cook meals B) Ability to feed oneself C) Ability to write checks D) Ability to bathe oneself E) Ability to take medications

A, C, and E The correct options are skills that allow the client to live independently in society. They may or may not be performed on a daily basis. The other options are activities of daily living.

A charge nurse notices a newly nurse consistently not finishing client care tasks by end of shift. Which statements should charge nurse make?

A. " You should set aside time to plan your day at the beginning of each shift."

The nurse anticipates that a right-handed client with a fractured right arm will require assistance with activities of daily living. What skill is the nurse demonstrating? A) Cognitive skill B) Behavioral skill C) Interpersonal skill D) Psychomotor skill

A. Cognitive skill The nurse is using sound judgment and clinical decisions to provide individualization of care. A decision is made without direct interaction with the client but is based on knowledge about the client. No psychomotor skill is involved in this decision-making process. There is no such thing as a behavioral skill.

An assistive personnel (AP) tells a charge nurse that it is unfair that she has to take care of all the clients who are incontinent. Which of the following responses by the charge nurse is appropriate?

A. "I delegate tasks to personnel based on their job descriptions.

A nurse is caring for an older adult client who has dementia and has become aggressive. The client's provider has prescribed wrist restraints. Which of the following actions should the nurse take while applying the restraints?

A. Apply the padded portion of the restraint around the client's wrist.

A nurse receives notification of fire on unit. Which action should nurse take first?

A. Assist clients in immediate danger to a safe location.

A nurse is caring for a client who is terminally ill and receiving nutritional support. The client's adult children disagree about continuing nutritional support. The dilemma is referred to the ethics committee. The nurse should expect which of the following actions from the committee?

A. Assisting in weighing the options involved in the decision.

A nurse is admitting a client to a cardiac intensive care unit. At what time during the client's stay at the facility should the nurse begin planning for the client's discharge needs? A. At the time of the admission interview B. When the client is transferred to the telemetry unit. C. As soon as the provider authorizes discharge. D. Following evaluation of available client resources.

A. At the time of the admission interview The nurse should begin to assess the client's discharge planning needs and support systems at the time of admission. In order to ensure continuity of care, the nurse should not wait until the client is transferred to the telemetry unit to assess discharge planning needs. In order to ensure continuity of care, the nurse should not wait until the provider authorizes discharge to assess discharge planning needs. In order to ensure continuity of care, the nurse should not wait until the client's available resources have been evaluated to assess discharge planning needs.

Do you need further explanation or clarification on any of the following ethical principles?

A. Autonomy B. Nonmaleficence and beneficence C. Fidelity D. Veracity E. Justice

Leininger's theory of cultural care diversity and universality specifically addresses: A) Caring for clients from unique cultures B) Understanding the humanistic aspects of life C) Identifying variables affecting a client's response to a stressor D) Caring for clients who cannot adapt to internal and external environmental demands

A. Caring for clietns from unique cultures The goal of Leininger's theory is to provide the client with culturally specific nursing care, in which the nurse integrates the client's cultural traditions, values, and beliefs into the plan of care.

The assessment phase of the teaching process includes: A) Determining learning needs B) Setting priorities C) Selecting teaching methods D) Selecting teaching approach

A. Determining learning needs Information obtained during the assessment will determine what is necessary for the client to learn. Because the health status of the client may undergo changes, assessment for learning needs is an ongoing process. Setting priorities and selecting teaching methods are part of the planning phase. Selection of the teaching approach is part of the implementation phase.

A client tells the nurse, "I'm not happy with the way the patient care technician did my bath. He just seemed to be in a hurry and did not wash my back like I asked." The nurse decides to go talk with the technician to learn his side of the story as well. This is an example of: A) Fairness B) Curiosity C) Risk taking D) Responsibility

A. Fairness Fairness involves analyzing all viewpoints to understand the situation completely before making a decision. Curiosity gives the critical thinker the motivation to continue to ask questions and learn more. Risk taking involves trying different ways to solve problems.

The nursing assessment is which phase of the nursing process? A) First B) Second C) Third D) Fourth

A. First The nursing process cannot proceed unless the nurse first conducts a client assessment. The other phases of the nursing process occur after assessment.

Emergency Care

A. Good Samaritan Act. B. A nurse is required to perform in a "reasonable and prudent manner"

Theories that are broad and complex are: A) Grand theories B) Descriptive theories C) Middle-range theories D) Prescriptive theories

A. Grand theories Grand theories are described as broad and complex. Middle-range theories are limited in scope, less abstract, address specific phenomena or concepts, and reflect practice. Descriptive theories describe phenomena, speculate as to why the phenomena occur, and describe the consequences of phenomena. Prescriptive theories address nursing interventions and predict the consequence of a specific intervention.

Health Insurance Portability and Accountability Act of 1996

A. HIPAA privacy rules pertain to health care providers, health plans, and health clearinghouses and their business partners who engage in computer-to-computer transmission of health care claims, payment and remittance, benefit information, and health plan eligibility information and who disclose personal health information that specifically identifies an individual and is transmitted electronically, in writing, or verbally. B. Patient privacy rights are of key importance. Patients must provide written approval of the disclosure of any of their health information for almost any purpose. HCP must offer specific information to patients that explains how their personal health information will be used. Patients must have access to their medical records, and they can receive copies of them and request that changes be made if they identify inaccuracies. C. HCPs who do not comply with HIPAA regulations or make unauthorized disclosures risk civil and criminal liability.

The nurse prepares a client for a lumbar puncture. Before the start of the procedure the nurse is sure to: A) Have the client void. B) Place the client in Sims' position. C) Premedicate the client with analgesics. D) Insert a peripheral intravenous (IV) catheter.

A. Have the client void The nurse takes care of physical needs (voiding) that could interrupt the procedure and possibly increase the risk of complications. The client assumes the fetal position or sits upright with arms over a bedside table. Because lidocaine is used in lumbar puncture, analgesics are not essential. Peripheral IV catheters are not required for this procedure.

The nurse asks the client whether the client has any allergies. This is an example of: A) Health history data B) Biographical information C) History of present illness D) Environmental history data

A. Health history data Known allergies are a part of historical data. Biographical data include age, address, occupation, work status, marital status, course of health care, and insurance. The history of the present illness includes when the symptoms began, whether they began suddenly or gradually, whether they come and go, and other information about the illness. The environmental history includes data about the client's home and working environments.

nurse routinely asks clients if they take any vitamins or herbal medications, encourages family members to bring in music that clients like to help them relax, and frequently prays with clients if that is important to them. The nurse is using which model of care? A) Holistic B) Health belief C) Transtheoretical D) Health promotion

A. Holistic The holistic model attempts to create conditions that promote optimal health. The holistic model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions. The health belief model addresses the relationship between a person's beliefs and behaviors. The transtheoretical model of change discusses a series of changes through which clients move, starting with precontemplation and ending maintenance. The health promotion model defines health as a positive, dynamic state and not merely the absence of disease.

A nurse teaching new nurse about obtaining a telephone prescription from provider. Which statement indicates understanding of teaching?

A. I should repeat prescription back to provider for verification."

Which tasks can be delegated to a UAP? A. Inserting a Foley catheter. B. Measuring and recording the client's output through a Foley catheter.C. Teaching a client how to care for a catheter after discharge. D. Assessing for symptoms of a UTI

A. Is a sterile invasive procedure and should not be delegated to a UAP. B. Falls within the implementation phase of the nursing process and dose not require nursing judgment. Evaluation of the I&O must be done by the nurse. C. Client teaching requires the abilities of a nurse and should not be delegated. The UAP may be instructed to report anything unusual that is observed and any symptoms reported by the client, but this does not replace assessment by the nurse. D. Assessment must be performed by the nurse and should not be delegated. The UAP may be instructed to report anything unusual that is observed, or any symptoms reported by the client, but this does not replace assessment by the nurse

Bioterrorism

A. Learn the symptoms of illnesses that are associated with exposure to likely biologic and chemical agents. B. Understand that they could appear days or weeks after exposure. C. Nurses and other HCPs would be the first responders when victims seek medical evaluation after symptoms manifest. First responders are critical in identifying an outbreak, determining cause of outbreak, identifying risk factors, and implementing measures to control and minimize the outbreak.

Patient Identification

A. The Joint Commission has implemented new patient identification requirements to meet safety goals. B. Use at least two patient identifies whenever taking blood samples, administering meds, or administering blood products. C. The patient room number may not be used as a form of identification.

A charge nurse is preparing to observe a newly licensed nurse perform a routine abdominal assessment. Which of the following actions should the charge nurse expect the newly licensed nurse to take? A. Place the client in a dorsal recumbent position for the exam. B. Auscultate for vascular bruits with the disphragm of the stethescope. C. Begin the assessment by using light palpation over the abdomen. D. Ensure that the client has a full bladder before beginning the procedure.

A. Place the client in a dorsal recumbent position for the exam. To prepare the client for a routine abdominal assessment, the nurse should place the client in a dorsal recumbent or supine position and ensure that the client relaxes her abdominal muscles. The charge nurse should expect the newly licensed nurse to use the bell of the stethoscope to auscultate for vascular bruits. The charge nurse should expect the newly licensed nurse to begin the assessment by inspecting the client's abdomen for changes in color, contour, and symmetry. The charge nurse should expect the newly licensed nurse to have the client empty her bladder before beginning the procedure for optimal examination of the abdomen.

Hospice nurse planning care & client does not have advance directives. Which intervention should nurse include in plan of care?

A. Provide client with information about advance directives.

A postsurgical client calls for a nurse and asks to be repositioned. The nurse finds that the client's drainage tube is disconnected and the intravenous (IV) line has 100 ml of fluid remaining. Which of the following should be performed first? A) Reconnect the drainage tube. B) Inspect the condition of the IV dressing. C) Improve the client's comfort and turn her to her side. D) Go to the medication room and obtain the next IV fluid bag.

A. Reconnect the drainage tube The nurse should reconnect the drainage tube first to ensure that the wound is properly draining. The client should then be turned (with care taken to ensure that the tubing remains connected), followed by replacing the IV fluid bag, checking the IV site, and restarting the IV fluid. With 100 ml left, the nurse has a bit of time to replace the IV bag before it runs dry, so caring for the client's wound and comfort should come first.

Environmental factors heavily affect a client's care. Your first concern for the client includes which of the following? A) Safety B) Nurse staffing C) Confidentiality D) Adequate pain relief

A. Safety Client safety is an environmental factor and is always the first concern. Pain relief, staffing, and confidentiality are important but are not environmental factors.

A 72-year-old man diagnosed with chronic obstructive pulmonary disease 5 years ago has been participating for the last 2 years in a pulmonary rehabilitation exercise class offered by the local hospital at a fitness facility. This is what level of prevention? A) Tertiary prevention B) Primary prevention C) Secondary prevention D) Quaternary prevention

A. Tertiary prevention Tertiary prevention occurs when a defect or disability is permanent and irreversible, and the aim is to reduce negative impacts and complications. Primary prevention is true prevention that precedes disease and involves clients considered physically and emotionally healthy. Secondary prevention is aimed at individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Quaternary prevention is not a recognized term.

A nurse is developing a plan of care for a school-age child whose family is homeless. Which of the following findings should the nurse identify as the priority?

A. The child has inflamed fissures at the corners of her mouth.

In the examples given below, which nurse is acting to avoid a data collection error? A) The nurse asks her colleague to chart her assessment data. B) The nurse considers conflicting cues in deciding on the correct nursing diagnosis. C) The nurse who assesses the edema in a client's lower leg is unsure of its severity and asks her co-worker to check it with her. D) After performing an assessment the nurse critically reviews his level of comfort and competence with interviewing and physical assessment skills.

A. The nurse asks her colleague to chart her assessment data A nurse who is uncertain and asks a colleague to consult is avoiding a data collection error. The nurse reviewing his level of comfort and competence is being complete but can miss his own errors. Considering conflicting clues does not help avoid data collection errors. Asking a colleague to chart data is incorrect.

4. Nurse retention is an important focus for health care organizations as we face a growing shortage of health care professionals in the future. According to Herzberg's motivation factors, which of the following would most likely contribute to increased job satisfaction? A. the organization recognizes and rewards those nurses who advance their education and achieve certification such as the CCRN certification for critical care RNs. B. Hiring bonuses of up to $5,000 are given to nurses to reduce the vacant positions and prevent short-staffing C. Nurse managers place an emphasis on establishing effective relationships with the nurses who work for them. D. Salary is increased.

A. The organization recognizes and rewards those nurses who advance their education and achieve certification such as the CCRN certification for critical care RNs

Nursing theories focus on the phenomena of nursing and nursing care. Which of the following is true of phenomena? A) They are aspects of reality that can be consciously sensed or experienced. B) They convey the general meaning of concepts in a manner that fits the theory. C) They are statements that describe concepts or connect two concepts that are factual. D) They are mental formulations of an object or event that come from individual perceptual experience.

A. They are aspects of reality that can be consciously sensed or experienced. Phenomena are defined as aspects of reality that can be consciously sensed or experienced.

Controversial Ethical Issues Confronting Nursing (Cont.)

Allocation of scarce resources Do all individuals merit the same care? Is health care a right or a privilege? Possible solutions Rationing for older adults Uninsured children given more equitable share Emphasis on preventive care Health care rationing

Controversial Ethical Issues Confronting Nursing

Abortion When does life begin? Does the fetus have rights? If so, do the rights of the fetus take precedence over the mother's right to control her own reproductive functions? When, if ever, is abortion morally justified? Should fetal stem cells be used for research that may help cure chronic debilitating diseases? Should minors have the right to abortion without parental consent or awareness?

Which statement regarding ethical decision making is true?

Accepting some ambiguity and uncertainty are a part of ethical decision making

What are some good team communication guidelines?

Active listening, communicate genuine concern and interest, provide the employee with adequate information, use team members ideas in the plan of action, maximize feelings of self respect, focus on the team members ability to help themselves, don't minimize value of time allowed to learn, seek alternatives, respect values and dignity, depresonalize potential conflict situations

This type of resistance to change attacks the idea, refuses to change, argues, organizes resistance of other people

Active resistance

Hersey & Blanchard's Situational Theory

Addresses follower characteristics in relation to effective leader behavior. Consider follower readiness as a factor in determining leadership style using task behavior and relationship behavior. An additional aspect of this model is the idea that the leader not only changes the leadership style according to followers' needs but also develops followers over time to increase their level of maturity.

2 biggest/worst actions that lead to malpractice lawsuits

Altering/falsifying a medical record, violation of an internal or external standard of practice

A verdict of suspension or loss of licensure represents what type of law?

Administrative

Defense for Intentional Torts (Cont.)

Advance directives Legal document that outlines the patient's wishes in the event that he or she is incapacitated to do so Living wills and Medical Power of Attorney are examples of advance directives

ABC Framework

Airway- FIRST Breathing- SECOND Circulation- THIRD Disability- FOURTH

Which document addresses the role of the nurse in taking appropriate action regarding instances of illegal, unethical, and/or inappropriate behavior when caring for a patient population of any age

American Nurses Association (ANA) Scope and Standards of Practice

Identify three bioterrorism agents

Anthrax, pneumonic plague, botulism, smallpox, inhalation tularemia, viral hemorrhagic fever, ricin, sarin, radiation.

Malpractice Elements (Cont.)

Applying causation Document facts Document what you see and do Role is to render nursing services, not to judge Leave the determination of fault to courts Proper actions and truthful documentation will be the best defense

What is evidence based care model standards to follow?

Ask a clinical question, acquire the evidence, appraise the evidence, apply the evidence to practice, assess the outcomes

Intentional Torts

Assault and battery, Invasion of privacy, False imprisonment, Exposure of a person, Defamation, Fraud

Intentional Torts

Assault: a threat Battery: acting out the threat False Imprisonment: restraining a client w/o order of reason and not letting them leave.

Which type of communication is necessary to implement a democratic leadership style?

Assertive communication skills

Communication Skills

Assertive communication: A. Includes clearly defined goals and expectations. B. Includes verbal and nonverbal messages that are congruent. C. Is critical to the directing aspect of management.

Samantha's assessment of Mary reveals that Physician Orders for Life-Sustaining Treatment (POLST) would be beneficial. How should Samantha best address Mary's need for POLST?

Assess Mary's ability to have an informed dialogue about POLST.

Simple triage and rapid treatment (START)

Assess Respirations. Assess Circulation. Assess Mental Status

The nurse is admitting a new patient and is collecting data through obtaining a health history and physical assessment. What phase of the problem-solving process is the nurse focusing on with the patient?

Assessing

What should the nurse consider when implementing delegation to staff (assignments)

Assign appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities.

HESI Hint #4

Assignments are often tested on the NCLEX-RN. The Nurse Practice Acts of each state govern policies related to making assignments. Usually, when determining who should be assigned to do a sterile dressing change, for example, a licensed nurse should be chosen--and RN or LPN who has been checked off on this procedure.

What are some ways in which nurses feel empowered?

Assist with decision making, Keeping workloads manageable, reward/recognition, fairness/equality

What are some examples of ethical dilemmas

Assisted Suicide, technology issues, gene therapies, designer babies, organizational climate

A nurse is assessing a client's negligible progress in following a weight loss program. Which of the following is a likely reason the client was unable to achieve a short-term goal established during the planning phase of the nursing process? A. The goals were realistic & formulated w/client input. B. The underlying problem behind past weight gain was misidentified. C. The implementation of the plan used flexibility in following the nursing actions D. The nurse obtained objective & subjective data during the assessment.

B

A nurse works in a mental health facility that uses a case management nursing model to provide care. The nurse should recognize that which of the following describes a case management approach to care? A. A nurse provides total care for several clients B. Collaboration between disciplines creates a multidisciplinary care plan for each client. C. The focus of care is on detecting disorders at an early stage. D. The team leader assigns care for a group of clients

B

An older adult client who has early Alzheimer's disease is living w/an adult child who is employed part-time but is committed to keeping her parent at home. Which of the following options is appropriate for the nurse to discuss w/the client & family at this time? A. Hospice care B. Adult day care C. An assisted-living facility D. Long-term care facility

B

Which of the following characteristics of a goal is missing from the statement "Client will ambulate daily"? A) Observable B) Measurable C) Client centered D) Singular goal or outcome

B. Measurable Goals must be measurable, such as "Client will ambulate 15 feet daily." The other characteristics are met in this goal statement.

A manager has proposed to the hospital board that it hires someone to teach management and leadership classes and that head nurses are paid to attend the classes. What is this an example of?

Building human capital

This is the unintentional tort of acting or failing to act, resulting in harm to the person owed care

Negligence

If an infectious disease can be transmitted directly from one person to another, it is: A) A susceptible host B) A communicable disease C) A portal of entry to a host D) A portal of exit from the reservoir

B) A communicable disease If an infectious disease is transmitted directly from one person to another, it is a communicable disease. Portals of entry and exit are the mechanisms of disease transmission. A susceptible host is a person who can acquire an infection.

A parent calls the pediatrician's office frantic because her 2-year-old son drank a bottle of cleaner. Which of the following is the most important instruction the nurse can give to this parent? A) Give the child milk. B) Call the poison control center. C) Give the child syrup of ipecac. D) Take the child to the emergency department.

B) Call the poison control center. The poison control center will direct all care given to a child who has ingested a substance. Based on the description of the poison, poison control center staff will tell the parent whether the child needs to go to the emergency department and what substances should be given to the child

A client is isolated because the client has pulmonary tuberculosis. The nurse notes that the client seems angry but knows this is a normal response to isolation. The best intervention is to: A) Provide a dark, quiet room to calm the client. B) Explain the isolation procedures and provide meaningful stimulation. C) Reduce the level of precautions to keep the client from becoming angry. D) Limit family and other caregiver visits to reduce the risk of spreading the infection.

