EAQ Delegation Master List
The nurse leader noticed that the staff nurse recently promoted to the surgical unit is lacking confidence at work and is worried about a pending review by the nursing director. Which source of power is applicable in this situation?
Coercive power
Which are considered as nurse competencies within the synergy model of care delivery? Select all that apply.
Collaboration clinical judgement cultural competency
What should be done if an Oto thermometer isn't registering?
Check charge or send to biomed engineering and obtain new.
What does it mean if the pulse ox is not alarming when O2 is at 92%?
Check the alarm level settings. May be too low and need readjusted.
The registered nurse (RN) is caring for four different post-surgical clients. Which activity delegated to the licensed practical nurse (LPN) would be appropriate to achieve a suitable care outcome? Select all that apply.
Client 1 Client 2 Client 5
The registered nurse (RN) is delegating tasks to licensed practical nurses (LPNs) regarding client care. Which factors should be considered when delegating a task to the LPN? Select all that apply.
Client's condition Complexity of the task Predictability of outcomes
While trying to define a problem, the nurse leader finds out the external and internal constraints on implementing a solution. Which problem-defining process is the leader nurse performing?
Contextualizing the problem
The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task?
Critical thinking is of utmost importance for selecting a suitable nursing assistant for delegation of a task in a situation where a client requires more attention, as the delegatee should be able to perform the task effectively. Time, safety, and stability are also the elements for effective delegation, but these are suitable depending on the situation for assigning a task and delegation.
What should the team leader identify as a priority when assigning clients to team members?
Each team member's strengths
Which of the following characteristics exemplified by a registered nurse is a leader trait?
Endorsing and thriving on taking risks that bring about change
What is the application of Roger's diffusion theory?
Engages key leaders in a change to infuse the energy from early adopters
The registered nurse is assigning work to four delegatees. Which delegatee most likely has a limited relationship with the delegator?
Delegatee B
Which important consideration of the delegator is applicable to the "selling" in Hersey's model?
Delegatee requiring explanation
Which element of the healthcare system is the registered nurse (RN) practicing when the delegator shares accountability with the RN?
Delegation
Which healthcare settings are appropriate for delegating care according to the functional model of nursing? Select all that apply.
In the functional method, each healthcare provider knows the expectation of his or her assigned role and completes tasks quickly and effectively. This model works well in emergency situations and ambulatory clinics. Hospice settings are not suitable for this type of care, because in hospice care the client requires chronic and continuous care. Inpatient care settings are not suitable for the use of the functional model of care delivery because these settings need acute care and continuous care by careful monitoring. Acute care agencies are not suitable for the functional model because acute and more specific individualized care is required.
Which are the organizational outcomes of transformational leadership? Select all that apply.
Increased loyalty Increased commitment Increased performance
Which care settings are more suitable for unlicensed nursing personnel (UNP)? Select all that apply.
Extended care and long-term care settings are more suitable for unlicensed nursing personnel (UNP). Acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals. Acute care, surgical care, and emergency care are not suitable for UNPs because the clients are less stable compared to those in extended care and long-term care. Since acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals, the UNP's role is very limited.
Which activity indicates improper follow-through on the part of the delegatee?
Failure to report results
Which aspect relates to the quality of relationships while assessing the degree of conflict resolution in nursing leadership? Select all that apply.
Generation of empathy Understanding being created
What causes a non priority patient to become priority if it exits ?
Head trauma with INCREASED ICP, Bleeding FROM MAJOR ARTERY, Increased (blood sugar)BS IN COMA, decreased BS C S&S OF SHOCK, Paperwork FOR PREOP CHECKLIST, Poop FROM AN SCI ABOVE T6 OR APPENDICITIS (STRAIN AND RUPTURE), lab studies- ABGs, chronic conditions C ACUTE LIFE THREATENING PROBLEM. Angina c decreased LOC, decreased cardiac output = decreased urine output, arrhythmia, dizziness/faint PAIN- BACK PAIN : abdominal aortic aneurysm, RLQ: appendicitis, (RLQ with rebound tendernessand rigidity over the right rectus muscle or McBurney's point) ectopic pregnancy, or back pain with blood transfusions, .
What is contraindicated with an allergy to yeast?
Hepatitis B vaccine
The nurse manager noticed that one of the staff nurses is giving excuses for performing one task on time but ignoring another assigned task. What does the nurse manager do in this situation?
Identify the reason for procrastination.
The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply.
If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. The client will also have a positive Trousseau sign and have anxiety and irritability. The Chvostek sign would also be positive, not negative. The client would show signs of anxiety and irritability. The central nervous system should have increased activity with alkalosis, not decreased.
The registered nurse is organizing a community health care program for administering tetanus vaccinations. Which member of the health care team is most suitable for delegating the task of administering vaccinations
Licensed practical nurse
What should be done if staff doesn't recognize false imprisonment such as gerichair c tray, not allowing patient to leave w/o MD orders, or anything preventing freedom to move about?
MORE EDUCATION
What should be done if staff uses extension cords for equipment?
MORE EDUCATION
Which work is automatically increased for the delegator when there is a decrease in direct client care?
Supervision
A client with asthma and depression is admitted to the hospital. Which tasks delegated by the delegator would indicate the task is applicable for the registered nurse?
Teach the client how to use a metered-dose inhaler
What meds/herbs should you make sure to ask patients if they are taking (so can implement bleeding precautions)?
NSAIDS, ASA, Heparin, Coumadin, Garlic, Ginkgo, Ginseng, and Vitamin E.
With which conditions are droplet precautions important?
Neisseria meningitis, mycoplasma pneumonia, strep group A, or pertussis.
What are the 2 general rules for vaccines?
No vaccine given if pt temp > 101 or on an antibiotic.
The nurse leader asks the team members not to talk to each other while writing their ideas for solving a predefined problem. Which type of group decision-making style does the nurse leader follow?
Nominal group technique
The nursing manager said, "Nurse leaders must also be excellent change managers." Which statement supports this?
Nurse leaders will ensure that the disruption and chaos of change does not affect client care.
The legal authority wants a record of the tasks performed by the delegatees and asks the delegatees to maintain a record of completed tasks. Which task is marked by the licensed practical nurse (LPN)? Correct1 Task A 2 Task B 3 Task C 4 Task D
The LPN is a licensed nursing professional whose scope of practice includes tasks such as the administration of oral medications. Admission of the client to the ophthalmology department is under the scope of a registered nurse. Collection of the data that is used for the assessment of the client is a task that can be performed by an unlicensed nursing practitioner. Provision of basic hygiene care is the task that is to be performed by nursing assistive personnel.