B) Explain the isolation procedures and provide meaningful stimulation. When a client is in isolation, the nurse should take measures to improve the client's stimulation and make sure to explain the isolation procedures. Darkening the room can increase the sense of isolation. The nurse should not change the isolation level but should provide plenty of emotional support and make time for the client to prevent a sense of isolation. As long as family and caregivers follow infection precautions, there is no reason to limit contact with these individuals.

A nurse is preparing to transfer an older adult client who is 72 hr postop from a surgical procedure to a long term care facility. Which of the following should the nurse include in the transfer report? Select all that apply. A. Type of anesthesia used B. The client's advance directives status C. The client's vital signs on day of admission D. The client's medical diagnosis E. Need for special equipment

B, D, E

The family of the nurse's confused, ambulatory client insists that all four side rails be up when the client is alone. The best way to handle this situation is to: A) Ask them to stay with the client at all times. B) Inform them of the risks associated with side rail use. C) Thank them for being conscientious and put the four rails up. D) Provide the client with a one-to-one sitter while the side rails are up

B) Inform them of the risks associated with side rail use. The use of side rails when a client is disoriented will cause more confusion and further injury. A confused client who is determined to get out of bed may attempt to climb over the side rail or climb out at the foot of the bed, and may fall or experience other injury. After the nurse has this discussion with the family, then the nurse should perform a thorough nursing assessment and develop a plan to ensure the client's safety.

When providing health maintenance teaching to new employees in the food-handling department, the nurse emphasizes the need to perform hand hygiene after using the bathroom to prevent: A) Food poisoning B) Spread of hepatitis A C) Bacterial food infections D) Salmonella contamination

B) Spread of hepatitis A The hepatitis A virus is spread via fecal contamination of food, water, or milk. It is essential that food handlers wash their hands anytime they use the bathroom. Food poisoning can be due to bacterial contamination of food from a variety of sources, but not usually feces. Salmonella contamination usually arises from uncooked eggs.

The nurse has just admitted a client to rule out active hepatitis B. The client is confused, spitting and scratching everyone who enters the room. The nurse should: A) Wait an hour until the client calms down and then use gloves when touching the client. B) Use gloves, mask, face shield, and gown when entering the room to perform the initial assessment. C) Administer a sedative and then perform the assessment after the client is asleep; no precautions would be needed. D) Realize that isolation equipment might further confuse the client and avoid using a face mask and shield but use gown and gloves.

B) Use gloves, mask, face shield, and gown when entering the room to perform the initial assessment. Hepatitis virus is a blood-borne virus, but the client is increasing the risk of cross contamination by spitting (saliva can be a source of bacterial contamination) and scratching others, which can break the skin and become a source of risk. All of the barriers listed would minimize cross contamination from the client to the nurse. Even though gloves may be all that is needed because of limited contact with the client, after an hour the client will remain confused and may not understand. The client may become aggressive again and spit or scratch, and other barriers are needed to stop that source of possible risks. A sedative may be given if needed, but trying to perform an assessment when the client is asleep is not appropriate and will prevent the nurse from successfully establishing rapport with the client. Although masks and shields might be frightening to some confused clients, if the client is spitting and body fluids could be exchanged, a barrier should still be used.

A nurse manager is planning a department meeting to discuss client advocacy. Which of the following situations should be included in the discussion? Select all that apply. A. Discussing treatment options w/a client who was pancreatic cancer B. Notifying the surgeon when a client signing a surgical consent form has questions about the procedure C. Helping a client make a list of questions she would like to ask the provider D. Clarifying the dosage of a med prescribed for an older adult client who has impaired liver function E. Carrying out end-of-life wishes outlined in the living will of an older adult

B, C, D, E

A nurse who has just assumed the role of unit manager is examining her skills in interprofressional collaboration. Which of the following actions support interprofessional collaboration? Select all that apply. A. Use aggressive communication when addressing the team B. Recognize the knowledge & skills of each member of the team C. Ensure that a nurse is assigned to serve as the group facilitator for all interdisciplinary meetings D. Encourage the client & family to participate in the team meeting E. Support team member requests for referral

B, D, E

Which of the following instructions provided by a nurse reflects effective communication regarding delegation of a task to an AP?

B. "Check the urinary output at 1100 for John Doe and report it to me immediately."

A nurse is caring for a client who recently learned she has a mutation of the BRCA2 gene. The client states she does not plan to tell her adult daughters about diagnosis. Which response displays client advocacy by the nurse?

B. "Let's review what you understand about this test result.

A nurse is teaching a newly licensed nurse about using electronic medical records. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

B. "My access to client electronic medical records may be tracked by my nurse manager.

A client says, "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the client through the stages of change toward regular exercise? A) "Walking is OK. I really think running is better." B) "Yes, walking is great exercise. Do you think you could go for a 5-minute walk this next week?" C) "Yes, I want you to begin walking. Walk for 30 minutes every day and start eating more fruits and vegetables, too." D) "They probably aren't walking fast enough or far enough. You need to spend at least 45 minutes walking if you are going to do any good."

B. "Yes, walking is great exercise. Do you think you could go for a 5-minute walk this next week?" This option supports the preparation stage in which the client is beginning to consider making small changes. The other options are not good ones for this client.

A nurse is caring for group of clients. Which assessment findings should nurse recognize as priority to report to charge nurse?

B. A client 2 days post operative & urine output of 20 mL/hr

A nurse just received report on 4 clients med-surg unit. Which client should nurse assess first?

B. A client postop following a total knee arthroplasty & a cap refill of 4 seconds.

The nursing theory that emphasizes the delivery of nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family is: A) Rogers' theory B) Abdellah's theory C) Henderson's theory D) Nightingale's theory

B. Abdellah's theory The question describes the nursing theory developed by Fay Abdellah and others. Rogers' theory considered the individual as an energy field existing within the universe. Henderson's theory defines nursing as "assisting the individual, sick, or well, in the performance of those activities that will contribute to health, recovery, or a peaceful death." Nightingale viewed nursing as providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition.

The nursing diagnosis Hypothermia is an example of which of the following? A) Risk nursing diagnosis B) Actual nursing diagnosis C) Potential nursing diagnosis D) Wellness nursing diagnosis

B. Actual nursing diagnosis An actual nursing diagnosis describes a human response to health conditions or life processes in an individual, family, or community. The term readiness is present in a wellness nursing diagnosis. A potential nursing diagnosis is a risk for diagnosis.

When teaching older adults, the nurse should: A) Speak in a loud tone of voice. B) Begin and end with the most important information. C) Avoid repeating information to reduce confusion. D) Include as much information as possible in each teaching session.

B. Begin and end with the most important information Short-term memory is often reduced in older adults; therefore, repeating important information, and especially presenting it at the beginning and end, enhances retention. Speech at lower voice levels is better understood by the older adult. Repeating information does not create confusion but rather facilitates learning in the older adult. Older adults may have slower cognitive function and will remember more effectively if the information is paced properly.

A client's wound is not healing and appears to be worsening with the current treatment. What is the first option the nurse should consider? A) Notifying the physician B) Calling the wound care nurse C) Consulting with another nurse D) Changing the wound care treatment

B. Calling the wound care nurse Calling in the wound care nurse as a consultant is appropriate because he or she is a specialist in the area of wound management. Professional and competent nurses recognize limitations and seek appropriate consultation. Notifying the physician may be appropriate after the nurse decides on a plan of action with the wound care nurse specialist. The nurse may need to obtain orders for special wound care products. Unless the nurse is knowledgeable in wound management, changing the wound care treatment could delay wound healing. Also, the current wound management plan might have been ordered by the physician. Another nurse most likely will not be knowledgeable about wounds, and the primary nurse would know the history of the wound management plan.

Which of the following is the most accurate information to give a nurse during change-of-shift reporting? A) Client refuses to take medications. B) Client reports sharp pain in left anterior knee. C) Client encouraged to consume more fluids. D) Client expressed concern about pending surgery.

B. Client reports sharp pain in elft anterior knee The information in option 2 represents objective data that the nurse can use as part of baseline information. "Encouraged" and "more" are vague terms. "Concern" is also vague; relating the exact concern would be more accurate. Option 1 may be true, but accurate data would also report why the client refused medication.

A nurse on a medical-surgical unit is caring for a client who is terminally ill. Which of the following actions demonstrates that the nurse is practicing in an ethical manner when caring for the client?

B. Collaborate with the client to establish realistic goals for his end-of-life care.

Interdisciplinary care plans represent: A) All nursing personnel having input in the care plan. B) Contributions of all disciplines in caring for the client. C) The client's express wishes and advance directives. D) Physicians and nurses working together to develop a plan of care.

B. Contributions of all disciplines in caring for the client Interdisciplinary care plans include the contributions of all disciplines involved in the patient's care. The client's advance directives and express wishes may be included, as well as nursing and physician input, but other involved disciplines also contribute their plans.

7. When discussing the client's care with a nurse's aide, the nurse instructs the aide to report any coughing during meals in the client, who recently experienced a stroke and requires feeding. In this situation the nurse is acting as which of the following? A) Educator B) Delegator C) Client advocate D) On-the-job trainer

B. Delegator The nurse is delegating the task of feeding to the aide but is also providing directions.

6. Which theories describe an orderly process beginning with conception and continuing through death? A) Systems theories B) Developmental theories C) Interdisciplinary theories D) Stress and adaptation theories

B. Developmental theories Developmental theories discuss human growth from conception to death. The other options are incorrect

The primary nurse asked a clinical nurse specialist (CNS) to consult on a difficult nursing problem. The primary nurse is obligated to do which of the following? A) Implement the specialist's recommendations. B) Discuss and review advised strategies with the CNS. C) Report the recommendations to the primary physician. D) Clarify the suggestions with the client and family members.

B. Discuss and review advised strategies wtih the CNS Because the primary nurse requested the consultation, it is important that the primary nurse and the CNS communicate and discuss recommendations. The primary nurse can then accept or reject the CNS's recommendations. A consultation requires review of the recommendations but not immediate implementation. Reporting the recommendations to the physician would be appropriate after the nurse first talks with the CNS about recommended changes in the plan of care and the rationale. Only then should the primary nurse call the physician. The client and family do not have the knowledge to determine whether new strategies are appropriate or not. It is better to wait until the new plan of care is agreed upon by the primary nurse and physician before talking with the client and/or family.

When developing a nursing care plan for a client with a fractured right tibia, the nurse includes in the plan of care independent nursing interventions, including which of the following? A) Apply a cold pack to the tibia. B) Elevate the leg 5 inches above the heart. C) Perform range-of-motion movement with right leg every 4 hours. D) Administer aspirin 325 mg every 4 hours as needed.

B. Elevate the leg 5 inches above the heart Elevation of the leg does not need a physician's order. Applying a cold pack and administering medication do require a physician's order. Range-of-motion movement of the fractured tibia is inappropriate.

Behavioral Approach

Kurt Lewin, Iowa State University, Conveyed information about 3 leadership styles that are still widely recognized today. Autocratic, democratic, laissez-faire.

A theory is a set of concepts, definitions, relationships, and assumptions that: A) Formulates legislation B) Explains a phenomenon C) Measures nursing functions D) Reflects the domain of nursing practice

B. Explains a phenomenon A theory is a set of concepts, definitions, relationships, and assumptions that explains a phenomenon. Theories do not formulate legislation, measure nursing functions, or reflect any domain of nursing practice.

11. A person's ideas, convictions, and attitudes about health and illness can be described as: A) Moral beliefs B) Health beliefs C) Holistic views D) Negative health behaviors

B. Health beliefs Health beliefs are an individual's perceptions of health or illness, which may be based on factual information or misinformation, common sense or myths, or reality or false expectations. Moral beliefs are learned behaviors that are in accordance with the principles of right or wrong. Holistic views consider the emotional and spiritual well-being of the individual. Negative health behaviors include behaviors that are typically harmful to health, such as smoking, drug or alcohol abuse, poor diet, and refusal to take appropriate medications.

Clients maintain health or enhance their health by routine exercise and proper nutrition. This is known as: A) Illness B) Health promotion C) Control of external variables D) Wellness education

B. Health promotion Health promotion activities help clients maintain and enhance their present level of health. Wellness education instructs persons on how to care for themselves in healthy ways and includes topics such as physical awareness, stress management, and self-responsibility. Illness is defined as poor condition or disease. External variables are outside factors that influence a person's health beliefs and practices. They include family practices, socioeconomic factors, and cultural background.

Different attitudes about illness cause people to react in different ways when illness does occur. Medical sociologists call the reaction to illness: A) Health belief B) Illness behavior C) Health promotion D) Illness prevention

B. Illness behavior Illness behavior is the client's reaction to illness. The other three options are models of health

A nurse manager is conducting an annual performance review for a staff nurse. Which of the following strategies should the nurse use in the review process.

B. Include peer evaluations completed by other staff nurses D. Have the nurse conduct a self-appraisal prior to the review. E. Complete a performance checklist.

. Indirect care measureA 34-year-old client had a surgical repair of an abdominal hernia in the morning. At 12 noon, the nurse records the client's vital signs on the recovery room flow sheet. What is this an example of? A) Psychomotor skill B) Indirect care measure C) Physical care technique D) Anticipating complications

B. Indirect care measures Recording vital signs is an example of indirect care. Taking vital signs is an example of a psychomotor skill. Anticipating complications is a cognitive skill that is an assessment skill. Recording vital signs is a direct care measure and not a physical care technique.

A charge nurse observes staff nurse's behavior has changed over past few weeks. Which behavior should charge nurse identify as an indication staff nurse is working while impaired?

B. Isolates herself from other staff members

When calling a nurse consultant about a difficult client-centered problem, which of the following should the primary nurse report? A) Client's concern about the current treatment B) Length of time current treatment has been in place C) Spouse's reaction to the client's current treatment D) Physician's reluctance to change the current treatment plan

B. Length of time current treatment has been in place Reporting the length of time the current treatment has been used gives the consulting nurse facts that will influence formulation of a new plan. The other options are subjective and emotional issues or conclusions about the current treatment plan and may bias the nurse consultant's decision regarding a new treatment plan.

3. If you applied the concepts of Theory Y to describe nurses, which of the following statements would be the best descriptions? A. Nurses prefer to be directed and want job security more than other things B. Nurses use self-direction and self-control to achieve work objectives in which they believe. C. Nurses have a hard time accepting responsibility, but they learn this over time. D. Nurses don't really want to work and would quit if they could.

B. Nurses use self-direction and self-control to achieve work objectives in which they believe

Which of the following is subjective information to be entered in the client's medical record? A) Skin warm and dry. B) Pain intensity 8 out of 10. C) Breath sounds clear to auscultation. D) Amber urine in sufficient quantities.

B. Pain intensity 8 out of 10 Pain is purely a subjective phenomenon. Although the pain intensity rating is an objective number, it depends on the client's report. The other options are objective data.

A nurse manager finds an increase in UTIs on the unit. To address this problem, which action should nurse manager take first?

B. Perform a chart review to gather data about the clients who developed infections.

10. A nurse teaches the importance of folic acid intake to a group of pregnant women. This is considered which level of preventive care? A) Illness behavior B) Primary prevention C) Tertiary prevention D) Secondary prevention

B. Primary prevention Primary prevention is considered true prevention. It aims at maintaining physical and emotional health in an already healthy individual.Primary prevention is considered true prevention. It aims at maintaining physical and emotional health in an already healthy individual.

A parish nurse for a Catholic church provides a free blood pressure screening the first Sunday of every month. This is what level of prevention? A) Tertiary prevention B) Primary prevention C) Secondary prevention D) Quaternary prevention

B. Primary prevention Primary prevention is true prevention that precedes disease and is aimed at clients considered physically and emotionally healthy. Secondary prevention involves individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Tertiary prevention occurs when a defect or disability is permanent and irreversible, and the aim is to reduce negative impacts and complications. Quaternary prevention is not a recognized term.

5. Consider your role as a staff nurse in a patient care unit of a hospital. What factors are present that may serve as a substitute for your need for leadership for your nurse manager? A. Your desire for a promotion and an increase in pay. B. Professional nursing standards, code of ethics, and the intrinsic reward you get from this important work. C. Your manager spends time telling you exactly what to do and how to do it. D. Your nurse manager is inspiring and highly motivating to work for.

B. Professional nursing standards, code of ethics, and the intrinsic reward you get from this important work.

After establishing a nursing diagnosis of Acute pain, the nurse develops which of the following appropriate client-centered goals? A) Determine effect of pain intensity on client function. B) Reduce pain intensity to the level of a client rating of 3 or below during the client's hospital stay. C) Encourage client to implement guided imagery when pain begins. D) Administer analgesic 30 minutes before physical therapy treatment.

B. Reduce pain intensity to the level of a client rating of 3 or below during the client's hopsital stay

A nurse provides counseling to a family in spiritual distress caused by the recent, but expected, death of a family member when the nurse implements which of the following interventions? A) Praying with the family B) Reminiscing with the family C) Arranging for the chaplain to visit the family D) Obtaining a consult with a psychiatric clinical nurse specialist

B. Reminiscing with the family Reminiscing is an active intervention that allows family members to remember the deceased in a positive way. One expects spiritual distress in the acute stage of loss. Praying with the family and arranging for a chaplain's visit may be appropriate interventions, but they are not counseling.

The nurse is teaching a parenting class for a group of pregnant adolescents and has given the adolescents baby dolls to bathe and talk to. This is an example of: A) An analogy B) Role playing C) A demonstration D) A return demonstration

B. Role playing Role playing involves rehearsing a desired behavior. In demonstration the nurse shows the client what to do, whereas in return demonstration the learner practices the skill to show that it has been learned. An analogy is a means of translating complex language or ideas into words or concepts that the client understands.

Nurse caring for older client with renal failure. Client tells nurse he has decided to stop hemodialysis. Which actions should nurse take to act in role of advocate for client?

B. Support the client's decision regarding treatment

The nurse should plan to teach a client about the importance of exercise: A) When there are visitors in the room B) When the client's pain medications have taken effect C) Just before lunch, when the client is most awake and alert D) When the client is talking about current stressors in his or her life

B. When the client's pain medications have taken effect It is difficult for a client to learn when the client is in pain. Pain medications should be administered and the client taught while the client is alert but pain free. A quiet time should be selected when there are no or few distractions; the nurse should avoid times when visitors are present or when the client is discussing other stressors. The second best time to teach is when the client is most awake and alert, providing that all pain issues have been addressed.

A nurse is caring for a client who has a sealed radiation therapy implant. Which of the following precautions should the nurse plan to take when providing client care?

B. When wearing the lead apron, avoid turning her back to the client.

6. Leadership is defined as A. being in a leadership position with authority to exert control and power over subordinates. B. a process of interaction in which the leader influences others toward goal achievement. C. managing complexity. D. being self-confident and democratic.

B. a process of interaction in which the leader influences others toward goal achievement.

2. A participative leadership style is appropriate for employees who A. are not able to get the task done and are less mature B. are able to contribute to decisions about getting the work done C. are unable and unwilling to participate D. need direction, structure, and authority

B. are able to contribute to decisions about getting the work done

Avolio states that there are four factors that cover the components of authentic leadership. What is occurring when analyzing data rationally before making decisions?

Balanced processing

An organization has hired six RNs who have recently immigrated to the United States. The manager has noticed they interact very little with other staff, often speaking in their own language during their breaks, although they speak English while on duty. Which intervention would be the most helpful action for the manager to help these new RNs better assimilate?

Begin a short sharing session before client report, so all RNs can share information about their cultures and differences in client care.

These are organized thoughts about why people exist in the universe

Beliefs

The nurse engages in actions to promote the good of the patient. The nurse is engaging in fulfillment of which ethical principle?