Which responsibility of the nurse manager differs from the responsibilities of a nurse leader?
Planning the budget
Which behavior from the nurse leader exhibits charismatic leadership qualities?
Possesses an inspirational quality that makes team members attracted to him or her
Which factors does the registered nurse consider in the decision to delegate process? Select all that apply.
Predictability of outcomes Complexity of the task to be performed
Total client care is delegated to a registered nurse. Which member of the healthcare team is responsible for consulting other healthcare professionals in planning and delivering client care?
Primary nurse
What would the nurse state is a characteristic of an effective leader?
Problem-solving skills
The delegator explains the procedure of the task to the delegatee and asks to provide regular feedback on the events. Which delegation right is the delegator referring to in this situation? 1 The right person Correct2 The right supervision 3 The right circumstances 4 The right communication
The delegator is supervising the task by asking the delegatee to provide regular feedback on the events of the specific assigned task. The delegator has to understand and assess the abilities and skills of the delegatee to determine that the right person is selected to perform the specified task. The right circumstance may be assessed by checking the environment, equipment, and resources to perform the task. The delegator has to develop and maintain open lines of communication to promote a positive work environment.
Which behavior of the delegator with respect to the work delegated to a delegatee is characterized as "selling" according to the Hershey's Model?
The delegator's behavior when explaining or persuading the delegatee is characterized as " selling" according to Hershey's Model. The delegator's behavior when guiding or directing the delegatee is characterized as "telling." The delegator's behavior when observing or monitoring the delegatee is characterized as "delegating." The delegator's behavior when encouraging or problem solving is characterized as "participating."
Why does the leader ask the direct care nurse, "Do you block cooperative efforts to resolve issues?"
The direct care nurse uses avoidance often.
The nurse as a leader is using a transactional leadership style. Which effect on followers often results from this style of leadership?
The followers will correct errors in a reactive manner.
The nurse manager is teaching the licensed practical nurse (LPN), the evidenced-based practice regarding the use of saline and the low-dose heparin flush solution for capped angiocatheters. Which statement by the LPN indicates they understood the teaching? Select all that apply.
"The use of heparin flushes disappeared in the late 1990s." "The use of high doses of heparin solutions is not recommended in adults."
The senior nurse advises a newly promoted nurse concerning various aspects of the leadership role. Which advice by the senior nurse would the newly promoted nurse most likely consider as leading by example?
"Try to be a participant in political activity in the local community."
The nurse manager reviews the performance report of a direct care nurse and asks the nurse to focus on "emotional intelligence" in order to be promoted as the nurse leader. Which statement would the nurse leader most likely use while advising the nurse on areas for improvement?
"Try to be more sensitive to the experiences of others."
A client with rheumatoid arthritis calls the outpatient clinic to report that pain with exercising has increased. What should the nurse suggest to the client to decrease pain?
"Decrease the number of repetitions of the exercises."
A nurse with burnout asks the nurse manager, "What can I do to prevent burnout in the future?" What is the best response by the nurse manager?
"Develop a wide variety of coping strategies."
Which question asked by a nurse leader establishes and maintains a human rapport with staff?
"How are your children?"
The registered nurse (RN) is planning to provide feedback to the licensed practical nurse(LPN). Which questions asked by the RN help in eliciting the LPN's work quality? Select all that apply.
"How did the patient respond?" "What changes were observed in the client?"
The charge nurse is teaching the newly-hired registered nurse (RN) about delegating tasks to unlicensed nursing personnel (UNPs). Which statement made by the newly hired RN indicates the need for further teaching?
"I should assist the staff in sorting out and articulating values."
The registered nurse, as a leader, is teaching about leadership roles to a group of nurse practitioners. Which statement made by a nurse practitioner indicates effective learning?
"I should use experience and knowledge to judge reasonable risks."
The registered nurse (RN) is teaching a novice RN about delegating tasks to licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). Which statement made by the novice RN indicates a need for further teaching?
"I will delegate the task of assisting the client with bathing to the LPN."
Which statement made by the nurse leader would satisfy the basic expectations of the client?
"I will return at 5 o'clock pm."
A nurse leader is teaching the nursing staff about preparing objectives. Which statements by a member of the nursing staff indicate effective learning? Select all that apply.
"I will specify the target to be achieved." "I will not include unrealistic and unattainable goals." "I will provide the level of accomplishment for the end result."
The nurse as a leader teaches staff about organizational disciplines to support change and evolution. Which statement of the nurse is relevant in the context of maintaining self-awareness and using reflection?
"Personal mastery fosters openness in the face of change."
A registered nurse (RN) and newly hired licensed vocational nurse (LVN) are caring for a client with chronic obstructive pulmonary disease (COPD). Which statement made by the RN would be appropriate according to the participation style of Hersey's model of leadership?
"Please show me how you determine respiration rate."
The leader is teaching a nursing student about systems theory. Which statement by the student nurse indicates the need for further teaching? Select all that apply.
"Systems theory accounts for unpredictability." "Systems theory focuses on the effect of random events."
Which of these clients can be provided care safely by unlicensed nursing personnel? Select all that apply.
A client who is stable A client who is recovering
What happens when a registered nurse does not trust other individuals in the healthcare organization? Select all that apply.
Altered client care Compromised healthcare Limited career opportunity
Which among the Five Rights of Delegation is the cornerstone of delegation? 1 "Right person" 2 "Right supervision" 3 "Right circumstance" Correct4 "Right communication and direction"
Among the Five Rights of Delegation, "right communication and direction" is the most important right of delegation. It is the most useful in maintaining the quality and safety outcomes, as it involves communication and direction. "Right person" is useful for understanding which person has the appropriate skills to perform the task. "Right supervision" involves monitoring the tasks that are performed with the goal of improving outcomes. "Right circumstance" seeks to ensure that the appropriate equipment and resources are available for the delegatee.
Who should feed a stable trach patient on a vent?
An LPN
Who should change sheets, get water for, enemas, stool spec/I&O for stable patients?
An NA
Who should feed a patient with a chronic CVA?
An NA
Who should feed a person with chronic parkinson's?
An NA
Who should transport a patient to an area within the hospital?
An NA
Who should evaluate a patients pain after a narcotic?
An RN or LPN
Which aspects are considered when determining the willingness of a nursing assistant before delegating a task? Select all that apply.
An individual's *willingness* is related to *attitude, confidence, and commitment.* Ability is related to knowledge and skills in a specific situation. Personality characteristics can influence the effectiveness of the delegator.