Beneficence

This ethical principle means "doing good" for others

Beneficence

This takes the value of right/wrong and applies it to life/death issues

Bioethics

Strategies for groups to decide on changes

Brainstorm, nominal group techniques, focus groups, delphi technique(Panel of professionals to educate)

Quasi-Intentional Torts

Breach of Confidentiality: RN releases diagnosis of the patient to press Defamation of Character: RN tells coworkers that she believes a client has been unfaithful to the spouse.

A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, and a causal relationship between breach of duty and injury. What else must be included? Which element is necessary to prove professional negligence? Select all that apply.

Breach of duty Presence of injury Ability to foresee harm Causal relationship

How do managed health care organizations control costs?

By providing incentives to consider lower cost treatment alternatives

A nurse has prepared an IM injection for a client who is preoperative, when another client suddenly calls for assistance. The nurse asks an LPN to give the injection since an AP is waiting to take the client to surgery. Which of the following is an appropriate action by the LPN? A. Prepare a new syringe for the client who is preop B. Give the prepared med to the client who is preop C. Help the client requesting assistance so the nurse can give the prepared injection D. Report this request to the charge nurse

C

A nurse is caring for a client who is being prepared for surgery. The client hands the nurse info about advance directives & states, "Here, I don't need this. I am too young to worry about life-sustaining measures & what I want done for me." Which of the following actions should the nurse take? A. Return the papers to the admitting dept w/a note stating that the client doesn't wish to address the issue at this time. B. Explain to the client that you never know what can happen during surgery & that he should fill the paper's out "just in case." C. Contact a client representative to talk w/the client & offer additional info about the purpose of advance directives D. Inform the client that the surgery cannot be conducted unless he completes his advance directives forms

C

A nurse is caring for a group of clients on a medical unit. Which of the following is the priority finding the nurse should report to the provider? A. A client receiving metoclopramide (Reglan) reports diarrhea B. A client receiving tamsulosin (Flomax) reports feeling dizzy C. A client receiving cephalexin (Keflex) reports dyspnea D. A client receiving erythromycin (E-Mycin) reports epigastric pain

C

A nurse is observing a newly licensed nurse & an AP pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates a need for further education? A. The nurse spreads his legs apart B. The nurse uses his body weight to counter the client's weight C. The nurse's feet are facing inward, toward the center of the bed D. The nurse uses the muscles in his arms to lift the client off the bed using the drawsheet

C

A nurse is overheard telling other nurses that the unit manager gives preferential treatment to nurses on the night shift. Which of the following approaches by the unit manager reflects an assertive response to resolution of this conflict? A. Understand that the vocal nurse is misinformed & take no action. B. Assign the vocal staff nurse to work the night shift to allow direct experience w/the night shift. C. Meet one-on-one w/the vocal staff nurse to discuss the concerns raised D. Confront the staff nurse during the next unit meeting regarding her statement

C

A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following will provide the most relevant info regarding the efficacy of the procedure? A. Frequency w/which the procedure is performed B. Client satisfaction w/performance of procedure C. Incidence of complications r/t procedure D. Accurate documentation of how the procedure was performed

C

A nurse manager has received a performance appraisal from the unit manager. Which of the following actions by the unit manager requires intervention? A. The evaluation was conducted in the unit manager's office B. Data that was collected for the previous 12 months was presented C. Verbal concerns provided by a staff member were incorporated into the data D. The nurse was asked to review the performance appraisal & complete a self-evaluation

C

Human Relations

Focuses on empowerment of the individual worker as the source of control, motivation, and productivity in meeting the organizations goals -Hawthorne Experiments -Hawthorne Effect -Emphasizes that participatory decision making increases worker autonomy and provides training to improve work

12. For which airborne disease(s) would the nurse be required to use gloves, respiratory devices, and gown when in close contact with the client? A) Herpes simplex, scabies B) Viral pneumonia, atelectasis C) Chickenpox, pulmonary tuberculosis D) Multidrug-resistant respiratory syncytial virus

C) Chickenpox, pulmonary tuberculosis Airborne precautions are required for chickenpox and tuberculosis, because in these diseases small particles float in the air and a barrier is required to prevent contamination of the nurse. A respiratory protection device is form-fitted to the face to prevent the escape of air around the seal. Gloves and gown are also worn to prevent contamination and transport of infective particles to other clients. For viral pneumonia a regular mask is used as a barrier because the particles do not float in the air and are more likely to be found on surfaces unless coughing or spitting is occurring. Atelectasis is the collapse of alveoli, and airborne precautions are not needed. Herpes and scabies are spread by contact, and gloves and gown would be necessary; masks would not be needed. For multidrug-resistant respiratory syncytial virus the protection of the client would be as important as preventing the spread of these disorders. Therefore, gown, gloves, and mask would be used as in reverse isolation to prevent cross contamination of the client.

During the nurse's assessment of a 56-year-old man, he reports increased alcohol consumption because of stress at work. One of the expected outcomes for this client will be to: A) Decrease stress in his life. B) Teach him ways to promote sleep. C) Decrease his alcohol intake during times of stress. D) Provide the client with information about stress management classes.

C) Decrease his alcohol intake during times of stress. Resources for stress management and sleep promotion can help accomplish reduced alcohol intake during times of stress in the client's life. Management of stress is the expectation, but decreasing stress may not be possible.

The nurse discovers an electrical fire in a client's room. The nurse's first action would be to: A) Activate the fire alarm. B) Confine the fire by closing all doors and windows. C) Evacuate any clients or visitors in immediate danger. D) Extinguish the fire by using the nearest fire extinguisher.

C) Evacuate any clients or visitors in immediate danger. The nurse's first step when a fire is discovered is to evacuate any clients or visitors in immediate danger. Then the nurse should activate the fire alarm, confine the fire, and then extinguish it.

Before the nurse washes the hands when leaving an isolation room, what is the last thing that is removed? A) Mask B) Gown C) Goggles D) Head cover

C) Goggles Goggles are the least contaminated item and the last to be removed before hand washing. The gown and gloves have been removed first. Head covers are usually not worn in isolation rooms as a barrier. The mask is considered contaminated, and it should be untied and discarded after the gown is removed to minimize contamination from the gown or gloves.

To remove a glove that is contaminated, what should the nurse do first? A) Rinse the glove before removing it to minimize contamination. B) Pull the glove off the back of the hand until it slides off the entire hand and discard it. C) Grasp the outside of the cuff or palm of the glove and pull it away from the hand without touching the wrist or fingers. D) Put the thumb inside the wrist to slide the glove over the hand with minimal touching of the hand by the other gloved hand.

C) Grasp the outside of the cuff or palm of the glove and pull it away from the hand without touching the wrist or fingers. When the outside of the cuff is grasped with the contaminated gloved hand, then dirty to dirty remains intact. Pulling the glove away from the hand entirely without touching the wrist or fingers further minimizes the contamination by the gloved hand. If the nurse puts the gloved thumb inside the glove, the nurse has contaminated the bare hand with a contaminated thumb. Pulling the glove off by holding it at the back sounds good and could minimize contamination, but it is very difficulty to remove a glove this way without the risk of tearing the glove and creating contamination through the tear. If excessive secretions are present on gloves, then a towel or the drape could be used to wipe off excessive secretions before an attempt is made to remove the gloves.

14. The nurse is setting up a sterile field for the physician. Which of the following statements concerning a sterile field is correct? A) The sides of the drape over the table are still sterile until they are touched. B) Reaching over the field is not a source of contamination if the nurse has on a clean gown and gloves. C) One inch around the border should be considered to be the barrier between the sterile field and under the table. D) A liquid spill onto the sterile field is a source of contamination from the table below the drape, even if the barrier is waterproof.

C) One inch around the border should be considered to be the barrier between the sterile field and under the table. A 1-inch margin is considered unsterile and is the barrier spacing between the sterile field in the center of the drape and the edge of the drape. Liquids spilled on a waterproof drape will not absorb from or be contaminated from the surface beneath. Although such a situation could be messy, bacteria would not cross from the unsterile to the sterile side. The edge of the table and the 1-inch border create the edge of the sterile field. Anything below the edge, including the side of the drape, becomes unsterile. Reaching over a sterile field is always a source of contamination and should not be done.

What is the single most effective method by which the nurse can break the chain of infection? A) Give all clients antibiotics. B) Wear gloves when caring for all clients. C) Wash hands between procedures and clients. D) Make sure housekeeping staff are using the right chemicals.

C) Wash hands between procedures and clients. Adequate hand washing will remove bacteria and wastes or contaminates to minimize cross contamination between clients. Use of alcohol-based waterless antiseptics between clients is also effective if the guidelines for using these cleansers are followed. Giving all clients antibiotics is impractical and is a source of new superinfections when persons who do not need antibiotics are given them and then the bacteria mutate to become resistant to older drugs. It would be both unethical and costly to try to control infections by treating everyone in the facility. Although wearing gloves to perform procedures that carry the risk of direct contact with contaminated material is a correct method of bacterial control, wearing gloves at all times is impractical, expensive, and unrealistic. Housekeeping staff are trained to use the correct agents for decontamination and disinfection of all surfaces that place clients at risk.

During the planning phase of the nursing process, the nurse along with the client decides which of the following? (Select all that apply.) A) Interventions B) Nursing diagnosis C) Expected outcomes D) Client-centered goals E) Nurse-centered priorities

C, and D Expected outcomes and goals are the main components of the planning phase of the nursing process. The nurse determines these from the assessment. The client should be the focus of the planning stage. Interventions are initially determined by the nurse.

Inappropriate reactions when dealing with reality shock

Native (i'll just keep doing this because it's easier), runaway, rutter, burnout, loner, remain new, be the change agent

A nurse is teaching a newly licensed nurse about incident reports. Which statement by new nurse indicates an understanding of teaching?

C. "I should complete an incident report for an unexpected client occurrence.

3. Based on the transtheoretical model of change, what is the most appropriate response to the following client statement: "Me, exercise? I haven't done that since Junior High gym class and I hated it then!" A) "That's fine. Exercise is bad for you anyway." B) "OK. I want you to walk 3 miles four times a week and I'll see you in 1 month." C) "I understand. Can you think of one reason why being more active would be helpful for you?" D) "I'd like you to ride your bike three times this week and eat at least four fruits and vegetables every day."

C. "I understand. Can you think of one reason why being mroe active would be helpful for you?" The transtheoretical model of change describes a series of changes that clients move through, starting with precontemplation and ending with maintenance. The first stage for this client would be to validate the client's opinion and move to the first part of precontemplation. The other options are later steps in the model.

A nurse is providing discharge teaching to a client who is scheduled to receive oxygen at home. Which of the following client statements indicates an understanding of the teaching?

C. "I will verify the flow rate on my oxygen equipment daily.

A nurse is speaking with daughter of a client who has advanced Alzheimer's disease. The daughter is fcrying and tells the nurse, "I don't know how much longer I can keep this up." Which responses should the nurse make?

C. "Let's discuss options for respite care."

Which of the following statements is the World Health Organization's definition of health? A) "Complete freedom from disease" B) "Mental, social, and spiritual well-being" C) "State of complete physical, mental, and social well-being, not merely the absence of disease" D) "A state of being that people define in relation to their own values, personality, and lifestyle"

C. "State of complete physical, mental, and social well-being, not merely the absence of disease" The World Health Organization defines health as a "state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity." There are several definitions of health. Health is a state of being that people define in relation to their own values, personality, and lifestyle. Health and illness must be defined in terms of the individual. Health can include conditions previously considered to be illness. Pender, Murdaugh, and Parsons note that views of health include mental, social, and spiritual well-being. Pender notes that not all people who are free of disease are equally healthy.

Which of the following is an open-ended question the nurse might use when interviewing a client? A) "Do you have any concerns right now?" B) "Is your family worried about your being in the hospital?" C) "What do you mean when you say, 'I don't feel quite right'?" D) "How many times do you get up to go to the bathroom at night?"

C. "What do you mean when you say, 'I don't feel quite right'?" The way the nurse asks question 3 allows the client to respond completely and with more than a one-word answer. The other options allow the client to respond with one word and make it unlikely that the client will give additional information.

The nurse is assessing the urinary history of a middle-aged married woman. The nurse asks her if she gets up at night. She replies, "Yes." What other question should the nurse ask? A) "How many times do you get up at night?" B) "How long have you been getting up at night?" C) "Why do you get up at night?" D) "How easily do you go back to sleep after you get up?"

C. "Why do you get up at night?" Perhaps it is the client's husband who is getting up in the middle of the night because of a prostate problem, and this is why she is awakened. The nurse should not assume nocturia without further assessment questions.

A nurse is caring for a client who has a terminal illness and voices concern about how she will care for herself at home after discharge. Which of the following statements should the nurse make?

C. "Your case manager will coordinate the resources you will need throughout your illness.

nursing diagnosis is: A) The diagnosis and treatment of human responses to health and illness B) The advancement of the development, testing, and refinement of a common nursing language C) A clinical judgment about individual, family, or community responses to actual and potential health problems or life processes D) The identification of a disease condition based on a specific evaluation of physical signs, symptoms, the client's medical history, and the results of diagnostic tests

C. A clinical judgment about individual, family, or community responses toa ctual and potential health problems or life processes A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual and potential health problems or life processes. It is not a disease condition or medical diagnosis, or the diagnosis and treatment of human responses to health and illness. Nursing diagnoses are not a development or refinement in nursing language.

Maslow's hierarchy of needs is useful to nurses, who must continually prioritize a client's nursing care needs. The most basic or first-level needs include: A) Self-actualization B) Love and belonging C) Air, water, and food D) Esteem and self-esteem

C. Air, water, and food The first level of Maslow's hierarchy of needs includes the need for air, food, and water—basic elements of survival. Love and belonging are on the second level, esteem and self-esteem are on the fourth level, and self-actualization is the final level.

A nurse refers to a client's postsurgical written plan of care, noting that the client has a drainage device collecting wound drainage. The surgeon is to be notified when drainage in the device exceeds 100 ml for the day. The nurse carefully notes the amount of drainage currently in the device. This is an example of: A) Planning B) Evaluation C) Assessment D) Intervention

C. Assessment Assessment is the process of observing and collecting data. Planning is the step in which the diagnosis is analyzed for problem resolution. Intervention consists of the steps actually taken after planning. Evaluation measures the effectiveness of the plan.

A nurse uses an institution's procedure manual to confirm how to insert a Foley catheter. The level of critical thinking the nurse is using is: A) Commitment B) Scientific method C) Basic critical thinking D) Complex critical thinking

C. Basic critical thinking At the basic level of critical thinking, a learner trusts the experts and follows a procedure step by step. Complex critical thinkers separate themselves from authorities and analyze and examine choices more independently. Commitment is the third level of critical thinking in which the person anticipates the need to make choices without assistance from others. The scientific method is a process of problem solving.

What type of interview technique is the nurse using when the nurse asks the question, "Do you have pain or cramping?" A) Active listening B) Open-ended questioning C) Closed-ended questioning D) Problem-oriented questioning

C. Closed-ended question The example is a closed-ended question which the client can answer with a one-word reply. Open-ended questions allow the client to answer with more information. The other options are not correct.

The client is a 65-year-old overweight woman with multiple medical diagnoses, including diabetes mellitus type 2, hypertension, and residual right-sided weakness resulting from a previous cerebrovascular accident. What tool should be used to plan her care? A) Care plan B) Care map C) Concept map D) Critical thinking

C. Concept map A concept map is a visual representation of client problems and interventions that shows their relationships to each other and allows easy synthesis of data about the client.

A nurse is participating in obtaining a client's informed consent. Which of the following tasks is the role of the nurse when witnessing informed consent?

C. Confirm client voluntarily signed consent.

A nurse manager planning teaching on use of critical pathways with a group of new nurses. Nurse should include which info in teaching?

C. Critical pathways prevent unnecessary expense

How are error events in health care categorized?

Near miss, adverse event, accident, never event

A learning objective for a client taking digoxin (Lanoxin) is to correctly take a radial pulse for 1 minute before medication administration. The learning objective has been achieved when the client: A) States, "I understand." B) States, "Just place two fingers at the thumb side of the wrist." C) Demonstrates correct finger placement and counts the beats correctly D) Demonstrates by placing two fingers at the inner antecubital space and counts the beats for 60 seconds

C. Demonstrates correct finger placement and counts the beats correctly Direct observation is a means of evaluating whether a learning objective has been achieved. In option 3 the client demonstrated radial pulse taking correctly. Option 1 provides no way of measuring if the client was able to correctly take a radial pulse. Option 2 does not indicate if the client was able to count the number of beats for 1 minute. In option 4 the fingers were placed in the antecubital space rather than over the radial artery. The client demonstrated incorrect placement.

A client who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. The best teaching method would be: A) Role playing B) Simulation C) Demonstration D) Group instruction

C. Demonstration Demonstration with return demonstration is the best method to teach a psychomotor skill. Group instruction is not typically effective in teaching specific psychomotor skills, because it does not allow for individualized instruction. Role playing and simulation are not appropriate in this situation.

Each science has a domain, which is the perspective of the discipline. This domain: A) Represents the recipients of the benefits of the science or discipline B) Is a model that explains the linkage of science, philosophy, and theory that is accepted and applied by the discipline C) Describes the subject, central concepts, values and beliefs, phenomena of interest, and central problems of the discipline D) Is a dynamic state of being in which the developmental and behavioral potential of the individual is realized to the fullest

C. Describes the subject, central concepts, values and beliefs, phenomena of interest, and central problems of the discipline The domain contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline. A paradigm is a model that explains the linkage of science, philosophy and theory that is accepted and applied by the discipline.

Nurse manager completing a performance improvement audit & determines documentation of client discharge teaching is < expected. Which actions should nurse implement first?

C. Determine factors that interfere with documentation of client education

The school nurse is about to teach a freshman-level health class on nutrition. To achieve the best learning outcomes, the nurse: A) Provides information using a lecture format B) Uses simple words to promote understanding C) Develops topics for discussion that require problem solving D) Completes an extensive literature search focusing on eating disorders

C. Develops topics for discussion that require problem solving The use of problem solving helps adolescents to achieve learning outcomes. Providing information in a lecture format and using simple words would probably not be successful with this age group. Literature searches are not appropriate teaching for this age group.

"Unhappy and worried about health" is not a scientifically-based nursing diagnosis, and it can lead to error in: A) Data collection B) Date clustering C) Diagnostic label D) Medical diagnosis

C. Diagnostic label The diagnostic label is the name of the nursing diagnosis as approved by the North American Nursing Diagnosis Association (NANDA) International. The question does not discuss data collection, medical diagnosis, or data clustering.

A nurse caring for a client recovering from a stroke. The provider recommends extracranial-intracranial bypass, but client tells nurse he wont have surgery. Which actions should nurse take?

C. Discuss with client his concerns about having the surgery.

Which of the following nursing interventions is written correctly? A) Change dressing once a shift. B) Perform neurovascular checks. C) Elevate head of bed 30 degrees before meals. D) Apply continuous passive motion machine during day.

C. Elevate head of bed 30 degrees before meals Option 3 is specific—it indicates what to do and when

An older adult client who is on fall precautions is found lying on the floor of his hospital room. Which of the following actions is most appropriate for the nurse to take first? A. Call the client's provider B. Ask a staff member for assistance getting the client back in bed C. Inspect the client for injuries D. Ask the client why he got out of bed w/out assistance

C. Inspect the client for injuries

17. The nursing process is an example of an open system. An open system: A) Is universal and dynamic B) Represents a relationship between two concepts C) Interacts with the environment by exchanging information D) Is a process through which information is returned to the system

C. Interacts with the environment by exchanging information An open system is defined as a system that interacts with the environment, exchanging information between the system and the environment.