The nurse manager implements a change in the back care routine provided to bedridden clients to help prevent pressure ulcers. The nurse manager observes a decrease in the incidences of pressure ulcers in the unit and appreciates the efforts of the team members who implemented the change. Which step of Kotter's eight-step change model is reflected in this scenario?
Anchoring the changes in the culture
What is the status of the primary healthcare provider as a member of the healthcare team that is in the span of control of a registered nurse (RN)?
Answerable to the nurse manager
What should be given to a patient on coumadin before they have surgery? When should it be given?
Aqua Mephyton (Vitamin K) is needed b4 surgery for someone on coumadin so they don't bleed out (it helps coagulation). If it is D/C 24 hours before they may still bleed because it's not long enough prior to surgery so Vit K will help.
While caring for a client with asthma, the delegator assigns the client to a registered nurse (RN) and to a licensed practical nurse (LPN). Which component of delegation is transferable to the RN? Select all that apply. Correct1 Authority Incorrect2 Supervision Correct3 Responsibility Correct4 Accountability 5 Communication
Authority, a component of delegation, is transferred to the registered nurse (RN) by the delegator. Responsibility is the component of delegation that is transferable to the RN. Accountability is also a component of delegation that is transferable to the RN. Supervision and communication are rights of delegation.
What should be done for pain and discomfort?
Avoid drugs, use nursing interventions (positioning, heat, etc.), when in doubt flush the patient out.
A nurse manager in a surgical unit finds that many clients are developing urinary tract infections post-operatively and wants to discuss the measures to prevent it with the team. Which action of the nurse manager reflects good communication practice?
Calling the team for a brief meeting
During the delegation process, which healthcare professional acts as a liaison between the team leader and healthcare provider?
Charge nurse
A client is hospitalized with a brain injury and a skull fracture. The registered nurse is delegating tasks to the healthcare team. Which member of the healthcare team is suitable to provide client care? Select all that apply. Correct
Charge nurse newly hired RN
The healthcare unit reviews the evaluation report of a newly promoted nurse leader and rates the performance as excellent. At which qualities did the nurse excel? Select all that apply.
Charting new paths that lead to progress Demonstrating positive feelings in the workplace
The registered nurse delegates a task to the unlicensed nursing personnel (UNP). Which client care is suitable for UNP?
Client C
The nurse is caring for four clients in an emergency department. Which client should be given least priority by the primary healthcare provider based on his/her condition?
Client with closed extremity trauma
Which task can be safely delegated by a registered nurse (RN) to unlicensed nursing personnel (UNP) for a client with thrombocytopenia? 1 Shaving the client Correct2 Positioning the client 3 Maintaining oral hygiene 4 Giving intravenous platelet infusions
Clients with thrombocytopenia are at risk of bleeding with slight bruising. Therefore tasks that do not risk bruising the client may be delegated to the UNP. The RN should shave the client and maintain oral hygiene. Intravenous infusions should not be administered by a UNP to any client.
What is the most important skill of the nurse leader?
Clinical care coordination
The hospital management is planning a study that compares the benefits and harms of a particular method to the benefits and harms of alternative methods when treating clients with chronic disorders. Which approach does the nurse manager follow to improve client care?
Comparative effectiveness research (CER)
A registered nurse is teaching a group of newly hired licensed registered nurses, licensed practical nurses, and unlicensed nursing professionals. Which teaching strategies would be appropriate to develop competencies? Select all that apply.
Competencies can be developed through different teaching strategies such as case studies, online learning, and clinical nursing practice. These strategies can help in improving the learning ability of the student nurses, licensed practical nurses, and unlicensed nursing professionals. Teaching experience and demographics may not be required to develop competencies.
Which theory of nursing leadership involves the traditional organizational hierarchy playing a less significant role as the "keeper of high-level knowledge?"
Complexity theory
Which theory states that leaders should expand and respond to a dynamic change rather than prescribing and approaching change as a lock-step, pre-prescribed method?
Complexity theory
The nursing leader stated, "The reimbursed cost is less than the full charge for a service in the hospital." Which type of health reimbursement does the nurse leader describe?
Contractual allowance
The registered nurse is interviewing for a management position and wants to present a powerful image. What can the nurse focus on when preparing for the interview? Select all that apply.
Conveying positive body language Appearing well groomed and well dressed Showing confidence in work and abilities
The nurse manager finds that there is an increased infection rate in the unit due to an increased number of client visitors. The nurse believes that a change in the visitor policy could help reduce the infection rates. The leader is initiating an open dialogue about external and internal realities among the team members. Which attribute of Kotter's eight-step model is involved in this action by the nurse manager?
Creating urgency
The leader teaches the student nurse about STAMP (staring, tone and volume of voice, anxiety, mumbling, pacing) assessment. During the session, the leader mentions rapid speech and dilated pupils. What component is responsible for these two conditions?
anxiety
Total client care is delegated to a registered nurse. Which member of the healthcare team is responsible for consulting other healthcare professionals in planning and delivering client care? Incorrect1 Charge nurse Correct2 Primary nurse 3 Associate nurse 4 Nurse navigator
The primary nurse is responsible for consulting other healthcare professionals in planning and delivering client care. The charge nurse delegates work to other healthcare team members in the absence of the delegator. The associate nurse is delegated to provide care to the client according to the primary nurse's specifications. The nurse navigator works through the healthcare system to help clients obtain high-quality care.
The nurse is caring for a client with breathing difficulty and is unable to auscultate any breath sounds on one side. Which action should be implemented first by the nurse?
The priority care for clients with breathing difficulties who present with absent breath sounds is a needle thoracostomy. This procedure involves removing the fluid or abnormal air from the pleural space. Intubation is done for the client in severe respiratory distress. Supplemental oxygen should be given to the client with decreased oxygen saturation levels. Ventilation with a bag valve mask is given to clients if respirations are inadequate or absent.
Which theory would the nurse describe as addressing the follower's needs so that the interaction raises the follower to higher levels of motivation?
Transformational theories
A registered nurse is caring for a client according to the total client care model of nursing. Which activity performed by the nurse manager would be appropriate in this situation? Select all that apply.
Weighing the expenses of a registered nurse (RN) vs. LPNs Deciding the type of care provided by nursing assistive personnel
The nurse resolves a conflict with another nurse by using accommodation. In what situations is accommodation appropriate for resolving conflict? Select all that apply.
When facing trivial issues When the other person's solutions appear better When harmonious relationships have to be preserved
Which statement is correct regarding delegation? Select all that apply.
Delegation involves two people—delegator and delegatee—with the transfer of authority to perform the task. The delegator retains accountability for the outcome of the task delegated. The delegatee holds responsibility but not accountability for the task. Assignment involves the transfer of both responsibility and accountability of the work to the delegatee. Principles of delegation outline what nurses need to know and do in relation to completing the task
Which are disadvantages to the functional system of care delivery? Select all that apply.