12. The client who is most ready to begin a client teaching session is the client who has: A) Experienced nausea and vomiting for the past 24 hours B) Just been told that he needs to have major surgery C) Voiced a concern about how insulin injections will affect her lifestyle D) Complained bitterly about the low-fat, low-cholesterol diet he must follow after his heart attack

C. Voiced a concern about how insulin injections will affect her lifestyle

The nurse asks a client how she feels about impending surgery for breast cancer. Before initiating the discussion the nurse reviewed information about loss and grief in addition to therapeutic communication principles. The critical thinking component involved in the nurse's review of the literature is: A) Experience B) Problem solving C) Knowledge application D) Clinical decision making

C. Knowledge application The nurse sought appropriate information to be able to communicate more knowledgeably with the client. Experience is acquired through clinical learning situations. Problem solving is a series of steps to resolve a problem. Clinical decision making is a process in which critical thinking steps are followed for problem resolution.

Which of the following models of health or illness defines health as a positive, dynamic state, not merely the absence of disease? A) Maslow's hierarchy of needs B) Rosenstoch's health belief model C) Pender's health promotion model D) The holistic health model of nursing

C. Pender's health promotion model Pender's health promotion model was developed to be a "complementary counterpart to models of health protection." This model defines health as a positive, dynamic state, not merely the absence of disease. Maslow's hierarchy of needs defines what is necessary for human survival and health, such as food, water, safety, and love. Rosenstoch's health belief model addresses the relationship between a person's belief and behaviors. It predicts how clients will behave in relation to their health and how they will comply with their health regimen. The holistic health model creates conditions that promote optimal health.

A public health nurse is developing a list of recommendations for her supervisior on how to use EBP to improve community outcomes. Which of the following should the nurse recommend as a qualitative research method?

C. Phenomenology

A home health nurse is planning her daily visits and receives lab results for four adult clients. The nurse should first see the client who has which of the following lab values?

C. Platelets 100,000

During the day the nurse spends time instructing a client in how to self-administer insulin. After discussing the technique and demonstrating an injection, the nurse asks the client to try it. After the client makes two attempts it is clear that the client does not understand how to prepare the correct dose. The nurse discusses the situation with the charge nurse and asks for suggestions. This is an example of: A) Reflection B) Risk taking C) Problem solving D) Client assessment

C. Problem Solving This is an example of problem solving because the nurse is taking a problem to a supervisor for help in finding a different approach. Reflection is the process of purposefully thinking back and recalling a situation to discover its purpose or meaning. Risk taking involves trying a different approach. Client assessment is the first step in the process of instruction.

A client recently diagnosed with cervical cancer is going home after undergoing surgery. The client is avoiding discussion of her illness and postoperative orders. In going over discharge instructions with the client, the nurse: A) Teaches the client's spouse B) Focuses on knowledge the client will need in a few weeks C) Provides only the information the client needs to go home D) Convinces the client that learning about her health is necessary

C. Provides only the information teh client needs to go home Because this client does need to have some postoperative knowledge, the teaching should focus on the information the client will need until she has had a chance to move through the grief process. Teaching the spouse does not focus on caring for the client, although his knowledge can be helpful. Teaching ahead about information that the client will need in a few weeks is not appropriate. Until the client is able to process her grief, convincing her that learning about health is not productive.

The nurse is demonstrating the proper technique for using a glucometer to a group of clients newly diagnosed with diabetes. The nurse smiles and praises one of the clients when she correctly performs a finger stick. This teaching approach is referred to as: A) Timing B) Entrusting C) Reinforcing D) Group instruction

C. Reinforcing Social reinforcement includes smiles, compliments, or words of encouragement. Timing is not a teaching approach. It refers to the planning phase of the teaching process. Entrusting allows the client to manage his or her own care, with the nurse available for assistance if needed. A client newly diagnosed with diabetes would not be able to manage self-care. Group instruction is an instructional method, not a teaching approach.

This type of leader leads people to feeling confused, without goals or guidance and is often ineffective with little control or responsibility for the leader (not efficient)

Laissez-Fare

Which of the following terms is defined as a mental self-image of strengths and weaknesses in all aspects of one's personality? A) Body image B) Family roles C) Self-concept D) Emotional change

C. Self-concept Self-concept is a mental self-image of strengths and weaknesses in all aspects of one's personality. Self-concept is important in relationships with other family members. When a client is ill, his or her self-concept changes and this may lead to tension and conflict. Body image is defined as a subjective concept of physical appearance. Many illnesses can cause changes in physical appearance, and clients and families react differently to these changes. Clients react differently to illness or the threat of illness. Individual behavioral and emotional reactions depend on the nature of the illness. Illness impacts family roles. When an illness occurs, parents and children try to adapt to major changes resulting from a family member's illness.

All of the following are considered internal variables that influence a client's health beliefs and practices except: A) Emotional factors B) Developmental stage C) Socioeconomic factors D) Perception of functioning

C. Socioeconomic factors Socioeconomic factors are considered external variables. A person seeks approval and support from neighbors, peers, and co-workers; this affects health beliefs and practices. Economic variables may affect a client's level of health. For example, a client with a fixed income who needs long-term medications may determine that food and shelter are more important than the medication; therefore, the client's health suffers. Perception of functioning is an internal variable. It is defined as the way an individual perceives his or her physical functioning and how it affects health beliefs and practices. Emotional factors are internal variables. These include a client's degree of stress, depression, or fear, which can influence health beliefs and practices. An individual's developmental stage is considered an internal variable. A client's thinking about health is dependent on his or her level of development.

A client comes into the clinic for a complete physical examination. The nurse obtains a health history and determines that the client is at risk for heart disease. Which of the following would lead the nurse to conclude this? A) The client is 25 years old. B) The client lives near a chemical plant. C) The client's father died of a heart attack at age 40. D) The client works as a carpet salesman.

C. The client's father died of a heart attack at age 40 Genetic predisposition to specific illnesses is considered a major physical risk factor. The client's father died of a heart attack at the age of 40, which increases the client's risk of heart disease and heart attack. Age may increase or decrease a client's susceptibility to certain illnesses. Age risk factors are often closely associated with other risk factors, such as family history and personal habits. The client is 25 years old; therefore, based on age alone, risk is low for heart disease at this time. The client lives near a chemical plant; this constant exposure to chemicals may lead to health problems. The physical environment in which a person works and lives can increase the likelihood that certain illnesses will occur, but without further information the nurse cannot assess the heart disease risk related to the client's possible chemical exposure.

A nurse is assigned to a client who has returned from the recovery room following surgery for a colorectal tumor. After an initial assessment, the nurse anticipates the need to monitor the client's abdominal dressing, intravenous infusion, and drainage tubes. The client is in pain and will not be able to eat or drink until intestinal function returns. The nurse will have to establish priorities of care in which of the following situations? A) The family comes to visit the client. B) The client expresses concern about pain control. C) The client's vital signs change showing a drop in blood pressure. D) The charge nurse approaches the assigned nurse and requests a report at the end of the shift.

C. The client's vital signs change showing a drop in blood pressure A drop in blood pressure indicates a possible emergency situation, including bleeding at the surgical site. Concern about pain control, including a thorough assessment focusing the client's pain, would be the second priority. The end-of-shift report and the family's visit are lesser priorities.

4. There is a contemporary move toward addressing nursing as a science or as evidenced-based practice. This suggests that: A) One theory will guide nursing practice. B) Scientists will make nursing decisions. C) Theories will be tested to describe or predict client outcomes. D) Nursing will base client care on the practice of other sciences.

C. Theories will be testing to describe or predict client outcomes Theories will be tested to describe or predict client outcomes as nursing is addressed as a science and an art. Scientists will not make nursing decisions, and nursing will base client care on the practice of nursing science, which will be guided by multiple theories.

Which of the following statements about prescriptive theories is accurate? A) They describe phenomena. B) They have the ability to explain nursing phenomena. C) They reflect practice and address specific phenomena. D) They provide a structural framework for broad abstract ideas.

C. They reflect paractice and address specific phenomena Prescriptive theories address nursing interventions for a phenomenon and predict the consequence of a specific nursing intervention. Descriptive theories describe the phenomena, speculate on the reason the phenomena occur, and predict nursing phenomena. Grand theories are broad and complex and provide a structural framework for broad, abstract ideas about nursing.

This type of leader makes no attempt to motivate or move the group in any direction

Laissez-Fare

This budget used by businesses is to purchase equipment

Capital Expenditure budget

In this type of organization, authority figures have all of the power/control

Centralized/Traditional

HESI Hint #15

Change causes anxiety. An effective nurse change agent uses problem-solving skills to recognize factors such as anxiety that contribute to resistance to change and uses decision-making and interpersonal skills to overcome that resistance. Interventions that demonstrate these skills include seeking input, showing respect, valuing opinions, and building trust.

Torts

Civil actions—plaintiff files lawsuit to seek compensation for damages suffered from perceived wrong Unintentional torts Incidents or accidents Intentional torts Deliberate acts

This is the law that involves the violation of one persons rights against anothers

Civil law

Psychiatric Nursing Practice and the Law

Civil procedures, Voluntary admission, Involuntary admission, Emergency admission, Legal and civil rights of hospitalized clients, competency hearing, insanity, inability to stand trial.

Common causes of negligence

Client falls, equipment injuries, failure to monitor, failure to communicate, medication errors, medical errors

Restraints

Clients may be restrained only under the following circumstances: 1. in an emergency. 2. for a limited time. 3. for the purpose of protecting the client from injury or from harm

Incident Reports should include

Clients name and medical #, date, time, and location, factual description of incident and injuries incurred. Names of any witnesses, corrective actions that were taken including notifying provider and any referrals. Name and dose of any meds or ID # of any equipment that was involved.

This is the model in which each person in an organization share a mission, vision, values and partnerships. They believe that each person has a right to healthcare and each person is accountable to communicate and contribute to their healthcare. It is a planned partnership. Empowerment for each persons healthcare begins with themselves.

Clinical Practice Model for healthcare

Intentional Torts

Closely related to criminal acts Assault and battery False imprisonment Defamation Libel Slander

The failure to engage in which activity is considered a fatal flaw of leadership? Select all that apply.

Collaboration Communication Self-improvement Staff development

Where Does the "Law" Come From?

Constitutional law—refers to rights, privileges, and responsibilities as set forth by the U.S. Constitution, including the Bill of Rights Administrative law—rules and regulations passed by boards of nursing Common law—decisions made by judges in court cases Case law—composed of decisions rendered in court cases by appeals courts

What are some disadvantages of team nursing care?

Continuity suffers if daily team assignments vary, team leaders must have good leadership skills, There may be inefficient time for planning and communication between team members and teams

What is the role of the staff nurse pertaining to budget?

Control spending /cost on the unit without compromising patient safety

Which function of the management process involves the performance evaluation of staff?

Controling

An experienced nurse using contingency theory is orienting a new graduate to the unit. What needs will the nurse meet with the new graduate using this theory? (Select all that apply.)

Counseling Developing Coaching

List the 5 dimensions of followership

Courage to assume leadership/responsibility as needed, courage to serve, courage to challenge, courage to participate in change/transformation, courage to leave

How can the nurse manager best minimize the personal risk for legal liability?

Creating a work environment that prioritizes patient needs

A nurse is arrested for possession of illegal drugs. What kind of law governs this type of activity?

Criminal

Court Actions Based on Legal Principles

Criminal actions—considered harmful to society as a whole Civil actions—concern private interests and rights between individuals involved in cases Sometimes an event can have both criminal and civil consequences

These are offenses committed against state laws

Criminal acts

Types of law

Criminal, Civil

These are clinical protocols involving all disciplines

Critical pathways

List some behaviors characteristic of a leaders

Critical thinking, problem solving, respect people, communicates skillfully, sets goals, shares a vision, develops self and others

What are some roles of the nurse manager?

Customer service, team building and motivation, decisions/mediation, evaluations, delegation, change agent, clinical consults, staff development, corporate supplier

A nurse is reviewing a client's health care record & discovers that the client's DNR order has expired. The client's condition is not stable. Which of the following actions should the nurse take? A. Assume that the client does not want be resuscitated, & take no action if she experiences cardiac arrest B. Write a note on the front of the provider order sheet asking that the DNR order be reordered C. Anticipate that CPR will be instituted if the client goes into cardiopulmonary arrest D. Call the provider to determine whether the order should be immediately reinstated

D

A nurse manager finds an increased incidence of health-care associated infections (HAIs) on a long term care unit. Which of the following is the priority action the nurse manager should take to address the problem? A. Monitor the staff's hand hygiene techniques B. Hold a mandatory in-service about hand hygiene & infection rates C. Require nurses to take an online course on HAIs D. Conduct a chart review to gather data about clients who developed HAIs

D

A nurse manager is about to write a 2 month performance appraisal for a newly graduated nurse. Which of the following factors should the nurse manager take into consideration when planning a performance appraisal interview for this nurse? A. The written appraisal & interview should sound friendly & be informal B. No one except the nurse manager should have input regarding the nurses's appraisal C. A nursing administrator who does not know the nurse should conduct the interview to promote fairness D. The nurse should have a copy of performance standards before the appraisal interview

D

A nurse manager is providing info to the nurses on the unit about ensuring client rights. Which of the following outlines the rights of individuals in health care settings? A. American Nurses Association Code of Ethics B. HIPAA C. Patient Self-Determination Act D. Patient Care Partnership

D

A nurse on a med surg unit is planning care of assigned clients. Which of the following clients should the nurse assess first? A. A client who is newly admitted & is to have an indwelling urinary catheter inserted B. A client who has kidney stones & reports flank pain 6 out of 10 C. A client diagnosed w/early-stage chronic kidney disease w/a serum creatinine level of 2.0 mg/dL D. A client who has a cast newly applied on his forearm and reports tingling of his fingers

D

A nurse manager is reviewing the function of "Code of Ethics for Nurses with Interpretive Statements" during a staff meeting. The nurse manager recognizes that this document is: A. legally binding B. mandatory for the practice of nursing C. a description of requirements for licensure D. a guide for professional actions

D.

Controversial Legal Issues Affecting Nursing (Cont.)

Health care delivery issues Outpatient clinics and same-day surgery centers Role in discharge planning and patient education very important Telephone nursing triage and telemedical nursing care Utilization review—process to help reduce growing costs of health care

A couple has brought in their adolescent daughter for a school physical. The parents tell the nurse that they are worried about all the safety risks for this age group. As the nurse plans to teach the parents about these risks, the nurse remembers that adolescents are at a greater risk for injury from: A) Home accidents B) Poisoning and child abduction C) Physiological changes of aging D) Automobile accidents, suicide, and substance abuse

D) Automobile accidents, suicide, and substance abuse Adolescents are more likely to be involved in automobile accidents, commit suicide, and engage in substance abuse than are those in other age groups. Children are more susceptible to poisoning and child abduction, and older adults are more susceptible to home accidents and the physiological changes of aging.

6. A gown should be worn when: A) The client's hygiene is poor. B) The client has acquired immunodeficiency syndrome (AIDS) or hepatitis. C) The nurse is assisting with medication administration. D) Blood or body fluids may get on the nurse's clothing from a task the nurse plans to perform.

D) Blood or body fluids may get on the nurse's clothing from a task the nurse plans to perform. Gowns should be worn when there is a possibility that blood or body fluids could get on the nurse's clothes or when the client is on contact isolation status. The other options are not appropriate uses of gowns.

A child for which the nurse is caring in the hospital starts to have a grand mal seizure while playing in the playroom. What is the most important intervention the nurse can do during this situation? A) Begin cardiopulmonary resuscitation. B) Restrain the child to prevent injury. C) Place a tongue blade over the tongue to prevent aspiration. D) Clear the area around the child to protect the child from injury.

D) Clear the area around the child to protect the child from injury. An area around the child should be cleared to prevent injury. Restraining the child or placing a tongue blade in the child's mouth may actually be a cause of injury. Cardiopulmonary resuscitation is required only if heart function stops after the seizure.

A nurse manager is working with a committee of nurses whose task is to update the policies for new employee orientation. The nurse manager directs the team to collect as much data as possible & recommend several options. Which of the following decision-making styles is being demonstrated by the nurse manager? A. Decisive B. Flexible C. Hierarchical D. Integrative

D.

Which of the following statements reflects the current trend in the directives from the Centers for Disease Control and Prevention (CDC) for minimizing risks of infection? A) Discard all dressings into red bags. B) Do not recap bottles of solutions to minimize risk of contamination. C) Recap syringes or break needles off before discarding into sharps containers. D) Keep all drainage tubing below the level of the waist and/or site of insertion.

D) Keep all drainage tubing below the level of the waist and/or site of insertion. Keeping the solution in drainage tubes draining away from the drainage site on the body reduces the risk for bacteria growth. Running any solution backward in the tubing puts the client at risk by bringing any bacteria that may be present lower in the system back to the body, and cross contamination will occur. As in surgical areas, anything below the waist should be considered at potential risk for infection. Needles are not to be recapped or cut because of the increased risk of experiencing puncture wounds while doing so. Not all dressings need to be placed in red bags; only dressings with moisture require placement in a red bag. Bottles of solution that are sitting in the client's room should be closed to prevent airborne contaminants from entering and creating an unsterile situation.

When transferring a sterile item to a sterile field, the nurse should: A) Open the outer package and let the sterile assistant take the item from the nurse to put on the edge of the drape. B) Use a sterile lifting tool (forceps) to pick up the inner package and transfer it to the middle of the field. C) Open the outer package and use a sterile glove to pick up the item and drop it on the sterile field in the middle of the drape. D) Open the package by peeling back the cover without touching the inner package and drop the item within the sterile field without touching the 1-inch border.

D) Open the package by peeling back the cover without touching the inner package and drop the item within the sterile field without touching the 1-inch border. The rule is "sterile to sterile" to prevent contamination. The outer cover is considered unsterile. As long as the inner packet is not touched, the packet is considered sterile. The 1-inch border or barrier between the edge of the drape and the field is the dividing line for sterile versus nonsterile. Using a sterile glove to remove the inner packet is all right, but dropping it into the middle of the field will contaminate other items. A sterile assistant can take the item from the nurse, but placing it on the edge of the drape will contaminate the item because it is not inside the 1-inch border/barrier. Using sterile forceps to remove the inner packet is acceptable, but putting the item into the middle of the field will again risk potential contamination from reaching over the sterile field.

During the night shift a client is found wandering the hospital halls looking for a bathroom. The nurse's initial intervention would be to: A) Insert a urinary catheter. B) Ask the physician to order a restraint. C) Assign a staff member to stay with the client. D) Provide scheduled toileting during the night shift.

D) Provide scheduled toileting during the night shift. Providing scheduled toileting during the night makes it less likely that a client will wander while being confused and ensures staff presence to decrease confusion at the times when the client is away from bed. Inserting a urinary catheter is not necessary. Assigning a staff member to stay with the client might not be necessary if the scheduled toileting is successful. Restraints are unnecessary in this case.

5. Lisa, a nurse assistant, is working with the nurse during the nurse's shift. One of the nurse's clients has upper limb restraints. In delegating care of this client to Lisa, the nurse would tell her to: A) Secure the restraints to the side rails. B) Check to see if the client can have a medication for sleep. C) Call the physician if the client becomes more agitated with the restraint. D) Report any signs of redness, excoriation, or constriction of circulation under the restraint.

D) Report any signs of redness, excoriation, or constriction of circulation under the restraint. The restraint sites much be checked regularly for signs of redness, excoriation, or constriction, and this task may be delegated. Calling the physician and performing medication assessments are nursing responsibilities. Restraints should never be secured to the side rails.

After the nurse assists a client with a history of seizures to a recliner chair, the client begins to have a seizure. The nurse should immediately: A) Turn the client onto his or her stomach. B) Recline the client's chair all the way back. C) Return the client to the bed and place the client on his or her side. D) Slide the client to the floor and cradle the client's head in the nurse's lap.

D) Slide the client to the floor and cradle the client's head in the nurse's lap. The nurse's lap is the safest position for the client's head, and the client is less likely to sustain an injury if the client is already on the floor. Attempting to move the client laterally by oneself could result in injury to the client and/or nurse. Placement in a reclining position could cause excess secretions to accumulate in the oral pharynx and obstruct the airway. Turning the client onto his or her stomach would decrease access to the airway.