Poor communication Fragmentation of care changes in client status go unnoticed
Which qualities of a leader indicate a transformational approach to leadership? Select all that apply.
Possessing charismatic behavior Possessing intellectually stimulating behavior Having inspirational and motivational behavior
As a part of the nursing curriculum, the nursing faculty is teaching nursing students about high-quality clinical delegation experiences and has also chosen to engage the students with nursing mentors. Which skill does the nursing faculty expect the nursing students to develop via this approach?
Professional self-confidence in delegation
What is the duty of the nurse as delegator if the delegatee has limited knowledge and ability to perform a task?
Provide guidance
What are the various challenges related to delegation? Select all that apply.
Providing clear direction to the delegatee Understanding the skill set of the delegatee Maintaining an open line of communication with the delegatee
The registered nurse (RN) delegates the task of caring for a client with a leg fracture to a licensed practical nurse (LPN) and asks the LPN to alert her if any issues arise. What approach is the RN taking as delegator in this instance?
Providing little guidance
The registered nurse assigned a task to a licensed practical nurse. The task was not successfully completed by the deadline. Which action by the registered nurse would be characteristic of a transactional leader?
Punishes the nurse
Which action of the nurse as a leader is supported by the Style theories of leadership?
Pursuing effective relationships with subordinates
What should be done if someone is pulling out their IVs?
Put a mitten on them (least restrictive).
During a vaccination drive at a well-child clinic, a nurse notes that a recently hired nurse is not wearing gloves while vaccinating an infant. What should the nurse advise the newly hired nurse to do?
Put on gloves, because standard precautions are required.
The nursing team is providing care for a client. The team leader develops client care plans and coordinates care among the team members. Which member of the team acts as a team leader?
RN
According to chaos theory, what is the most important factor contributing to a successful organization?
Readiness to accept change
Which initiative demonstrated by the registered nurse is an effective art of communication of a leader?
Reinforcing the values behind the change
Which behavior is an example of the nurse's role as an executive in the Gardner task of leadership?
Representing the organization and client care services on councils
After orthopedic surgery a 15-year-old adolescent reports pain and rates it a 5 on a scale of 0 to 10. A nurse administers the prescribed 5 mg of oxycodone every 3 hours as needed. Two hours after having been given this medication, the adolescent reports pain and rates it a 10 of 10. What action should the nurse take next?
Request that the primary healthcare provider evaluate the need for additional medication.
The licensed practical nurse (LPN) has been asked to monitor the blood pressure of a client with hypertension. The LPN reports to the registered nurse (RN) that the blood pressure monitor is malfunctioning. Which component of the duty is the LPN practicing?
Responsibility
The nurse manager is planning to develop leadership skills in direct care nurses. What activities should the nurse encourage the direct care nurses to participate in to develop these skills? Select all that apply.
Serve on practice councils Join local professional associations Participate in American Heart Association activities
The nurse leader is representing the nursing unit and the values and beliefs of the organization to staff members. Which leadership task does the nurse's behavior indicate according to Gardner's tasks of leadership?
Serving as a symbol in a management position
Which theory emphasizes that leadership effectiveness depends on the executive nurse's interpersonal skills?
Situational-contingency theories
Which model of ethics considers broad social issues and involves accountability to the overall institution?
Social justice model
What are the elements integrated into delegacy? Select all that apply.
Stability Critical thinking
Which element creates an integrative process that fosters effective delegation decisions by the registered nurse? 1 Ability 2 Liability Correct3 Stability 4 Ethnicity
Stability is the element that creates an integrative process that fosters effective delegation decisions. Ability is the factor that needs to be assessed to determine the level the leaders determine. Liability is the person's responsibility and accountability for individual actions. Ethnicity does not play a role in the process of delegation.
Which action of the registered nurse (RN) represents his or her leadership ability?
Supervising the tasks assigned to unlicensed nursing personnel
The registered nurse delegates a task to the unlicensed assistive personnel (UAP). After the UAP starts the task, the registered nurse (RN) asks for feedback related to the task. Which right of delegation is the RN following?
Supervision
Which activity of the registered nurse is included in supervision? 1 Performing the given task 2 Allocating a portion of the work 3 Providing information to the delegator Correct4 Providing guidance and oversight in delegating a task
Supervision is defined as "provision of guidance and oversight of a delegated nursing task." It includes open lines of communication between the delegator and the delegatee to provide guidance. Responsibility is the activity of performing a given task. Delegation is the activity of allocating a portion of work. Authority is the activity of providing information to the delegator.
What do we need to know about delegating?
TELL= Taught (does the person know the skill), Evaluate (return demonstration), License (is one needed for the skill), and Lists (agency policy).
The nurse is caring for a client admitted with fluid overload. Which tasks are most appropriate to be delegated to the patient care associate? Select all that apply.
Documenting vital signs, documenting urine output Repositioning the client every one or two hours
What are the three strategies that the nurse can perform while assisting other nurses in making delegation decisions? Select all that apply.
Doing Asking Offering
The registered nurse (RN) is communicating with a healthcare team regarding the delegation of tasks. Which factors can determine the quality of communication between the RN and healthcare team? Select all that apply.
Effectiveness Meaningfulness Understandability
What should a nurse manager as a leader do to provide a non-threatening and positive environment to the group members? Select all that apply.
Encourage group members to actively participate Create an environment conducive to solving problems Protect the members and their suggestions from attack
How can registered nurses develop delegation and supervisory strategies to adapt to their changing roles? Select all that apply.
Engaging a nurse mentor helps provide guidance and facilitate problem-solving related to delegation and supervision. Reinforcing delegation knowledge through continuing education helps nurses become familiar with the changing trends in health care delivery in context of delegation. Seeking high-quality clinical delegation experience early in a nurse's career helps nurses gain confidence in delegation skills. Practicing the nursing care process in various clinical settings helps the nurses to improve patient outcomes, but would not specifically help develop delegation and supervisory strategies. Becoming familiar with the hierarchy of authority in the health care organization may help nurses understand management-related issues. However, this knowledge would not directly help nurses develop delegation and supervisory strategies.
For whom does the interdisciplinary team meet?
For those with chronic non compliance issues (Ex: sickle cell admitted 3x for crisis, DM admitted for hyperglycemia, celiac not gaining weight, asthma admitted for bronchospasms several times a year).
The chief operating officer conducts an interview for the position of nurse leader and asks about Kotter's eight-step model. Which attribute cited by the nurse relating to helping build the momentum is correct?
Forming a powerful coalition
Clients that can delay treatment for more than 3 hours and remain stable
Green tag. Yellow tag 30min-2hr
A nurse manager determines that one of the nurses in the intensive care unit may be experiencing burnout. What can the nurse manager do to help this nurse begin to confront the problem?
Help the nurse identify personal responses to daily stresses on the job.
Which action of the clinical nurse is consistent with Gardner's task of "achieving work unity"?
Helping clients accomplish optimal functioning
Which action makes a nurse manager also a nurse leader?
Helping employees reach the highest level of their potential excellence
The transformational leader demonstrates charismatic behavior and the careful consideration of the value of every individual in the organization. What might be the expected organizational outcomes with this type of leadership? Select all that apply.
Increased loyalty Increased performance
The registered nurse (RN) administers intravenous fluids to a client who was in a motorcycle accident. Which assessments made by the nurse would be appropriate based on the principle of right task of delegation?
Institutional policies of drug administration
How should a student nurse be trained for implementing delegation in practice?
Interaction with highly qualified, clinically experienced nursing mentors fosters professional self-confidence in the student nurse. These experiences allow student nurses to build up their ability to be successful delegators. Delegation knowledge should also be reinforced in nursing continuing education programs. Didactic content about delegacy can be improved by pairing the education and the clinical experience from the healthcare practice site. The student nurse does not have enough knowledge to make master delegation decisions without adequate training.
What statements are related to a mentorship program organized by the nurse manager in a health organization? Select all that apply.
It expands the knowledge about cultural diversity. It involves selection of mentors who ascribe to transcultural values and beliefs. It should not make people of different cultures pattern their behavior after the prevailing culture.
Which type of performance appraisal method is depicted when a nurse manager keeps a written record of positive and negative performance of employees in a designated time period?
critical incident model
Which characteristics of a licensed practical nurse should be considered before delegation of tasks? Select all that apply.
critical thinking diagnostic reasoning synthesizing info
Which behavior of the nurse leader is characterized as delegating according to the Hersey's model?
Observing or monitoring
After oral surgery the dentist writes a prescription for pain medication for an 18-month-old child. Which medication does the nurse question?
Oxycodone/aspirin
For what things should you use massage?
To decrease PAD pain, claudication (pain with walking) and increase circulation= increased O2 and decreased pain, prevent hemorrhage after delivery, decrease neuropathy, after bleeding stop hemophiliac.
Which application would the registered nurse state is related to the trait theory in practice?
To develop assertiveness
As a manager, the nurse leader is planning to implement a change in the client care delivery system. Which initial step taken by the nurse leader as a manager would be most appropriate for this change?
To identify the inefficiency that requires improvement
What is the ultimate goal of delegation?
To maximize patient care outcomes
Who should floaters be assigned to?
To patients with a condition similar to what they would see on their own floor, and most stable person possible, NEVER cardiac patients or borderline/antisocial patients (will eat them up bc so manipulative).
Why does a nurse manager assign a resource person in a healthcare organization?
To serve as a mentor
Who should an NA never position?
Total Hip replacement, total knee replacement, Increased ICP, acute CVA, or Above knee/below knee amputations.
An organization having poor work flow was suffering financial losses. A team member introduced creative solutions that were publicly recognized by leadership. Which leadership theory is at work in this scenario?
Transformational theory
Which factors does the registered nurse consider in the decision to delegate process? Select all that apply.
Two factors responsible for the decision to delegate process are predictability of outcomes and complexity of the task to be performed. Evaluation, nursing judgment, and pervasive functions are not factors in the decision to delegate process.
The nurse is advising a client to carry a prescription of epinephrine autoinjector. Which insect bite or sting is responsible for the nurse providing this advice?
Wasp
A nurse is helping a client determine and articulate personal values about health problems. The nurse also explains the effect of these problems on lifestyle adjustments. Which Gardner's task of leadership is the nurse leader applying?
affirming values
The registered nurse (RN) is delegating tasks to licensed practical nurses (LPNs) regarding client care. Which factors should be considered when delegating a task to the LPN? Select all that apply.
clients condition complexity of the task predictability of outcomes
The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task?
critical thinking
The nurse leader is teaching the staff that the health care provider continuously strives to work effectively within the cultural context of a client. Which cultural principle is the nurse leader explaining?
cultural competence
Which of Gardner's tasks involves anticipating client outcomes for single clients or families and helping them formulate their vision of future well-being?
envisioning goals
An obese client leads a sedentary lifestyle and complains of leg pain when walking long distances. A nurse leader is teaching the client different exercises that can relieve the pain and can be performed while working in an office or doing daily activities. Which of Gardner's leadership tasks is the leader nurse following?
explaining
What are the desired attributes of the nurse as a leader? Select all that apply.
identify the needs of followers Motivating others assertively towards the objective Using a critical thinking approach while making a decision
A nurse leader is educating student nurses in helping clients to perform their difficult self-care activities. Which key idea from a Source of Power is this statement referring to?
information power
A nurse manager proposes to change a protocol regarding the care of postoperative clients. However, the nursing staff openly expresses their resistance to the change and wants to continue with the original protocol. Which behavioral pattern in response to change best describes the nursing staff?
laggards
While auditing unit documents, a nurse finds some omissions. Which term best describes when the nurse meets with the staff to discuss the findings and communicates ways to achieve the desired goals?
management
The nurse manager is assisting the nursing staff with planning, priority setting, and decision making. Which Gardner's task of leading is being applied in this practice?
managing
=A client underwent angioplasty and is hospitalized for several days for observation. Which task can be delegated by the registered nurse (RN) to a licensed practical nurse (LPN)?
monitoring
The nurse is scheduled to be the co-leader of a therapy group being formed in the mental health clinic. When planning for the first meeting, it is of primary importance that the nurse consider what?
needs of the client being included
Which internal factors should be considered while implementing any change in an organization? Select all that apply.
number of staff leader competency nurse education level
A client reported being administered the wrong dose of medication by the wrong route, which may lead to serious complications. The nurse leader is gathering information to determine what happened. Which phase of client care management is the nurse leader following?
preparation
The nurse manager threatens a staff nurse about being penalized for poor performance in the unit. Which type of leader behavior did the staff nurse experience?
punitive
What motivation factors would the nurse describe as forming a part of two-factor theory of leadership? Select all that apply.
recognition achievement
The registered nurse (RN) is caring for a client who underwent a hysterectomy. Which tasks can be delegated to the unlicensed assistive personnel (UAP) to provide quality care to the client? Select all that apply.
recording VS assisting the client with bathing
A staff nurse is requesting that the nurse leader be her preceptor in the emergency department. Which source of power is effective in this situation?