4. A nurse is assigned to care for a client with a deep wound infection. Which of the following actions would result in the contamination of sterile gloves? A) The nurse grasps a sterile cotton-tipped swab to clean wound edges. B) The nurse takes a gauze pad in hand and places it in the wound. C) The nurse picks up a gauze pad soaked in sterile saline to cleanse the wound. D) The nurse pulls up the sheet over the client's perineum for better draping.

D) The nurse pulls up the sheet over the client's perineum for better draping. If the nurse touches a sheet (nonsterile) with sterile gloves, the gloves are contaminated. The other actions do not contaminate sterile gloves.

A client who has back pain presents to an emergency department and is provided a prescription of oxycodone. A staff nurse tells the charge nurse that he thinks the client is seeking drugs and is not actually in distress. Which of the following responses by the charge nurse is appropriate? A. "It sounds like nonpharmacological interventions would be best for this client." B. "Let's withhold the oxycodone until we can consult with the provider." C. "Contact mental health services to arrange for a consultation." D. "Clients are the experts on their own path."

D. "Clients are the experts on their own path." Replacing the client's pain medication with nonpharmacological interventions is an unethical practice. The nurse is making an assumption about drug-seeking behavior, which is not an appropriate basis for a decision. Withholding a client's pain medication is an unethical practice. The nurse is making an assumption about drug-seeking behavior, which is not an appropriate basis for a decision. There is no data to indicate the client needs a mental health consult. The nurse is making an assumption about drug-seeking behavior, which is not an appropriate basis for a decision. This response is appropriate because it indicates the nurse understands that the client's report is the best indicator of pain and is not making any assumptions.

An older man is being given a new antihypertensive medication. In teaching the client about the medication, the nurse should: A) Speak loudly. B) Present the information once. C) Expect the client to understand the information quickly. D) Allow the client time to express himself and ask questions.

D. Allow the client time to express himself and ask questions The nurse should allow the client time to express himself and ask questions. Speaking loudly is typically not effective, and information may have to be presented several times. The client will learn the information at his own speed.

On entering a client's room during change-of-shift rounds, the nurse notices that the client and spouse have their backs turned to each other, and both have their arms folded across their chests. The best action for the nurse to take at this time is to: A) Introduce himself or herself and begin discharge teaching. B) Proceed with the tasks the nurse was intending to perform. C) Say nothing and leave quickly, closing the door behind. D) Ask the client and spouse if they need some time alone right now.

D. Ask the client and spouse if they need smoe time alone right now. The situation suggests that the nurse entered during a stressful time. Offering privacy would be appropriate. Because the situation indicates tension between the couple, this is not the time to initiate teaching.

The surgical unit has initiated the use of a pain rating scale to assess the severity of clients' pain during their postoperative recovery. The nurse assigned to a client can look at the pain flow sheet to see the client's pain scores over the last 24 hours. Use of the pain scale is an example of adherence to which intellectual standard?

D. Consistency Using the same pain scale for all clients and ratings promotes consistency—each nurse has the same measurement scale to compare assessments. Relevance refers to how applicable the assessment is. An assessment has depth when it deals with less obvious issues. Specificity refers to the ability of the assessment to provide information about the particular problem of interest.

The nurse requests a stimulant laxative for a client who is receiving an opioid around the clock. What is the nurse demonstrating? A) Concern for safety B) Promotion of client health C) Colleague health education D) Control of adverse reactions

D. Control of adverse reactions The nurse is demonstrating knowledge of opioid side effects and being proactive by asking for an intervention that will most likely prevent the side effect of constipation associated with opioids. The intervention does not promote health; it is aimed at preventing a side effect of an opioid. Safety is not an issue. Requesting a laxative does not provide education.

A theory is a set of concepts, definitions, relationships, and assumptions or propositions to explain a phenomenon. The purposes of the components of a theory are to: A) Describe concepts or connect two concepts that are factual B) Formulate a perceptual experience to describe or label a phenomenon C) Express the global view about the individual, situations, or factors of interest to a specific discipline D) Describe, explain, predict, and/or prescribe interrelationships among the concepts that define the phenomenon

D. Describe, explain, predict, and/or prescribe interrelationships among the concepts that define the phenomenon Describing, explaining, predicting, and/or prescribing interrelationships among concepts are stated purposes of research.

The nurse reviews data regarding a client's pain symptoms, comparing the defining characteristics for Acute pain with those for Chronic pain. In the end the nurse selects Acute pain as the correct diagnosis. This is an example of avoiding which type of error? A) Error in data clustering B) Error in data collection C) Error in data interpretation D) Error in making a diagnostic statement

D. Error in making a diagnostic statement When a nurse compares collected assessment data with defining characteristics for two diagnoses, the selection of the correct diagnosis is an example of avoiding an error in making a diagnostic statement. There is no indication the data clustering or interpretation were incorrect.

Which of the following is objective information to be recorded in the client's medical record? A) Anxious over upcoming test. B) Increasing stress over past 2 months. C) Performs breast self-examination monthly. D) Expelled 1 tablespoon of yellow sputum.

D. Expelled 1 tablespoon of yellow sputum Objective data are measurable data. Options 1, 2, and 3 describe data that cannot be measured by the nurse but depend on the client's reports; thus they are subjective data.

One of the purposes of the use of standard formal nursing diagnostic statements is to: A) Evaluate nursing care. B) Gather information on client data. C) Help nurses to focus on the role of nursing in client care. D) Facilitate understanding of client problems by different health care providers.

D. Facilitate understanding of client problems by different health care providers. The use of standard formal nursing diagnostic statements provides a precise definition that gives all members of the health care team a common language for understanding the client's needs. The other options are not part of the reason for the development of nursing diagnostic statements.

All of the following are examples of active strategies of health promotion except: A) Exercise training B) Weight reduction C) Smoking cessation D) Fluoridation of drinking water

D. Fluoridation of drinking water Passive strategies of health promotion benefit individuals without any action by the individuals themselves. The fluoridation of municipal drinking water and the fortification of homogenized milk with vitamin D are examples of passive health promotion strategies. Weight reduction is considered an active strategy of health promotion. With active strategies of health promotion, individuals are motivated to adopt specific health programs. Smoking cessation requires clients to be actively involved in measures to improve their present and future levels of wellness while decreasing the risk of disease. Exercise training meets the criteria for active strategies of health promotion because it actively involves the client in his or her own health.

A nurse assessing a client who comes to the pulmonary clinic asks, "Tell me what medications you are taking for your breathing problem. I see from your last visit that Dr. Russell recommended routine exercise. Can you also tell me how successful you have been in following his plan?" The nurse's assessment covers which of Gordon's functional health patterns? A) Value-belief pattern B) Cognitive-perceptual pattern C) Coping/stress tolerance pattern D) Health perception/health management pattern

D. Health perception/health management patern The health perception/health management pattern involves the client's self-report of health and well-being, how the client manages his or her health, and knowledge of preventative health practices. The cognitive-perceptual pattern involves sensory-perceptual patterns, language adequacy, memory, and decision-making abilities. The coping/stress tolerance pattern involves the client's ability to manage stress, sources of support, and the effectiveness of the patterns in terms of stress tolerance. The value-belief pattern involves the values, beliefs, and goals that guide the client's choices or decisions.

Assessment data must be descriptive, concise, and complete. In performing an assessment the nurse should not: A) Include subjective data from the client. B) Perform a thorough physical examination. C) Use interpersonal and cognitive skills. D) Include inferences or interpretative statements not supported with data.

D. Include inferences or interpretative statements not supported with data The nurse should not generalize or form judgments not supported by the collected data. Inferences and interpretive statements must be supported by data. Assessments do include conducting a thorough physical examination, using interpersonal and cognitive skills, and obtaining subjective data from the client.

The Nurse Practice Act

Describes how to get licensure and enter practice in that particular state Explains how and when to renew your license Defines educational requirements for entry into practice Describes the process by which individual members of the Board of Nursing are selected and the categories of membership

A nurse has set a time limit for expected outcomes. What is the purpose of establishing such a time frame? A) Indicate which outcome has priority. B) Indicate the time it takes to complete an intervention. C) Indicate how long the nurse is scheduled to care for the client. D) Indicate when the client is expected to respond in the desired manner.

D. Indicate when the client is expected to respond in the dsired manner The time limit sets measurable points to evaluate the client's response and movement toward meeting the outcome goals. The other options are incorrect.

The health belief model addresses the relationship between a person's belief and behaviors, therefore: A) A person who smokes does not follow the model. B) This model provides a basis for caring for clients of all ages. C) A person who does not take necessary medications does not follow the model. D) It provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care regimens.

D. It provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care regimens. The health belief model provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care regimens.

A client who is alert and awake is being transferred to another hospital with a copy of his medical records. Before the transfer the nurse must: A) Ask the hospital lawyer if this requires approval from the risk management department. B) Discuss the need to copy the medical records with the client's family. C) Be certain that the physician writes an order for the record to be copied. D) Obtain written permission to copy the medical records for the receiving hospital.

D. Obtain written permissin to copy the medical records for the receiving hospital Obtaining permission to copy the records demonstrates the nurse's understanding of the provisions of the Health Insurance Portability and Accountability Act (HIPAA). Discussing medical records with the client's family is inappropriate because the client's family does not make the decision for a client who is capable of making his own decision. Policies and procedures would already be in place for the nurse with regard to copying medication records. It is not necessary to call the hospital lawyer. Copying a client's medical record does not require a physician's order.

During data clustering, a nurse: A) Provides documentation of nursing care B) Reviews data with other health care providers C) Makes inferences about patterns of information D) Organizes cues into patterns that lead to identification of nursing diagnoses

D. Organizes cues into paterns that lead to identification of nursing diagnoses During data clustering, the nurse organizes cues into patterns that indicate individualized nursing diagnoses and identify collaborative problems. The other options are incorrect.

Which of the following represents the most complex behavior in the psychomotor learning domain? A) Accepting the limitations imposed by a stroke B) Understanding the relationship of insulin, diet, and exercise in diabetes C) Performing self-catheterization without acquiring a urinary tract infection D) Performing activities of daily living after acquiring left-sided paralysis due to a brain injury

D. Performing activities of daily living after acquiring left-sided paralysis due to a brain injury Origination is the most complex behavior in the psychomotor learning domain. It is highly complex and involves developing new psychomotor skills and abilities from existing ones, as is seen in paralysis. Accepting limitations is a behavior in the affective learning domain. Understanding relationships is a behavior in the cognitive learning domain. Option 3 is a psychomotor learning behavior that is referred to as complex overt response, in which the client performs a motor skill using a complex movement pattern. It is not as complex as origination.

A nurse is assessing a client who is postoperative and has a PCA. The client exhibits restlessness, an elevated pulse, and decreased blood pressure. Which of the following actions should the nurse take?

D. Place the client in a modified Trendelenburg position.

A client needs to learn to use a walker. Acquisition of this skill will require learning in which domain? A) Affective domain B) Cognitive domain C) Attentional domain D) Psychomotor domain

D. Psychomotor domain The psychomotor domain concerns motor skills. The cognitive domain involves understanding, and the affective domain involves attitudes. The attentional domain is not a recognized domain. Attentional set is the mental state that allows the learner to focus on and comprehend a learning activity.

A client with diabetes mellitus who takes daily insulin injections is scheduled for surgery the next day. The client is to take nothing by mouth (NPO status) after midnight. The nurse questions whether insulin should be given the morning of surgery. This is an example of: A) Problem solving B) Previous experience C) Clinical practice guideline D) Scientifically based clinical judgment

D. Scientifially based clinical judgment The nurse is demonstrating awareness of the effect of insulin, which is to lower blood glucose level. Because the client will be NPO status for a long period of time, no calories will be consumed. Giving the usual injection of insulin could cause the client to experience hypoglycemia.

As an art, nursing relies on knowledge gained from practice and reflection on past experiences. As a science, nursing relies on: A) Experimental research B) Nonexperimental research C) Physician-generated research D) Scientifically tested knowledge

D. Scientifically tested knowledge As a science, nursing draws on scientifically tested knowledge applied in the practice setting.

A nurse working in a special care unit for children with severe immunologic problems cares for a 3-year-old boy from Greece. The nurse is having difficulty communicating with the father. What is the appropriate action? A) Care for the boy the same as for any other client. B) Ask the manager to talk with the father and keep him out of the unit. C) Have another nurse care for the boy, because maybe that nurse will communicate better with the father. D) Search for help in interpreting and understanding the culture differences by contacting someone from the local Greek community.

D. Search for help in interpreting and understanding the culture differences by contacting someone from the local Greek community Acquiring cultural and language assistance will help the nurse understand the needs of both the father and the son. The other three options are not culturally sensitive or helpful to the client and his father.

The nurse in a diabetic clinic conducts monthly seminars for diabetic clients. During these seminars, the importance of taking insulin as directed to prevent diabetic complications is emphasized. This is considered which level of preventive care? A) Illness prevention B) Tertiary prevention C) Primary prevention D) Secondary prevention

D. Secondary prevention Secondary prevention is prevention geared toward individuals who are already experiencing health problems or illness and who are at risk of experiencing complications or a worsening of their condition

A nurse is serving on a committee that is considering the creation of a policy that will allow nurses to insert peripherally inserted central catheters in the intensive care unit. Which of the following resources should the nurse consult in planning for this policy?

D. State Nurse Practice Act (NPA)

A nurse is going to teach a client how to perform a breast self-examination. Which of the following statements is the behavioral objective that best measures the client's ability to perform the examination? A) The nurse will discuss learning objectives. B) The client will verbalize the steps involved in breast self-examination within 1 week. C) The nurse will explain the importance of performing breast self-examination once a month. D) The client will demonstrate breast self-examination on herself by the end of the teaching session.

D. The client will demonstrate breast self-examination on herself by the end of the teaching session. Option D has a measurable outcome at a specific time. Options A and B do not show that the client has learned to perform the examination. Option C does not show learning.

Which of the following is an example of an appropriately stated learning objective? A) The client will ambulate 100 feet. B) The nurse will explain the importance of a diabetic diet. C) The nurse will demonstrate a sterile dressing change by the end of the first hospital day. D) The client will state three factors that affect cholesterol by the end of the teaching session.

D. The client will state three factors that affect cholesterol by the end of the teaching session. This learning objective includes the required singular behavior, measurable objective, and time frame for completion. Option 1 lacks a time frame for completion and is a behavioral objective. Options 2 and 3 are teaching objectives rather than learning objectives.

A client-centered goal is a specific and measurable behavior or response that reflects: A) The physician's goal for the specific client B) The client's desire for specified health care interventions C) The client's response compared to that of another client with a similar problem D) The client's highest possible level of wellness and independence in function

D. The client' highest possible level of wellness and independence in function A client-centered goal is a specific and measurable behavior or response that reflects a client's highest possible level of wellness and independence in function. The other options do not meet the definition of a client-centered goal.

Nursing's paradigm includes: A) Health, person, environment, and theory B) Concepts, theory, health, and environment C) Nurses, physicians, models, and client needs D) The person, health, environment/situation, and nursing

D. The person, health, environment/situation, and nursing Nursing's paradigm includes four linkages: the person, health, environment/situation, and nursing.

A nurse is providing change-of-shift report to the oncoming nurse. Which of the following information should the nurse include?

D. The time of the client's last pain medication

Evidence-based nursing practice is the end result of: A) Prescriptive theory B) Use of practical knowledge C) Application of theoretical knowledge D) Theory-generating and theory-testing research

D. Theory-generating and theory-testing research The result of theory-generating or theory-testing research is to increase the knowledge base of nursing. As these research activities continue, clients become the recipients of evidence-based nursing care.

Charge nurse evaluating plan of care novice nurse developed for a client to receive continuous NG tube feed. Which intervention should charge ensure part of care?

D. Use a 60 mL syringe to flush out a clogged tube

A nurse is precepting a newly licensed nurse who is caring for a client who has suspected pulmonary tuberculosis. The nurse should recommend new nurse take which action?

D. Wear an N95 respirator when in the client's room.

The nursing diagnosis Readiness for enhanced communication is an example of which of the following? A) Risk nursing diagnosis B) Actual nursing diagnosis C) Potential nursing diagnosis D) Wellness nursing diagnosis

D. Wellness nursing diagnosis The term readiness indicates a wellness nursing diagnosis. An actual nursing diagnosis describes a human response to health conditions or life processes in an individual, family, or community. A potential nursing diagnosis is a risk for diagnosis.

Goals of managed healthcare organizations

Decrease cost, promote health, provide seamless healthcare

Libel

Defamation that is written such as a negative or hostile remarks that is malicious and false.

Disciplinary Action

Deficiencies identified during appraisal or the course of employment should be presented in writing and corrective action should be based on policy.

Content Motivation Theories

Define motivation in terms of satisfaction of needs -Maslow's, Herzberg's two-factor theory, Theory X, Theory Y, Theory Z

Process Motivation Theories

Define motivation in terms or rational cognitive processes -Expectancy theory and Equity theory

Ethical Issues in Nursing

Define terminology commonly used in discussions about ethical issues Analyze personal values that influence approaches to ethical issues and decision- making Discuss the moral implications of the ANA and ICN codes of ethics Discuss the role of the nurse in ethical health care issues Recognize the role of genetics and genomics in nursing practice

What is the difference between delegating and assigning?

Delegate- RN remains accountable (verticle RN to UAP), Assign-Transfer of responsibility (Horizontal RN to RN) (verticle -responsibility of the task if transferred to the delegatee, accountability remains with the delegator)

HESI Hint #9

Delegating to the right person requires that the nurse be aware of the qualifications of the delegatee: Appropriate education, training, skills, experience, and demonstrated and documented competence.

This type of leader is usually characterized by guidance from the leaders, rather than control by

Democratic

This type of leader tries to move the group toward the groups goals - Shared responsibility (Somewhat efficient overall)

Democratic

Leadership styles and behaviors associated

Democratic (participative)--Assertive. Authoritarian (autocratic)--Aggressive. Laissez-faire (permissive)--Passive.

Malpractice or professional negligence is the failure of a person with professional training to act in a reasonable and prudent manner. How many components must be present for an individual to be found guilty of malpractice?

Five

Outcome audits

Determine what results, if any, occurred as a result of the nursing care provided.

According to Marquis and Huston (2021), there are other critical elements that nurse managers/leaders use to complete the decision-making process. From the following choices, select those that are considered crucial to problem solving and decision making.

Develop realistic timeline Carefully gather pertinent data Think logically Objectives clearly define

Board of Nursing

Develops and enforces the rules and regulations of nursing practice in the state. Also responsible for nursing practice, nursing licensure, nursing education for the state and disciplinary action.

Malpractice Elements (Cont.)

Did the patient suffer damages or injury? Must be proved that breach of duty caused injury to patient Damages—sum of money General damages—given for intangibles such as pain and suffering, disfigurement, interference with ordinary enjoyment of life, loss of consortium Special damages—out-of-pocket expenses Punitive damages—to punish those whose conduct goes beyond normal malpractice

Managing conflict among staff members would occur in which part of the management process?

Directing

Supervision Skills

Direction/guidance. Evaluation/monitoring. Follow-up.

What is heuristics?

Discrete, unconscious process to allow individuals to solve problems quickly

Samantha has approached Dr. Gonzalez in an effort to discuss Mary's care, and it is clear that they disagree about the necessary approach. What should Samantha do in order to promote a collaborative approach to conflict management?

Discuss Mary's situation with Dr. Gonzalez and try to agree on a common goal for her care.

Guidelines for Using Social Media (Cont.)

Do not disclose any information that may identify the patient; this includes but is not limited to biographical data (name, age, occupation), medical diagnosis, room number, implantable medical devices, and diagnostic reports. Do not write or verbalize negative or rude comments about a patient, family member, or health care team member.

Guidelines for Using Social Medial (Cont.)

Do not make harassing, profane, uncivil, hostile, sexually explicit, racially derogatory, homophobic, threatening or other offensive comments about co-workers, the employing institution, patient, or patient's family. Recognize that professional boundaries between you, your patient, and the patient's family exist and must be carried out in both the practice setting as well as in the online environment

Malpractice Elements

Do you have a professional duty? Nurse-patient relationship—a professional duty to a patient? Good Samaritan statutes Give immunity from malpractice to those attempting to give assistance at scene of accident Immunity excluded in cases of professional negligence What is the professional duty owed? Act as a reasonable nurse would under same or similar circumstances

What is the responsibility of a charge nurse who discovers that a medication error was made on the previous shift?

Document the incident as per hospital policy

Which of the following is a decision-making tool often used by today's nurse leaders/managers for program/unit evaluation?

Flow charts

Transactional Leaders

Focus on immediate problems, maintaining the status quo and using rewards to motivate followers.

How to prepare for a trial deposition

Don't volunteer information, be familiar with the case, clarify questions, don't assume, don't exaggerate, allow 5 seconds before answering (Practice this), tell the truth always, speak slow and clear, eye contact, bring resume, request a break/rest, think before answering, avoid anger/absolutes, read deposition ahead of time, if asked the same question twice- ask them to play back or repeat your previous answer.

Preschoolers and School-Aged Children Home Risks

Drowning, Motor Vehicle/ injury (children under 12 should be in back seat, booster seat for less than 40 lbs or 4'9"), burns (water heater no higher than 120F), Poison

What are some trends in informatics today?

EMR/Smartcards, telehealth, email help, health websites and evaluation of web resources

Fire Class C

Electrical fires

What is an example of a positive outcome of a leader's emotional intelligence?

Emotions are used effectively

Dont's of feedback

Focus on negatives, let personalities intrude, be vague, play favorites, correct people publicly

What are some decisional behaviors of nurse managers?

Employee evals, resource allocation, planning, job analysis and redesign

Third Infraction

Employee placed on suspension with or without pay.

This type of liability is dependent on hiring of quality staff, in a safe environment

Employer/Corporate liability

Transformational Leaders

Empower followers to assume responsibility for a communal vision, and personal development as a secondary outcome.

A nurse educator in a college setting has developed leadership skills as a result of attaining further education and sharing positive change within the department. What transformational leadership characteristic is this nurse educator demonstrating?

Empowering others

A nurse leader is considering using transformational leadership. What information would the nurse leader need to keep in mind?

Empowerment of both the leader and follower occurs

Invasion of privacy

Encroachment or trespassing on another's body or personality

Seizure Precautions

Ensure proper resuscitation equipment is readily available, do not put anything in clients mouth, padded side rails, note duration of seizure, etc

What is the staff RN role in research?

Ensure rights, Identify problems, assist with research, implement findings, read widely and critically, attend conferences, seek an environment in support of research, journal clubs, collaborate with researchers

What is the typical focus of managers? Select all that apply.

Establishing a legitimate source of power Delegating responsibilities to staff members Formulate the budget to achieve the stated goals

Formal statements of behavior rules for a group

Ethical Codes

This is a problem in which conflicts of belief exist making decisions difficult

Ethical dilemma

This is the "right" or "wrong" of human behavior, and the motivation behind it

Ethics

Which of the options below correctly correlate the decision-making model to the nursing process?

Evaluate: Evaluate decision-making steps Implement: Choose alternative, implement alternative

A nurse is determining whether the outcomes were met for a patient preparing for discharge with an open abdominal wound and reassessing if not met. What phase of the nursing process is the nurse performing?

Evaluating

This Practice for research holds the "TRIP" value system (translating research into practice)

Evidence based practice

TRUE OR FALSE: Decision-making tools such as decision trees or consequence tables are in place to prevent errors in the decision-making process.

FALSE

TRUE OR FALSE: Rationales and justification for decisions need to be communicated to stakeholders only when there is lack of clarity.

FALSE

TRUE OR FALSE: The American Nurses Association Code of Ethics is legally binding.

FALSE

TRUE OR FALSE: The HIPAA Privacy Rule provides protection for individually identifiable health information on a state level and may differ state by state

FALSE

TRUE OR FALSE:A patient can give informed consent by verbalizing understanding prior to receiving a complete explanation of medical-surgical treatment options.

FALSE

TRUE OR FALSE:The person who generates the lawsuit is the defendant.

FALSE

Common actions leading to malpractice lawsuits

Fail to assess properly, fail to report changes in pt status, fail to document, fail to obtain informed consent, fail to report co-worker negligence, fail to provide adequate education ** TWO BIGGEST** Altering/falsifying a medical record and Violation of an internal or external standard of practice

How Can I Avoid a Malpractice Claim? (Cont.)

Failure to assess, monitor, and obtain assistance adequately Do not delegate assessment and evaluation of patient care and progress Be aware of any changes in progress Document changes and events

How Can I Avoid a Malpractice Claim? (Cont.)

Failure to communicate adequately Communicate changes in patient's condition Document this communication (not to be done defensively)

Common mistakes made during change implementation

Failure to make need for change clear, unclear goals, too little time, poor leadership, insufficient coordination of the change process, insufficient education, dismissing complaints

Avoiding a Malpractice Claim (Cont.)

Failure to report Must report certain incidences or occurrences Unprofessional behavior of health care professional Evidence of child, adult, elder abuse or neglect Certain communicable diseases Certain deaths under suspicious circumstances Certain types of injuries possibly caused by violence Evidence of Medicare fraud Emergency Medical Treatment and Labor Act violations

Justice

Fair treatment in matters related to physical and psychosocial care and use of resources.

True or false, conflict is always a negative experience

False, not necessarily

Major issues handled by the state boards of nursing include what?

Falsifying documents, felonies, drugs/alcohol problems, functioning outside the scope of practice, abuse

It is the idea that context is an important mediator of transformational leadership, that led to the creation of full range leadership theory early in the 21st century. This theory originally developed by Antonakis, Avolio, and Sivasubramaniam suggests how many transformational factors impacting leadership style and its impact on followers?

Five

What component of professional negligence is represented when a nurse fails to look up an unfamiliar medication before administering it?

Foreseeability of harm

List some sources of power

Formal vs informal, authority, reward, coercion, expertise/information, connections/referent

Stages of Team Formation

Forming- Members of the team get to know each other. Your leader defines tasks for the team and offers a direction Storming-Conflict arises, and team members begin to express polarized use. The team is devilish is a role, and members began to take on various roles. Norming-The team establishes rules. members show respect for one another and begin to accomplish some of the tasks. Performing-The team focuses on accomplishment of tasks

What is vertical delegation?

From Rn to less qualified or UAP (RN is still accountable)

In this nursing care delivery model the staff members are assigned to complete tasks for a specific group of patients and unskilled workers are trained to perform routine simple tasks, evolved during WWII as a result of the nursing shortage.

Functional Nursing

What is the role of the American Nurses Association Code of Ethics and Interpretive Statements?

Functions as a guide to the highest standards of ethical practice for nurses

Controversial Ethical Issues Confronting Nursing (Cont.)

Futile care and physician-assisted suicide Futile care—medical intervention (beyond comfort care) without reasonable hope of benefit to patient Physician-assisted suicide (PAS)—AMA opposes (doctors do no harm)

The nurse manager on the unit where Mary is receiving care is applying Crisham's (1985) MORAL decision-making model to Mary's care planning. What is the nurse manager's best initial action?

Gather as much specific information about Mary's status and circumstances as possible.

Advice for giving feedback

Give both negative and positive, give immediately, give frequently, give negative feedback in private, base it on observed behavior, include suggestions for change.

This skill is a prerequisite for good delegation skills?

Good organizational skills

Laws relevant to Nursing

Good samaritan, confidentiality, slander/libel, false imprisonment, assault and battery, malpractice, liability, and negligence

3 qualifications for RN licensure in the USA

Graduate from an approved RN program, english language proficiency, disclosure of criminal convictions

What were some reasons for the crossing the quality chasm initiative from the institute of medicine?

Growing complexity of science and technology, increase in chronic medical conditions, poorly organized delivery of care system, constraints on exploiting the revolution in information technology

3 Fundamental Qualities of Effective Leaders

Guiding vision, passion, and integrity.

In this type of managed health care organization, the primary care provider controls access to services

HMO

Name 3 types of managed healthcare

HMO, PPO, POS

How nurse managers use knowledge

Have the right type & right number of personnel

Controversial Legal Issues Affecting Nursing

Health care costs and payment issues Questionable accuracy and monitoring of physician visit coding Improper use of diagnosis codes Failure to provide patient care or giving sloppy care Anesthesia services Unneeded critical or acute-care services Billing for physician assistant services Improper billing of nursing or physician services

Who Knows About the Disciplinary Actions Against Nurses? (Cont.)

Healthcare Integrity and Protection Data Bank (HIPDB) Federal data bank of information about health care providers National Practitioner Data Bank Part of a federal law under Medicare called the Health Care Quality Improvement Act. Identifies licensed individuals (nurses, physicians) who have committed malpractice and/or have had licensure problems across state lines

Six aims for quality improvement in healthcare - (Institute of Medicine)

Healthcare should be 1. safe 2. effective 3. pt centered 4. timely 5. efficient 6. equitable

What are some advantages to total patient care nursing?

High degree of autonomy, Lines of responsibility and accountability are clear, patient receives holistic unfragmented care

What are some advantages of primary nursing care?

High quality holistic patient care, Establish good rapport with RN, the RN feels challenged and rewarded

What are some advantages of team nursing care?

High quality, comprehensive care with a high proportion of subordinate staff, each team member participates in care decision making and contributes their own expertise

Telling Leadership Style

High task behavior and low relationship behavior

There are current and future paradigm shifts in health care that affect the leadership skills needed by nurses in the twenty-first century. What issue at the organizational and unit levels are nurse-leaders being directed to address?

High turnover rates by staff nurses

Professional organizations generally espouse standards of care that have what relationship to those required by law? Select all that apply.

Higher than those required by law Are established prior to those required by law

Moral and Ethical Principles (Cont.)

How do I determine who owns the problem? Determine the facts of the situation Identify the ethical issues of the situation Consider the possible input and assistance of an interdisciplinary ethics committee (IEC) Consider possible courses of action and their related outcomes After a course of action has been taken, evaluate the outcome

Controversial Ethical Issues Confronting Nursing (Cont.)

How does the abortion issue affect nursing? What are your values and beliefs, and how can you apply these values to your work and possible political action? Statement 1 of ANA's Code of Ethics for Nurses outlines your responsibility to care for all patients You do not have to sacrifice your own values and principles, but you cannot abandon your patients Conscience clauses

Controversial Ethical Issues Confronting Nursing (Cont.)

How should the ability to diagnose genetic defects prenatally be used? Tay-Sachs disease Cystic fibrosis Should screening remain voluntary or mandatory to detect fetal disorders? Safeguards need to be applied

What does the Hawthorne effect implied about people?

Human beings under investigation will respond to the fact that they are being studied

As a new graduate nurse is transitioning into her first pediatric nursing job, which statement suggests that this new nurse needs additional training, as identified by her preceptor and nurse manager?

I'm so glad we have a CPS case worker in our hospital to deal with all this. I could never do that job!

What are some common areas for Total Patient Care Nursing delivery?

ICU, PACU, and Nursing students often provide total patient care. :D

This drives healthcare, (QSEN standards also)

IOM- Institute of Medicine

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a management function?

Identifies outcomes in ethical decision making that should always be sought or avoided

A nurse has a difficult decision to make regarding patient care. What should the nurse due to influence a positive outcome? (Select all that apply.)

Identify a number of different options. Gather data and input from a variety of sources. Slow down the thinking process Understand the repercussions of each option

List the conflict resolution process

Identify the problem, generate possible solutions, evaluate suggested solutions, choose the best solutions, implement the solution chosen, is the problem solved?, if yes end process if not repeat.

What is the critical leadership skill when attempting to build a cooperative and effective team?

Identifying existing emotions in themselves and others

Which step in the problem-solving process assists the nurse leader to prioritize the problem or issue?

Identifying the problem

HESI Hint #3

If the nurse carries out a HCP's prescription for which he or she is not prepared and does not inform the HCP of his or her lack of preparation, the nurse is solely liable for any damages. If the nurse informs the HCP of his or her lack of preparation in carrying out a prescription and carries out the prescription anyway, the nurse and the HCP are liable for any damages

What are the 2 times in which confidentiality may be violated?

If the pt is indicating they may harm themselves or others, if the pt gives permission for the information to be shared

Steps to follow if possible lawsuit is pending

Immediately seek legal counsel, never sign documents without legal counsel, notify your malpractice carrier if covered and employer, keep all correspondence (written and verbal)

A UAP may perform care that falls within which component of the nursing process?

Implementation

A nurse is educating a patient who is scheduled to undergo an open cholecystectomy how to turn, cough, and deep breathe in order to prevent complications after the procedure. What phase of the nursing process is the nurse providing

Implementation

A nurse determines that action is justified for a patient with limited mobility after an injury. After a plan for a solution has been identified, what is the next step in the problem-solving process?

Implementing

What is the role of the nurse manager in assuring ethical nursing practice on the unit? Select all that apply.

Implementing the best decision with attention to cost Identifying desired outcomes Expert problem solver Primary decision make

What is the safety goal of JCAHO?

Improve communication among health care providers

How do administrative man managers make the majority of their decisions?

In a manner good enough to solve the problem

Which statement is true regarding the implications of a Good Samaritan law for a registered nurse? Select all that apply.

In order for protection to apply, the nursing care cannot be considered negligent A nurse who provided out-of-scope care is not protected by the Good Samaritan law

Which statement is true regarding criminal law cases? Select all that apply.

Incarceration is a likely consequence of being found guilty of a criminal offense Intentionally giving an overdose of a potent narcotic is a criminal offense A guilty verdict requires evidence beyond a reasonable doubt

Democratic Leadership Style

Includes group when decisions are made. Motivates by supporting staff achievements. Communication occurs up and down chain of command. Good when cooperation and collaboration are necessary.

What are some disadvantages of total patient care nursing?

Inconsistency- each RN may have different approach to care, not cost effective, Lack of RN availability

Strategies for group decision making

Increase acceptance, increase time, more ideas generated the better, increase team building, all members need knowledge, some members may dominate, competition can develop

What actions should the nurse take if he or she questions a HCP's prescription--that is, believes the prescription is wrong?

Inform the HCP; record that the HCP was informed and the HCP's response to such information; inform the nursing supervisor; refuse to carry out the prescription.

Theory Y

Leaders must remove work obstacles because, under the right work conditions, workers have self-control and self-discipline. -The workers' rewards are their involvement in work and in the opportunities to be creative. -Employees are motivated by their ties to the group, the organization, and the work itself.

What is the conclusion of interactional theories regarding successful leadership?

Leaders, followers, and the situation were all variables that interacted

This process includes data information collection and knowledge. It is the infrastructure for Evidence based practice, and collects data for standardized nursing practice, Hospital information data and administrative database maintenance (collection of private, secure data)

Informatics

What are some ways to lower resistance to change (Restraining forces)

Information dissemination (give as much info as possible for better understanding), Disconfirm currently held beliefs(risks if a change does happen), Psychological safety must be ensured, Command (usually commanding doesn't work)

What element must be included in the process of securing informed consent?

Information regarding the risks involved in the proposed procedure

This prevents some medical practices from being considered battery

Informed consent

This is the ability to influence the beliefs, opinions or behaviors of a person or group toward overall goal acheivement

Leadership

Defense for Intentional Torts

Informed consent—patient informed of: Nature of proposed care, treatment, services, medications, interventions, or procedures Potential benefits, risks, or side effects Likelihood of achieving care, treatment, and service goals Reasonable alternatives (risks and benefits) and option of refusing all interventions Never obtain a patient's consent to a procedure that has not been fully explained to them

These are activities that an RN may NOT delegate

Initial and follow up assessments, decisions and judgements about client plan of care, interventions that require professional RN knowledge or skills, decisions/judgements needed to evaluate care

What are some RN only tasks that should not be delegated?

Initial teaching, nursing diagnoses, assessments, delegation to others

For which reasons does the nurse manager understand that frequent individual and group communication is critical to employee satisfaction? (Select all that apply.)

It motivates all staff to do their jobs well and go "above and beyond." It provides a shared vision for all staff to work towards. It gives the opportunity for the manager to clarify policies and organizational changes.

This type of organizational structure is less bureaucratic, more flexible, decisions are made by those who implement the changes, autonomy is emphasized, communication is up and down

Innovative/Decentralized/Non-traditional

What are some common areas for team nursing delivery?

Inpatient and outpatient care settings (Med/Surg, Pine Rest Inpatient units etc)

The role of this group is to provide unbiased, expert advice to improve health. (they drive healthcare)

Institute of medicine (qsen, quality and safety - we teach to the IOM)

Name some ways that healthcare is financed

Insurance companies, Government insurance, managed care organizations

What are the main components of michigans professional health recovery program?

Intake, referral, treatment, recovery monitoring and completion

What are the qualities of a good leader?

Integrity, courage, initiative, energy, optimism, perseverance, balance, ability to handle stress, self awareness

These standards are maintained in policy and procedure manuals/online access. Developed by institutions

Internal standards

Name some types of Standards nurses must follow

Internal, organizational, accepted state and national standards, nurse practice acts, patient care partnerships

A nurse is caring for a patient that suddenly becomes short of breath and has a decrease in oxygen saturation to 86%. The nurse places the patient on 4 L of oxygen via nasal cannula and elevates the head of the bed. What decision tree would the nurse have used in this situation?

Intuitive judgment

Lewin's Force-Field Model

Involve the right people. Start small then expand. -Unfreeze -Move -Refreeze

High Task Structure

Involves routine, predictable, clearly defined tasks.

Low Task Structure

Involves work that is not routine, predictable, or clearly defined, such as creative, artistic, or qualitative research activities.

What is one way to promote open communication between patients and practitioners?

Involving health-care consumers as active members of the health-care team

The registered nurse is planning assignments for patients on a short-stay observation unit. Which activity should be assigned to the licensed practical nurse/licensed vocational nurse (LPN/LVN)?

Irrigate and apply a sterile dressing to a leg wound

What are some factors the RN should consider when delegating tasks?

Is there potential for harm?, Complexity of the RN activity/task, what problem solving/innovation is required, how predictable is the outcome?

Controversial Legal Issues Affecting Nursing (Cont.)

Issues about life and death decisions Abortion Fetal rights Human experimentation research Patient rights

List 4 points about grapevine communication

It always exists, it travels rapidly, spontaneous, may lack accuracy

What is the advantage of using a payoff table when applicable?

It assists in the visualization of the available historic and current data

What statement is true regarding decision making?

It involves choosing between courses of action

Which statement concerning autonomy and the employee is true? Select all that apply.

It is a form of personal liberty Its legal equivalent is self determination It is based on a person's right to make a choice It is supported by the process of progressive employee discipline

Is burnout an emotional disturbance or a reaction to organizational stressors?

It is a reaction to organizational stressors

HESI Hint #16

It is important to remember that in disaster and bioterrorism management, the nurse must consider both the individual and the community.

Which statement is true concerning critical thinking?

It requires reasoning and creative analysis

Which statement best describes the impact that the concept of respondeat superior has on the issue of nursing liability?

It supports the sharing of blame among all involved sources of health-care services

Hygiene-Maintenance Factors:Present

Job dissatisfaction can be avoided, but this alone will not lead to job satisfaction

What are some things that can make groups (in general) feel more empowered?

Joining/participating in Professional organizations, collective bargaining, shared governance

The practice of allocating organs for transplantation based on a person's "worth to society" is an example of what ethical principle for decision making?