referent power
A client with a severe allergy has been administered a high dose of antihistamine. The nurse finds that the client is drowsy and dizzy. Which type of need would the nurse prioritize in the client according to Maslow's hierarchy of needs?
safety needs
A nurse is teaching a group of recently hired staff members about defense mechanisms. An example given is Scarlett O'Hara, in the movie Gone with the Wind, who said, "I'll think about that tomorrow." What defense mechanism does this statement reflect?
suppression
During an interview for a nurse manager position, the panel asks the nurse about the primary role of a leader. Which answer provided by the nurse would be most appropriate?
to inspire followers
A nurse manager regularly analyzes herself and her performance, focusing on developing leadership qualities such as assertiveness, confidence, and task knowledge. Which leadership theory does the manager most likely subscribe to?
trait theory
The registered nurse (RN) is caring for a client who was admitted to the hospital due to severe diarrhea. The RN assigns the unlicensed assistive personnel (UAP) to check on the client hourly and perform hygiene care as needed. Which concept best explains this situation?
delegation
Which decision-making strategy involves systematic collection and summarization of opinions and judgments on a particular issue from the respondents?
delphi technique
The hospital administration has recently introduced bar coding and radio frequency identification (RFID) scanning for reducing medication errors. After a few days, the scanner is giving false reports and the hospital management gathered all the staff members to discuss ways to solve this issue and find alternatives. What type of decision-making strategy does the nurse manger most likely think to be useful in this situation?
focus groups
Which organizational outcomes are expected in followers under transformational leadership? Select all that apply.
increased morale increased performance
A nurse working in a medical unit finds that diabetic clients have a knowledge deficit regarding use of glucose-monitoring devices. The nurse requests that a colleague who works in the outpatient diabetic counseling department provide health teaching to the clients. Which type of power does the nurse's colleague hold?
information power
The nurse leader teaches about attributes that all change agents possess. Which attribute of a change agent is the key to self-support through challenges?
sense of humor
The registered nurse suggested that a newly hired registered nurse delegate tasks to nursing assistants. Which is an element that fosters effective delegation decisions by the newly hired registered nurse? 1 Skills Correct2 Stability 3 Practice 4 Environment
Stability along with safety, critical thinking, and time for decision-making creates an integrative process, which fosters effective delegation decisions. Skills are important for making decisions based on critical thinking. Practice accomplishes safety in delegation. Environment with feedback about performance is the best strategy for shaping the future behavior of individuals.
A patient care associate (PCA) is delegated a task that can be completed in 2 hours. The PCA has limited knowledge and willingness regarding that particular task. Which leadership style should be implemented by the delegator in this situation?
telling
A registered nurse (RN) delegates the task of oral care of a client with stomatitis, to an unlicensed assistive personnel (UAP). Which instruction should be given by the RN to the UAP? 1 "Use a mouthwash containing alcohol with the client." 2 "Teach the client to rinse the mouth once every 4 to 5 hours." Incorrect3 "Avoid using toothpaste containing sodium lauryl sulfate with the client." Correct4 "Be certain to use mouthwash containing sodium bicarbonate with the client."
Since the RN is accountable for the work of the UAP, she or he is giving instructions to the UAP before delegating the task. Sodium bicarbonate is slightly alkaline in nature and is soothing to the client. Alcohol will cause burning and aggravate ulcers, and is therefore contraindicated in clients with stomatitis. The oral cavity should be rinsed with sodium bicarbonate solution once every 2 to 3 hours. Sodium lauryl sulfate should be avoided as it is associated with the risk of stomatitis.
After a bomb blast in a city, why would the federal government send the Medical Reserve Corps (MRC) to the site?
The Medical Reserve Corps (MRC) helps establish first aid stations or special-needs shelters to victims of a disaster. The National Disaster Life Support Foundation renders core, basic, and advanced disaster life support training courses. International Medical Surgical Response Teams (IMSuRTs) establish fully functional field surgical facilities. A Disaster Medical Assistance Team (DMAT) is a medical relief team that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours.
Who should manage IVs for regular infusions, TPN, ABX, and drips?
The RN (LPN or NA should never manage IVs)
A client arrives in the emergency department in cardiac arrest. Which priority action indicates that the nurse is acting as a leader?
Resuscitating the client using clinical protocols
The nurse leader asks, "Do I avoid taking a stand so that I can escape risk?" Which behavior is the nurse most likely practicing?
rarely using competing
RULE: MED SURGE ASSIGN MED SURGE FLOAT NURSE
1. Diabetes mellitus 2. DVT( deep vein thrombosis) 3. Hypertension 4.Surgeries 5.Chronic condition 6. seizures
Who should teach self injections, dressing changes, or diets (except DM and CRF)?
An RN
Who should ambulate a newly admitted post-op/acutely ill patient?
An RN
Who should establish a patient's initial plan of care?
An RN
A nurse manager delegates the task of phlebotomy to the members of a healthcare team who are caring for a client with diabetes. Which individual on the team can be delegated to perform the task of phlebotomy?
Cross-trained technician
After delegating a task to the unlicensed assistive personnel (UAP), the registered nurse (RN) provides clear and concise directions to the delegate, to whom she assigned the task. Which right of delegation is the RN following? 1. Task 2. Supervision 3. Circumstance 4. Communication
4. Communication To ensure right communication, the RN should communicate properly and accurately to the delegatee. Right task refers to the delegation of an appropriate task based on institutional policies and procedures. Right supervision refers to obtaining feedback, monitoring, and evaluating the client appropriately. Circumstances such as the equipment and resources available should be evaluated to meet right circumstance.
Which skills are essential for the nurse who is setting priorities for client care? Select all that apply. 1 Evaluation 2 Assessment 3 Critical thinking 4 Case management 5 Clinical decision-making
2, 3, 5 Essential skills for the nurse who is setting priorities for client care include assessment, critical thinking, and clinical decision-making. Evaluation and case management are nursing skills; however, these are not essential for setting priorities.
The nurse manager orders the direct care nurse to assist in providing tertiary care to a client. Which type of treatment would the direct care nurse be involved in? 1 Chronic care 2 Rehabilitation 3 Health maintenance 4 Prevention of disease complications
2 Tertiary care includes rehabilitation. Chronic care and health maintenance are considered primary care, and prevention of disease complications is classified as secondary care.
Who should up date a patient's plan of care?
An RN or LPN
The registered nurse is assigning a task to an unlicensed nursing personnel (UNP). Which key elements are considered while assessing the UNP's ability to perform work? Select all that apply.