Justice

This is the ethical belief that each person must be treated equally

Justice

Tips for prevention of malpractice

Keep informed about new information r/t your practice (CEU's), Insist on employer keeping personnel informed of all changes in policy/procedure and new technology, follow standards of care, ID at risk clients for problems, maintain safe environment, document precisely, write detailed incident reports, file incident reports, recognize client behaviors that might be a problem

The director of a busy outpatient department is meeting with staff to ask input and make decisions about the feasibility of a freestanding unit. What issue by the nurse manager can stop the entire process if not rectified?

Keeping the objective and expectations for the group undefined.

Durable Power of Attorney

Legal document that designates a health care proxy, who is an individual authorized to make health care decisions for a client who is unable.

Living Will

Legal document that expressed the client's wishes regarding medical treatments in the event the client becomes incapacitated. Legal in all states, however state statutes and policies may vary.

Competency hearing

Legal hearing that is held to determine a person's ability to make responsible decisions about self, dependents, or property. 1. Persons declared incompetent have the legal status of a minor--they cannot: vote, make contracts or wills, drive a car, sue or be sued, hold a professional license. 2. A guardian is appointed by the court for an incompetent person. Declaring a person incompetent can be initiated by the state or the family.

What Happens When I Go to Court? (Cont.)

Look and act like a professional; be prepared Be clear, accurate, and very concise Give NO opinions; stick to facts Speak slowly; use a well-modulated tone Ask for questions to be repeated if you don't understand or don't remember Correct any misstatements Don't become angry or give emotional responses Avoid saying always, never, maybe, I think, and possibly Do not answer more than is asked

Impoverished Leader

Low production concern and low people concern

Participating Leadership Style

Low task and high relationship style

Delegating Leadership Style

Low task and low relationship style

What type of brain dominance creates a management style that is highly organized and detail oriented?

Lower left brain

This personality test studies Extro/introversion, sensing/intuition, thinking/feeling and judging/perceiving

MBTI (Myers-Briggs Type Indicator) personality testing (some employers use this to seek out possible new employees)

When making a decision about using a prn pool for added staffing, what can the nurse manager do to make the best decision?

Make a decision with all of the facts.

Fall Precautions

Make sure the client knows how to use call light, Respond to call lights in a timely manner, Orient client to setting, Maintain bed in low position, keep floor free from clutter, use bed alarms, educate, etc.

Authoritative Leadership Style

Makes decision for group. Communication occurs down the chain of command. Motivates by coercion. Good for crisis situations and bureaucratic settings. Effective for employees with little to no formal education.

Laissez-Faire Leadership Style

Makes very few decisions, and does little planning. Motivation is largely the responsibility of individual staff members. Communication occurs up and down COC and b/w group members Work output is low unless informal leader evolves from the group. Effective with professional employees.

This is the term used for professional negligence

Malpractice

This states that the supervisor that gives an order can be sued if the person below them fails to follow it.

Malpractice -(respondeat superior)

This is a health care delivery system that uses financial incentives and management controls to direct efficient and appropriate health outcomes (capitated system)

Managed Care

Novice nurse

May be students who are newly licensed nurses with minimal clinical experience. Approach situations from theoretical perspective relying on context free facts and establish guidelines. Rules govern practice.

Examples of incident Reports

Med errors, treatment errors, equipment errors, needle stick injury, client falls, visitor fall/injury, threat made to client/staff, loss of property

What Evidence Can Help Me in a Lawsuit?

Medical record 1 of 4 cases decided on basis of what's in the medical record Integrity, accuracy, and completeness make claim defensible or indefensible Good documentation—best defensive action Document extensively, accurately, and very factually.

A nurse does not assist with ambulation for a postoperative patient on the first day after surgery. The patient falls and fractures a hip. What charge might be brought against the nurse?

Negligence

How Can I Avoid a Malpractice Claim?

Medication errors Always follow the classic five rights. Calculate carefully Consider drug interactions, drug allergies Listen to patients or family members regarding new medications; recheck anything amiss Take time to administer correctly (will ultimately save time)

Which statement depicts leadership?

Members of a group will follow a person in a leadership position only by choice

Which activity best demonstrates a nursing unit manager's attention to the ethics standards of practice required of that position?

Membership on the institution's ethic board

Assault

Mental or physical threat (e.g., forcing [without touching] a client to take a medication or treatment)

Which activity is associated with a leadership role? Select all that apply.

Mentoring two new managers Establishing goals for the coming year Advocating for employee regarding personal policies Providing a motivational speech at the new employee orientation

Safety

Minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others.

Who Knows About the Disciplinary Actions Against Nurses?

NURSYS—Comprehensive electronic information system, including collection and warehousing of nurse licensing information and disciplinary actions Nurses can also access a system to provide nursing license verification for a fee of $30.00 National Practitioner Data Bank was part of a federal law under Medicare called the Health Care Quality Improvement Act Identifies licensed individuals (nurses, physicians) who have committed malpractice and/or have had licensure problems across state lines

A new nurse is working in the operating room suite. The nurse notices that the surgeon uses inappropriate humor concerning the patient while the patient is under anesthesia. What is the nurse experiencing?

Moral outrage

The pediatric nurse is admitting an 8-year-old child with cellulitis of both hands and arms from multiple infected bug bites in various stages of healing. The child has not received care for these infected bug bites. The nurse is upset and angry when she becomes aware that other unit staff have previously made several referrals to the local CPS agency about this family for issues related to neglect of care. Which ethical issue may be used to describe this situation

Moral outrage

Which term is used to identify a person's feelings of powerlessness to stop unethical behavior in another person or institution?

Moral outrage

This is a persons own code for what is acceptable behavior (conscience) this is learned

Morals

Nursing Malpractice

Most common unintentional tort action brought against nurses is a malpractice claim. Nurses need to know basic elements that must be proved before malpractice can occur. There have been 6208 cases in which malpractice payments were made on behalf of a specifically named nurse

Advanced beginner

Most new nurses function at the level of the advanced beginner. Practice independently in the performance of many tasks and can make some clinical judgments. Begin to rely on prior experience to make practice decisions.

HESI Hint #6

Motivation comes from within an individual. A nurse leader can provide an environment that will promote motivation through positive feedback, respect, and seeking input. Look for responses that demonstrate these behaviors.

Maslow's Hierarchy of Needs

Motivation occurs when needs are not met. Certain needs have to be met first, beginning with physiological needs, then safety and security needs, then social needs, followed by self-esteem needs, and then self-actualization needs. Needs at one level must be satisfied before one is motivated by needs at the next higher level of needs.

What happens if a student doesn't pass NCLEX after 3 x in one year

Must have to repeat an RN program. Then gets 3 more chances in 12 months to pass (this may vary state to state)

HESI Hint #7

NCLEX questions often include examples of nursing interventions that do or do not demonstrate these skills and characteristics

Unintentional Torts

Negligence and malpractice

Unintentional Torts

Negligence: RN fails to implement safety measures for a client who is at risk for falls. Malpractice: RN administers wrong dose of med d/t med calc error

What are some interpersonal behaviors of nurse managers?

Networking, conflict resolution, employee development, rewards/punishment

This type of error event shouldn't have happened. Ever.

Never Event

Which member of the health-care team is often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting wants and goals?

Nurses

Leadership and Management

Nurses act in both leadership and management roles. A. A leader is an individual who influences people to accomplish goals. B. A manager is an individual who works to accomplish the goals of the organization. C. A nurse manager acts to achieve the goals of safe, effective client care within the overall goals of a health care facility.

Critical Thinking Skills

Nurses are accustomed to using the nursing process as the model for problem-solving in client care situations.

Duty

Obligation to use due care (what a reasonable, prudent nurse would do); failure to care for and/or to protect others against unreasonable risk. The nurse must anticipate foreseeable risks. Example: If a floor has water on it, the nurse is responsible for anticipating the risk for a client's falling.

Why do our values often cause personal conflict in decision making?

Our values often collide with one another

Intergroup conflict

Occurs between two or more groups of individuals, departments, or organizations and may be caused by a new policy or procedure, a change in leadership, or a change in organizational structure. Example: there is confusion as to whether it is the responsibility of the nursing unit or dietary department to pass meal trays

Interpersonal conflict

Occurs between two or more people with different values, goals, and/or beliefs. In the healthcare setting involves disagreement among nurses, clients, family members, and within the healthcare team. Contributes to burnout and work-related stress. Example: a new nurse is given a client assignment that is heavier than those of other nurses, and when he asks for help, it is denied

Breach of Confidentiality

Occurs when data or information provided in confidence to you by a client is disclosed to a third party without your client's consent.

Intra-personal conflict

Occurs within the person and may involve internal struggle related to contradictory values or wants. Example: A nurse wants to move up on the career ladder but is finding that time with her family is subsequently compromised

Which factor should be considered when assessing the quality of ethical problem solving? Select all that apply.

Outcomes Decision-making process

One of the nurses on the unit said, "Male patients have a low threshold for pain." This is an example of what type of illogical thinking?

Overgeneralizing

What are some common errors of delegation?

Overloading self by not delegating, old patterns of behavior, unclear communication, release of control, pressure to delegate in appropriately

Things an RN should do when evaluating the delegation process

Oversees the care, determine if pt care needs have been met, allow for feedback

Which ethical principle associated with an adult child is legally given the right to make medical decisions for a cognitively impaired parent?

Paternalism

Which legal act gives patients the right to determine their desired end-of-life care?

Patient Self-Determination Act

What is informal power?

Powers under the radar (stems from relationships you build/rapport etc - the way you speak to certain people can gain you power)

Which represents the management functions that are incorporated into the management process?

Planning, organizing, staffing, directing, and controlling

Which characteristics are associated with Collin's Highly Capable Individual level of leadership? Select all that apply.

Possesses useful knowledge Demonstrates effective organization skills

Name two things required to motivate people

Power and authority

Tips for a successful Team conference

Present the info in a clear concise manner

False Imprisonment

Preventing movement or making a person stay in a place without obtaining consent. Physical or non physical means. (physical- pt is in danger to self or others). Requires a physician's order AND permission of the pt or the pt's family members. Restraints use as a last resort.

In this nursing care delivery model, the RN is the main caregiver and responsible for planning, directing and evaluating all care. Created in the 70's for promoting RN autonomy.

Primary Nursing

What are some disadvantages of primary nursing care?

Primary nurse must be able to practice with a high degree of autonomy, RN must accept 24 hour responsibility, more RN's are needed so it is not cost effective

List examples of the three levels of prevention in disaster management

Primary: Develop plan, train and educate personnel and public. Secondary: Triage, treatment-shelter supervision. Tertiary: Follow-up, recovery assistance, prevention of future disasters.

To decrease overtime, the manager of a surgical unit offers nurses who get their work finished on time for an entire 2-month period an extra day off with pay at regular time. What is this an example of?

Principal agent theory

HESI Hint #13

Priorities often center on which client should be assessed first by the nurse. Ask yourself: Which client is the most critically ill? Which client is most likely to experience a significant change in condition? Which client requires assessment by an RN?

Which of the following are behaviors associated with effective leaders?

Priority setting, critical thinking, skillful communication

Where does funding for research come from?

Private foundations, nursing organizations, government (organizations NIH, Dept of Health and human services)

This research term describes the likelihood that something will happen

Probability

Socialization

Process by which a person learns a new role and the values and culture of the group within which that role will be implemented.

Organizing and Staffing

Process of ensuring that the necessary human and physical resources are available to achieve the planning goals. -Assigning work to the right person or group and specifying who has the authority to accomplish certain tasks

What is an example of an unintentional tort?

Professional negligence

When discussing the role of mandated reporting for suspected child abuse, the student nurse understands that not reporting suspected abuse could result in which legal action?

Professional negligence

This health practice model advocates for continued growth of nursing, provides vision, practices self and shared governance and empowerment of nursing practice

Professional practice model

Good Samaritan Laws

Protect nurses who provide emergency assistance outside of the employment location.

Samantha is applying the American Nurses Association Code of Ethics for Nurses when planning the next steps of Mary's care. When applying the principles of the Code, Samantha should prioritize what factor?

Protecting and promoting Mary's rights, dignity, and well-being

Good Samaritan Act

Protects health practitioners against malpractice claims for care provided in emergency situations (e.g., the nurse gives aid at the scene to an automobile accident victim)

How Can I Avoid a Malpractice Claim? (Cont.)

Provide a safe environment Know how equipment works Remove hazards such as chemicals Ensure that environment is free of hazards, such as poorly placed furniture or equipment Document any incident correctly

The Nurse Practice Act (Cont.)

Provides definitions and scope of practice for each level of nursing practice Identifies situations that are grounds for discipline or circumstances in which a nursing license can be revoked or suspended Identifies the process for disciplinary actions, including diversionary techniques Outlines the appeal steps if the nurse feels the disciplinary actions taken by the Board of Nursing are not fair or valid

What are the key things that should be included in shift change report?

Pt ID, Pt Dx, Where the pt is, Treatment plan, Responses to treatments, omit personal opinion and judgement

Which characteristic of an organization has influence on the ethical decisions its managers' make? Select all that apply.

Purpose Societal role Societal constraints

Advance Directive

Purpose is to communicate a clients wishes regarding end-of-life care should be the client unable to do so. Two parts are the Living Will and the Durable Power of Attourney

QI vs CQI

QI - Nightengale began, structured/organized, evidence based CQI-Purpose, Identify and collect data, analyze, evaluate and change, responsibility, evaluate structure process and outcome

Pain tolerance is what type of research?

Qualitative

This research type is subjective, words are used as element of analysis

Qualitative

How Do I Protect Myself and My Patient from All These Risks?

Quality assurance, CQM, or CQI Peer review Look for better ways to give care Evaluate what nurses are doing Develop policies and procedures Prepare staff—competent?—skill documentation Continuing education and certification Employee evaluations Ongoing monitoring

Re-admission rates are what type of research?

Quantitative

This type of civil law involves damage to a persons reputation with words, defamation of character, invasion of privacy, or breech of confidentiality

Quasi-Intentional Tort

What influences the quality of a decision most often?

Questions asked and alternatives generated

Fire Safety

R-Rescue A-Alarm C- Contain E- Extinguish P-Pull A-Aim S-Squeeze S-Sweep

What are some reasons delegation is necessary?

RN shortage, health care reform, increased need for nursing services, cost containment, time management, demographic trends, use of UAP

What is horizontal delegation"

RN to RN (transfer of responsibility and accountability) Transfer to person of same expertise level.

Guidelines for Using Social Media

Recall that you have an ethical obligation to maintain and protect patient privacy and confidentiality. Never share or post patient images, videos, or any information pertaining to a patient on any form of electronic media; this includes the use of cell phones, smart phones, cameras, and other electronic devices in the clinical setting. Follow the institution's policies and procedures for taking photos or videos of patients for treatment purposes on electronic devices provided by the employer.

Legal Aspects of Licensure

Receiving license to practice nursing is a privilege, not a right License is granted by state after candidate has successfully met all requirements Each state's Practice Act may be different from other state's acts

This occurs when the novice RN begins to understand the culture of the unit after reality shock

Recovery

Triage Color Code System

Red--Most urgent, first priority. Life-threatening injuries. No delay in treatment. Yellow--Urgent, second priority. Injuries with systemic effects and complications. May delay treatment for 30-60 min. Green--Third priority. Minimal injuries with no systemic complications. Several hours. Black--Dying or dead. Catastrophic injuries. No hope for survival, no treatment

Task Structure

Refers to the degree to which work is defined, with specific procedures, explicit directions, and goals.

Poor Leader-Member Relations

Reflect distrust, a lack of confidence and respect, and dissatisfaction with the leader by the followers.

Avolio states that there are four factors that cover the components of authentic leadership. What is occurring when one openly shares feelings and information appropriate to a situation?

Relational transparency

A transition has occurred in the twenty-first-century industrial age leadership to what type of leadership?

Relationship age

HESI Hint #12

Remember the nursing process: Assessments, analysis, diagnosis, planning, and evaluation (any activity requiring nursing judgment) may not be delegated to UAP. Delegated activities fall within the implementation phase of the nursing process.

A 12-year-old child visits the school nurse about tiredness. While assessing the child, the nurse notices a black eye, which the child says occurred during a fall on the playground. This is the third school nurse visit in one month for vague, nonspecific complaints. What is the school nurse's priority action?

Report suspicion of abuse to the local Child Protective Services (CPS) agency.

What to do if workplace safety is compromised

Report to supervisor, call police, get medical attention, contact union/collective bargaining/ nurses association, participate in policy making

HESI Hint #5

Restraints of any kind may constitute false imprisonment. Freedom from unlawful restraint is a basic human right and is protected by law.

Timing of audits

Retrospective- occurs after the client receives care Concurrent-occur while the client is receiving care Prospective- predict how future client care will be affected by current level of services

How do nurses practice nonmaleficence for their pts?

Requires nurse to protect pts who can not protect themselves

What are restraining forces of change?

Resistance to change. They must decrease for the change to occur

This occurs when the novice RN adjusts to the new evironment

Resolution

In a leadership class discussing the role of advocacy in nursing, the student nurse learns that these are patient advocacy nursing values when caring for a pediatric patient who may be a victim of child abuse? (Select all that apply.)

Respect Empowerment Autonomy Caring

What do followers expect from good leadership?

Respect, tools to do the job, guidelines/input into the decision and how it will affect them as followers, openness to change, quality relationships with supervision, rewards/recognition, balance of life, professional development opportunities

How do nurses practice autonomy for pts?

Respecting the pts right to make their own choices about healthcare

Process audit

Review how care was provided and assume a relationship exist between nurses and the quality of care provided

How is the legal expansion of nursing roles accomplished?

Revision of the Nurse Practice Act

What are the 5 rights of delegation a nurse must remember?

Right task, Right circumstance, Right person, Right direction/communication, Right supervision/evaluation

How Do I Protect Myself and My Patient from All These Risks? (Cont.)

Risk management Process to review untoward events posing financial risk or lawsuit to institution Evaluate how to prevent recurrence by changing systems Tool—incident or occurrence report Do NOT include conclusions, opinions, defensiveness, and judgments or blame of others Do NOT mention that you filled out an incident report in the medical chart; however, do include factual documentation of the incident that occurred in the medical chart

How Do I Protect Myself and My Patient from All These Risks? (Cont.)

Risk management (simple actions by nurses) Apologize and offer to help Share uncertainties and bring down patient's expectations during informed consent process Do not participate in gossip or judging others

A nursing unit undergoing changes. Some staff members have verbalized displeasure with changes. Which actions should nurse take?

Role model a positive approach to changes. Encourage staff members who support changes to discuss with resistant staff.

Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a leadership role?

Role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard

Situations that increase a workers susceptibility to violence

Routine contact with the public, work alone or in small numbers, work late, poor security, patients and families with weapons, lack of experienced staff, units and patients that require seclusion/restraint activities

Seclusion/Restraint Precautions

Should be ordered for the shortest time possible, NO PRN orders allowed, must be prescribed by Dr based on face to face assessment of client (can place ptn in restraints on emergency basis, but Dr must see ptn w/in 1 hr), Order must be rewritten every 24 hrs. MUST CONDUCT NEUROSENSORY CHECKS Q2 HRs (circulation, sensation, mobility), must be able to fit two fingers in b/w restraint and skin, never leave client alone with restraints

The Change Process

Similar to the nursing process -Identify problem or opportunity -Collect data -Plan the change -Implement the Change -Evaluate the Change -Stabilize the change

Which problem-solving learning strategy provides the learner with the most realistic, risk-free learning environment?

Simulation

A nurse educator determines that the present classroom environment is ineffective in promoting critical thinking. What methods could the educator employ in the classroom to improve critical thinking? (Select all that apply.)

Simulation Case studies Problem-based learning exercises

A nurse has a difficult decision to make regarding patient care. What should the nurse due to influence a positive outcome? (Select all that apply.)