While assessing the work to be assigned to an unlicensed nursing personnel (UNPs), the registered nurse should consider the elements of safety, stability, and critical thinking. Attitude is one of the multiple factors that influences the effectiveness of the leader. Ethnicity is not a factor that plays a role in the process of delegation.
What does the nurse say is the advantage of an appropriate delegation? 1. Assistance 2. Accountability 3. Empowerment 4. Reduced stress
4. Reduced stress Appropriate delegation reduces stress and increases time efficiency by providing timely care to the client. Assistance or direction is asked by the delegatee to complete the task if the nurse provides limited information on an assigned task. The nurse is accountable and responsible for the task assigned to the delegatee if the delegation does not work properly. Delegation requires empowerment of the delegatee to accomplish a task.
The registered nurse is caring for an elderly client who is admitted with severe asthma. Which task delegated by the nurse is most suitable to be performed by the client attendant?
Assisting the client during nebulization
Which right does the question, "Do staffing ratios demand the use of high-level delegation strategies?" indicate? 1. The right task 2. The right person 3. The right supervision 4. The right circumstance
4. The right circumstance The right circumstance can be assessed by asking, "Do staffing ratios demand the use of high-level delegation strategies?" The right task is assessed by the legally appropriate delegate, using institutional policies and procedures. The right person is selected when the delegatee has the knowledge and experience to perform the specific task safely. Providing feedback related to the task and monitoring the client promote right supervision.
The case manager notes that a client's hospitalization is being prolonged for one day because of an unexpected adverse medication reaction. What action should the case manager take? 1 Add the extra day into the pathway. 2 Document the reaction as a variance. 3 Change all uses of the pathway to add the extra day. 4 Prepare documentation to submit to Medicare about the extra day.
2 Document the reaction as a variance. If a client's progress deviates from the normal path, a variance is indicated. A variance is anything that occurs to alter the client's progress through the normal critical path. The reason(s) for the variance should be analyzed and the care revised to meet the needs of the clients. An extra day is not added into the pathway and all uses of the pathway are not changed by adding an extra day based on this single variance. There is no evidence to support that the case manager needs to submit documentation to Medicare about the extra day.
What are interventions for a patient with a progressive neurological disease who may have respiratory problems as a result?
Use peak flow meter, get advanced directive, mechanical soft diet, and thickened liquids.
What does it mean if the pulse ox read 100% but patient is restless?
Patient may have been exposed to carbon monoxide.
What is the emergency care for a drowning client?
Safely rescuing the patient
What is the main motto of the Hersey's 2006 model?
Situational leadership
Which leadership theory focuses on the role of leaders in relational and contextual terms?
Style theory
What does it mean if the vent is beeping with a high pressure alarm?
The patient is causing problems (fighting the vent- holding breath,etc.).
Which point should the nurse exclude when developing strategies to project a powerful image?
Using authoritative language
What does it mean if the bladder scanner doesn't produce a reading?
Bladder is empty
The Joint Commission is surveying an organization's nursing care. Which question is the surveyor most likely to ask regarding right supervision when delegating?
"Do you monitor and evaluate the client's condition appropriately?"
The registered nurse is teaching a group of student nurses about the role of the nurse as a leader. Which statement by a student nurse indicates effective learning?
"The goal of the nurse manager is to develop a shared vision of the future with direct care nurses."
The nurse as a leader assists multidisciplinary leaders to achieve optimal functioning to benefit client care delivery. Which Gardner's task is the nurse applying?
Achieving workable unity
Which component is the ability to perform duties in a specific role?
Authority
Which component of delegation is defined as the ability to perform duties in a specific role?
Authority
Which behavior on the part of the nurse helps develop trust among subordinates?
Behaving with consistency
Who is responsible for establishing systems to monitor and verify the competency requirements related to delegation in an organization?
CNOs
Type of care for a nurse providing care to one patient the entire shift
Case management
A delegator is providing feedback to four delegatees. Which feedback is constructive feedback that can help the delegatee to improve quality of care?
D
What are the attributes of a nurse leader? Select all that apply.
Identifying the needs of others Using critical-thinking skills in making decisions Using focused energy and stamina to accomplish a vision
What type of relationship between the nurse delegator and delegatee causes the nurse delegator to use the leadership behavior of telling?
Limited
What should be done if staff applies restraints to a patient to keep them from falling or wandering?
MORE EDUCATION
What is the role of a nurse administrator in a healthcare setting?
Preparing the budget, staffing, strategic planning of programs and services, employee evaluations, and employee development
What would the nurse state is the primary priority for decreasing a client's risk of morbidity and mortality?
Prevention
The nursing manager wants to implement transformational leadership qualities. Which actions best describe this style of leadership? Select all that apply.
Providing intellectual stimulation Performing experiments with system redesign Using motivator factors to inspire work performance
The registered nurse suggested that a newly hired registered nurse delegate tasks to nursing assistants. Which is an element that fosters effective delegation decisions by the newly hired registered nurse?
Stability
What procedures are done sterile in the home?
IVs, dressings, and peritoneal dialysis.
What does it mean if a PCA pump isn't delivering medication to the patient?
The may be asking to often or not enough medication to control the pain.
Which among the Five Rights of Delegation is the cornerstone of delegation?
"Right communication and direction"
What are the rules for prioritizing patients?
Acute problems more serious than chronic. <24 hrs post op= more serious than medical conditions/older surgeries. Unstable patient more serious (ACUTE) than stable, when in doubt Select the more vital organ (heart or lungs over toes, fingers and legs).
A healthcare team is caring for a client with food poisoning. Which task is most suitable to be delegated to licensed practical nurse (LPN)?
Administering oral antiemetic medication
As a part of informed consent, a surgeon explains to the client who is scheduled for surgery the details of the surgery and the related care. The nurse as a leader witnesses the complete procedure. What information does the nurse leader ensure was provided to the client? Select all that apply.
Surgery procedures Name of the surgeon Description of the risks
A group member states "Administration won't go for it" while making a decision for a critical issue. Which strategy should a nurse leader implement to deal effectively with this situation?
brainstorming
Which objective is associated with creating urgency in Kotter's eight-step model?
To generate open dialogue about external and internal realities
What does it mean if the patients pacemaker is set at 75 and the patient's rate is 60?
It is defective and the MD should see the patient.
While delegating a specific task, the registered nurse says to the delegatee, "It is important that you measure the client's blood pressure every 15 minutes." What does this situation indicate?
The delegator is providing more guidance.
Which members of the healthcare team are under dependent status when a task is delegated by the registered nurse (RN)? Select all that apply.
Client attendant Licensed vocational nurse (LVN)
What is the key idea of role theory in nurse leadership? Select all that apply.