Slow down the thinking process Identify a number of different options. Understand the repercussions of each option. Gather data and input from a variety of sources.

Moral and Ethical Principles (Cont.)

So, how do I make an ethical decision? Many approaches to decision-making Deontological—all life is worthy of respect Teleological—that which causes a good outcome is a good action Situational—decisions made in one situation cannot be generalized to another situation

What concept does early leadership-theory development suggest?

Some are born to lead, whereas others are born to be led

What are some informational behaviors of nurse managers?

Spokesperson for staff and the organization, monitor activities of units/work groups, dissemination of information

By what authority may RNs delegate nursing care to others?

State Nurse Practice Act

Who is responsible for RN disciplinary action?

State boards of Nursing

Good Samaritan Laws

States that no person shall be liable in civil damages for administering emergency care or treatment at a scene outside of a hospital, dr's office or other place having proper medical care, for acts performed at the scene of such emergency, unless such acts constitute willful or Wanton misconduct.

What Defenses Might Be Available in Malpractice Claims?

Statute of limitations Assumption of the risk Contributory negligence

A state Nurse Practice Act is an example of which source of law?

Statutes

Where Does the "Law" Come From?

Statutory law—most common type of law affecting nurses Nurse Practice Acts are examples of state statutory laws Administrative law—law made by administrative agencies that have been given authority to pass rules and regulations and render opinions of state statutes on a particular subject area Nursing advisory opinions are examples of administrative law

Which of the following strategies should nurse leaders use to promote evidence-based practice?

Staying current with professional issues

What types of procedures should be assigned to professional nurses?

Sterile or invasive procedures

A nurse manager is using the decision-making model "SWOT" to determine whether it is feasible to add another on-call team in perioperative services. What words does the acronym "SWOT" represent?

Strengths, Weaknesses, Opportunities, Threats

What is SWOT analysis?

Strengths, weaknesses, opportunities, threats

Who Might Have Liability (Responsibility) in a Claim? (Cont.)

Student liability Responsible for own actions Held to standard of RN for performed tasks Don't accept assignments beyond preparation Communicate frequently with instructors

16. A review of systems (ROS) is based on information obtained from the client during the interview. This information is an example of ______________ data.

Subjective

Who Might Have Liability (Responsibility) in a Claim? (Cont.)

Supervisory liability Task properly assigned to competent worker? Adequate supervision provided? Nurse provided appropriate follow-up and evaluation of delegated task? Institutional liability Respondeat superior Carry insurance Policies or lack of common claim in court

What is the value of using a structured approach to problem solving for the novice nurse?

Supports the acquisition of clinical reasoning

HESI Hint#1

Surgical procedures should be explained by the health care provider. Remember that it is the nurse's responsibility to be sure that the operative permit is signed and is on the chart. It is not the nurse's responsibility to explain the procedure to the client.

Which situations is a nurse-manager legally responsible for reporting? Select all that apply.

Suspected incidents of elder abuse Examples of substandard medical care Client-reported incidents of child abuse Confirmed case of a communicable disease

A staff nurse is having difficulty with problem solving in patient care and the nurse manager is counseling the nurse. What suggestions by the nurse manager may assist the staff nurse in improving problem solving skills? (Select all that apply.

Systematize data collection Slow down thinking Override bias

TRUE OR FALSE: A wrong committed against another person or property is a tort

TRUE

TRUE OR FALSE: Adults learn differently than children; therefore, nurse leaders need to be familiar with teaching and learning styles to effectively educate staff members.

TRUE

TRUE OR FALSE: An organization's culture can affect the decision-making process.

TRUE

TRUE OR FALSE: Effective decision making is a learned behavior

TRUE

TRUE OR FALSE: Effective nurse leaders have developed critical thinking and decision-making skills that assist with collaborative leadership.

TRUE

TRUE OR FALSE: HIPAA gives the nurse leader a platform in which the nurse leader can prevent conflicts resulting from ineffective communication among staff members and patients.

TRUE

TRUE OR FALSE: If you become aware of the elements of the decision-making process, you will develop effective decision-making skills.

TRUE

TRUE OR FALSE: It is important that the nurse understands the difference between controlling a patient's decision and assisting the patient with an informed decision

TRUE

TRUE OR FALSE: Litigation is the process of bringing forth and trying a lawsuit.

TRUE

TRUE OR FALSE: Nurses should be concerned with the various laws and statutes that govern health care.

TRUE

TRUE OR FALSE: The "nursing process" provides a model for ethical decision making.

TRUE

TRUE OR FALSE: The key role that a nurse leader plays in regard to ethics in the workplace is to create an ethical working environment.

TRUE

TRUE OR FALSE: The nurse acts as the patient advocate with regard to informed consent.

TRUE

Planning

The decisions regarding what needs to be done, how it will be done, and who is going to do it.

Which statement regarding the MORAL decision-making model is true?

The identification and analysis of multiple alternatives for action is required

Directing

The leadership role assumed by a manager that influences and motivate staff to perform assign roles

Which statement about situational or contingency leadership theory is correct?

The leadership style chosen by a manager should reflect the task/relationship behavior of those being managed

Clinical reasoning

The mental process used when analyzing the elements of a clinical situation and using analysis to make a decision. Supports the clinical decision making process by guarding the nurse through the process of assessing and compiling data, selecting and discarding data based on relevance, and using nursing knowledge to make decisions about client care. Problem-solving is a part of decision-making.

A doctor orders a medical procedure that the staff nurse has reason to believe will harm the patient. Which statement accurately states the legal consequences of carrying out, or refusing to carry out, the procedure?

The nurse can be held legally liable for any harm if the procedure is carried out without question

HESI Hint #14

The nurse manager must analyze all the desired outcomes involved when assigning rooms for clients or assigning client care responsibilities. A client with an infection should not be assigned to share a room with a surgical or immunocompromised client. A nurse's client care management should be based on the nurse;s abilities, the individual client's needs, and the needs of the entire group of assigned clients. Safety and infection control are high priorities

Gardner states that integrated leaders-managers distinguish themselves from more traditional managers in six ways. Which is a distinguishing trait of a traditional manager rather than an integrated leader-manager?

They extend influence only to their own group

Which statement concerning the role of the powerful in organizational decision making is true?

They make decisions made that are in congruence with their own values

Patient- Centered Care

The provision of caring and compassionate, culturally sensitive care that addresses clients physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.

How do nurses treat pts with justice?

They must be nonjudgmental to every patient

How do nurses practice beneficence for pt care?

They need to assist pts in meeting all of their needs (Biological, psychological, social)

Keys to surviving reality shock

Think before you answer, take vacations, support co-workers (be a good listener), be comfortable, treat yourself, get rid of energy drains, learn to say NO

Evidenced-Based Practice

The use of current knowledge from research and other credible sources on which to base clinical judgment and client care.

Informatics

The use of information technology as a communication and information gathering tool that supports clinical decision-making and scientifically-based nursing practice.

What Criminal Acts Pose a Risk to the Nurse?

Theft and misappropriation of property Nursing practice violations Violations of the Food and Drugs Act

The manager that believes this theory of McGregor believes that employees need strict rules, constant supervision and threat of punishment

Theory X

What is the difference between Theory X and Theory Y (McGregor)

Theory X - Work is avoided, people want to do as little as possible, control and punishment is needed. Theory Y - Work itself can be motivating/rewarding, people actually want to do their job well, guidance and development with rewards are needed

The manager that believes this theory of McGregor believes in guidance rather than control and development rather than supervision with added rewards is the best way to manage employees

Theory Y

Which statement concerning nursing leadership functioning at its potential is true?

There is a need to integrate nursing management and nursing leadership

Expert nurse

These are nurses who have a significant amount of experience upon which to base their practice. Enhanced observational abilities allow a lot of nurses to be able to conceptualize situations more holistically. Well-developed critical thinking and decision-making skills allow nurses to recognize and respond to unexpected changes.

Proficient nurse

These are nurses who have a significant amount of experience upon which to base their practice. Enhanced observational abilities allow a lot of nurses to be able to conceptualize situations more holistically. Well-developed critical thinking and decision-making skills allow nurses to recognize and respond to unexpected changes.

Competent nurse

These are usually nurses who have been in practice for 2 to 3 years. Demonstrate increasing levels of skill and proficiency and clinical judgment. Exhibit the ability to organize and plan care using abstract and analytical thinking. Can anticipate the long-term outcomes of personal actions.

Information Resources

These keep managers up to date in delivering care to their patients. Ex: EBP Nursing

Charismatic Theory

These leaders have an inspirational quality that promotes an emotional connection from followers. They display self-confidence, have strength in their convictions, and communicate high expectations and their confidence in others. One consequence of this type of leadership is a belief in the leader is so strong that it takes on an almost supernatural purpose, and the leader is worshipped as if superhuman. Such as Florence Nightingale or Martin Luther King.

Which statement is true regarding an economic man style manager?

These managers gather as much information as possible and generate many alternatives

What statement regarding management decision-making aides is true?

They are subject to human error

What are driving forces for change?

They call for the change, enable it. It must increase in order for the change to occur

A nurse is using the nursing process to plan the care of a newly admitted patient that has had a stroke. What is the benefit of using the nursing process to devise a care plan?

This method of problem solving can be transferrable to non-patient problems.

Fielder's Contingency Theory

This theory of leadership effectiveness views the pattern of leader behavior as dependent upon the interaction of the personality of the leader and the needs of the situation.

What is the purpose of a mission statement?

To show purpose/reason for existence, outlines aim of organization, critical in strategic planning and guides planning

Miscellaneous Intentional Torts

Tortious interference with contract Intentional infliction of emotional distress Sexual harassment and discrimination

In this nursing care delivery model the nurse is responsible for planning, organizing, and delivering all care. It is the oldest method of organizing care.

Total Patient Care Nursing

The manager of several related departments brings the team together to inform them that they will all be cross training to other units for the purpose of increasing productivity. What form of leadership does this manager demonstrate?

Transactional

A nurse in a leadership role is committed to a vision for retention in the medical-surgical unit and is able to empower others with this vision. What form of leadership is this nurse demonstrating

Transformational

What type of leader is the person who is committed, has a vision, and is able to empower others with this vision?

Transformational

This research technique combines information from multiple sources, and is quick and powerful

Triangulation technique

True or False, the courts uphold the authority of boards of nursing to regulate standards

True

True or false, conflict is inevitable in large groups

True

Which activity supports the principles of strengths-based leadership?

Tuition reimbursement for LPN to RN transition programs

Nurse Leaders and Managers as Change Agents

Unfreezing--Initiation of a change. Moving--Motivation toward a change. Refreezing--Implementation of a change

A new nurse manager recognizes the importance of promoting a positive organizational culture on the unit. Which behavior indicates that this has occurred?

Unit staff meet weekly to share positive events, identify concerns, and review shared goals.

#1 thing to remember about negative feedback

Unsatisfactory work must be acknowledged and discussed

A nurse makes a decision using intuitive judgment regarding a patient's rapid change in condition. What action should the nurse take after the decision?

Use evidence-based data to validate decision

Critical thinking

Used when analyzing client issues and problems. Thinking skills include interpretation, analysis, evaluation, inference, and exclamation. This skills assist the nurse to determine the most appropriate action to take.

Motivation

Using your deepest preferences to move and guide you toward your goals, to help you take initiative and strive to improve, and to persevere in the face of set backs and frustration

These ethical concepts are learned and change with maturity and experience

Values (The amount of values a person holds, isn't as important as "which" values they consider important)

A nurse manager is having a difficult time in making a decision about reprimanding a staff nurse who has exceeded the absentee policy. Why would the manager's values cause personal conflict in making this decision?

Values often collide with one another

This is something in the environment that changes (research/experimentation methods)

Variable

Name the ethical principle meaning truthfulness. It also builds trust

Veracity

This type of liability is employers being held accountable for negligence of employees

Vicarious liability

Differentiate between voluntary and involuntary admission

Voluntary: Client admits self to an institution for treatment and retains his or her civil rights; he or she may leave at any time. Involuntary: Someone other than client applies for the client's admission to an institution (a relative, a friend, or the state); requires certification by one or two HCPs that the person is a danger to self or others; the person has a right to a legal hearing (habeas corpus) to try to be released, and the court determines the justification for holding the person.

Malpractice Elements (Cont.)

Was there a breach of professional duty? Must prove that the standard of care was not met Must demonstrate you did not act as a reasonable and prudent nurse would have acted under the same circumstances

Malpractice Elements (Cont.)

Well-documented observations Patient's condition on admission and discharge After incident (i.e., fall), note patient's physical and mental condition Patient's noncompliance with medical directives Any patient complaints or noncomplaints Note exactly what patient says Note patient's own admissions Clear discharge instructions Allergies or lack of any allergies

Hawthorne Experiments

Western Electric Plant in Chicago led to the belief that relations between workers and managers and among workers are the main determinants of efficiency. -Also concluded that the effect of being watched and receiving special attention could alter a person's behavior.

Controversial Ethical Issues Confronting Nursing (Cont.)

What about in vitro fertilization? Opponents argue it is an unnatural act and removes the biological act of procreation. Cost of procedure Should it be covered by insurance? "Designer babies"? Should parents be able to pick the gender of the baby? Limit to only heterosexual marriages? To whom does the embryo belong, and what are the embryo's rights?

Malpractice Insurance

What about individual malpractice insurance? Not very expensive Not used much What is institutional coverage? Most carry large policies covering acts or omissions by employed nurses Most individual policies are secondary to this

Malpractice Elements (Cont.)

What about textbooks and journals? Might be asked about texts used in workplace such as PDR and/or nursing journals What are professional standards for organizations? Professional organization's published standards of practice guidelines

Malpractice Elements (Cont.)

What about the Nurse Practice Act? Describes what nurses may do—fairly general Lists what is prohibited—more specific What is an expert witness? Common way to establish duty owed Testifies as to what a reasonable nurse would do in similar circumstances

Malpractice Elements (Cont.)

What are established policies and procedures? Crucial pieces of evidence for establishing standard of care Resources for questions regarding certain procedures What about accreditation and facility licensing standards? Evidence of standard of care for nurses working in accredited facilities

Controversial Ethical Issues Confronting Nursing (Cont.)

What are genetics and genomics? Genetics Refers to the study of genes and their role in inheritance Genomics A relatively new term that describes the study of all a person's genes, including interactions of those genes with each other and the person's environment

Controversial Ethical Issues Confronting Nursing (Cont.)

What are the ethical issues regarding transplantation? On what basis should someone receive an organ? Should severity of illness serve as the primary criteria, or should other factors be taken into consideration? If so, what other factors? Should economic status be used as a contributing factor in the process? How are donors solicited?

Understanding Ethics

What are your values? Clarify your values Choosing Prizing Acting on your value choice Your values may change over time Consider how your values affect your decision-making

Controversial Ethical Issues Confronting Nursing (Cont.)

What is the impact of social media and social networking on nursing practice? Nurses need to know the legal limitations for using social media Professional organizations have addressed this issue ANA offers six tips for using social media. NCSBN

Restraining forces

What will keep change from happening

Moral and Ethical Principles (Cont.)

Which principle or rule is most important? Autonomy and nonmaleficence? Consider relative benefits and burdens Abstract ideas about right and wrong are not helpful enough at the bedside Nursing ethicists Emphasize an ethic of caring—preserve humanity and dignity and promote well-being

Negligence is measured by reasonableness. What question might the nurse ask when determining such reasonableness?

Would a reasonable and prudent nurse act in the same manner under the same circumstances?

What is formal power?

Written policies set in stone

Second Infraction

Written warning. Manager meets with employee to distribute written warning. Review of specific rules/policies and discussion of potential consequences if action continues

A 94-year-old patient with end-stage renal disease is refusing to take any prescribed medications, saying, "They make me feel sick, and I want to enjoy the rest of my short life." Which of the following responses by the nurse is best?

You can certainly decide not to take these medications, but first I want to make sure you know why they were prescribed.

Guidelines for Using Social Media (Cont.)

You have an ethical duty to report any type of breach of confidentiality or privacy. Know your employing institution's policies and procedures regarding the use of electronic media and personal devices in the work place. Never speak on behalf of your employer or a co-worker unless provided authorization to do so and ensure that you follow the employer's policies and procedures. Data from: National Council of State Boards of Nursing (NCSBN). August, 2011. White paper: A nurse's guide to the use of social media. Retrieved from https://www.ncsbn.org/Social_Media.pdf

What Are the Basic Elements of Malpractice

You must have a duty (in other words, there must be a professional nurse-patient relationship) You must have breached that duty (in other words, you must have fallen below the standard of care for a nurse) Your breach of duty must have been a foreseeable cause of the patient's injury Damages or injury must have occurred

Verbal consent

a notation should be made. 1. It describes in detail how and why verbal consent was obtained. 2. It is placed in the client's record or chart. 3. It is witnessed and signed by two persons.

Taxonomy

a system that orders principles into a grouping or classification

Verbal or written consent can by given by:

a. Alert, coherent, or otherwise competent adults. b. A parent or legal guardian. c. A person in loco parentis (a person standing in for a parent with a parent's rights, duties, and responsibilities) in cases of minors or incompetent adults.

While the nurse is administering flu immunizations in November to a group of older adults at a community senior citizens' center, one of the seniors expresses a fear of contracting the flu from the injection. The nurse reassures the senior that this is not possible because the vaccine contains a dead virus and explains that this injection will produce _________ immunity, in which the senior's body will make antibodies to the virus.

active

Incident reports

alert administration to possible liability claims and the need for investigation; they do not protect against legal action being taken for negligence or malpractice

Who may give consent for medical treatment?

alert, coherent, or otherwise competent adults; a parent or legal guardian; a person in loco parentis of minors or incompetent adults

The nurse cannot, without a HCP's prescription:

alter the amount of drug given to a client. For example, if a HCP has prescribed pain medication in a certain amount and the client's pain is not, in the nurse's judgment, severe enough to warrant the dosage prescribed, the nurse cannot reduce the amount without first checking with the HCP. Remember nursing judgment cannot be substituted for medical judgment.

Informal Leader

an individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group rather than as the head or leader of the group. Considered to have emerged when they are accepted by others and are perceived to have influence.

Avoiding/ withdrawing

both parties know there is conflict, but they refuse to face it or work toward a resolution. lose-lose

What are the essential steps of effective supervision?

direction, evaluation, and follow-up

Defamation

divulgence of privileged information or communication (e.g., through charts, conversations, or observations)

Management

is about controlling complexity in an effort to bring order and consistency. Planning and budgeting, organizing and staffing, problem solving, and controlling complexity to produce predictability and order.

Leadership

is about creating change; establishing a direction, aligning people through empowerment, and motivating and inspiring them toward producing useful change and achieving the vision.

Democratic Leadership

is participatory, with authority delegated to others. To be influential, they use expert power and the power base afforded by having close, personal relationships. Engendered positive feelings in their groups, and performance was strong whether or not the leader was present.

Laissez-Faire Leadership

is passive and permissive and the leader defers decision making. Associated with low productivity and feelings of frustration.

List some barriers to effective delegation

lack of experience, lack of licensure, quality of care, assigning work to others, poor communication or follow through/follow up, lack of trust

Insanity

legal term meaning the accused is not criminally responsible for the unlawful act committed because he or she is mentally ill.

Middle-of-the-Road Leader

moderate people and production concern

Malpractice

negligence by professional personnel (e.g., professional misconduct or unreasonable lack of skill in carrying out professional duties)

Accountability

the ability and willingness to assume responsibility for actions and related consequences.

Participative Leadership

the leader focuses on involving followers in the decision making process.

Formal Leadership

when a person in a position of authority or in a sanctioned, assigned role within an organization that connotes influence, such as a clinical nurse specialist.

Virtuality

working through virtual means using digital networks, where the worker may be far from the patient but present in digital reality.