To understand behavior in certain circumstances To collect concepts that predict the actors' performance in a given role
A nurse manager is helping staff reach optimal functioning to enhance organizational functions. Which Gardner's task is reflected in this leadership behavior?
Achieving workable unity
Who should manage a patient on a vent after a week (chronic/stable)?
An LPN
A nurse in charge in the surgical intensive care unit notes that a number of clients do not seem to be responding to morphine that was administered for pain. Later in the evening the nurse finds a staff nurse dozing in the nurses' lounge. When awakened, the staff nurse appears uncoordinated and drugged, with slurred speech. What should the nurse in charge do?
Ask the nurse manager to be present before confronting the staff nurse.
Who does an interdisciplinary team consist of?
MD, RN, PT, Social worker, etc.
"In today`s workplace, female-male collaboration should provide efficacious models for the future." Which statements support this saying? Select all that apply.
men and women must learn to work together women and men bring separate perspectives to resolving problems
Which actions can the mentor take to develop effective leadership qualities in the aspiring leader? Select all that apply.
modeling behavior giving timely feedback providing appropriate advice
Which element creates an integrative process that fosters effective delegation decisions by the registered nurse? 1. Ability 2. Liability 3. Stability 4. Ethnicity
3. Stability Stability is the element that creates an integrative process that fosters effective delegation decisions. Ability is the factor that needs to be assessed to determine the level the leaders determine. Liability is the person's responsibility and accountability for individual actions. Ethnicity does not play a role in the process of delegation.
If the nurse is considering whether the right equipment and resources are available to complete a task, which delegation right is considered? 1 Task 2 Supervision Correct3 Circumstance 4 Communication
If the right equipment and resources are available to complete a task, it is considered the right circumstance. Task is the delegation right that involves asking if the task is appropriate to delegate based on institutional policies and procedures. Supervision is the delegation right involving the provision of clear feedback related to completion of an assigned task. Communication is the right that involves asking the delegator and delegate to understand a common work-related language.
What is given to anyone with acute exposure to any infection or enlarged lymph nodes?
Immunoglobulins
The registered nurse (RN) delegates obtaining and recording a client's pulse every 30 minutes. During the last hour, the licensed practical nurse (LPN) fails to report the client's elevated heart rate to the RN. Which factor best explains the situation? 1 Limited delegation 2 Information salience Correct3 Decayed information 4 Ineffective supervision
Information decay is the characteristic feature of communication that occurs when the client's health status changes rapidly; this might include a change in the client's vital signs such as the heartbeat. Nursing when performed with limited delegation leads to misusing valuable resources. Information salience is a characteristic feature of communication in which the information provided by the delegator is monitored and evaluated. Supervision is mainly provided to the new delegatees.
What is contraindicated with an allergy to egg?
MMR and flu shot
The nurse notes a conflict between staff members during a meeting. Which principle should the nurse follow, as a leader, to put the focus on mutual interest?
Responding expediently to the issues
The registered nurse (RN) who was caring for a postsurgical client went out for a break. The RN assigns the work to a healthcare professional who is also an RN. Which is the correct statement regarding this situation?
The situation describes assignment.
A nurse is explaining the nursing process to a nursing assistant. Which step of the nursing process should include interpretation of data collected about the client?
evaulation
In what order should patients be removed in the event of a disaster?
ABC= Ambulatory, bed ridden, and critical care patients.
Patients on/with what should never be sent to surgery?
ANTICOAGULATED PATIENTS: With low platelets, high PT or PTT, or on coumadin/heparin.
Which factors should be assessed to determine the level of followers' readiness according to Hersey's model? Select all that apply.
Ability Willingness
Which factors should be assessed to determine the level of followers' readiness according to Hersey's model? Select all that apply. Correct1 Ability Correct2 Willingness 3 Family history Incorrect4 Work experience Incorrect5 Educational qualifications
According to Hersey's model, the delegator should check the ability and willingness of the delegatee before delegating any task. Information about family history may not be required for delegating a task. According to Hersey's model, work experience and educational qualifications are not considered as factors required to determine followers' readiness.
Who should take care of an SCI after a week (chronic/stable)?
An LPN
RULES TO WATCH THE PATIENT WHEN THE PATIENT HAVE SERIOUS PROBLEMS
Anytime a forgien object inserted into the body the complication may be rupture of the organ. Cold/ Dehydrated baby is the DEAD BABY. Drunks and druggies commit SUICIDE Never discharge a WHEEZER watch for MUSCLE and WEAKNESS.
While delegating a task, the registered nurse says to the delegatee, "Please tell me how you go about performing this procedure, and I will share with you my perspective about how frequently and under what conditions we need to communicate with and report to each other." What does this indicate?
Asking a delegatee how he or she performs the procedure and sharing each other's perspective and when to communicate indicates that the delegator and delegatee are creating mutual expectations. When the delegatee demonstrates a task, it indicates that the delegatee requires explanation. The delegator will direct the procedures to the delegatee when the delegatee has limited knowledge. The delegator will motivate the delegatee when the relationship between the delegatee and delegator is established.
Which delegation actions may be performed by unlicensed nursing personnel while caring for a client? Select all that apply.
Asking the client to wash hands before meals Instructing the client to wear footwear while walking
The registered nurse finds that two nursing students are arguing with each other. Which action by the registered nurse best represents a leadership quality?
Assessing the condition and strategizing to resolve the matter by reducing the difference
Which of these clients is most appropriate for delegation to a cross-trained technician?
Client A
The registered nurse (RN) is assessing the conditions of four different clients. Which client care should be delegated by the RN to unlicensed nursing personnel (UNP)?
Client D
A nurse leader wants to implement the principle of non-maleficence while evaluating the staff. What is an effective way to perform this action?
Emphasizing the good qualities of the staff and giving positive direction for growth
Which activity performed by the registered nurse (RN) indicates following the "participating" leadership style in Hersey's model?
Establishing mutual expectations with the delegatee
Which Institute of Medicine Report attempted to help interprofessional teams work more effectively together?
Health Professions Education: A Bridge to Quality
The nurse is hired to work in a Magnet hospital. What should the nurse expect when providing care in this organization?
In Magnet hospitals, staff have autonomy and control over nursing practice. This would include attending care conferences to discuss client care needs. Salaries planned according to education level and assignments made according to years of experience would be expected in an environment with differentiated nursing practice. There is no care delivery method that utilizes physician input for annual performance appraisals.
A 9-year-old child has a fractured tibia, and a full leg cast is applied. Which assessment findings should the nurse immediately report to the healthcare provider? Select all that apply.
Inability to move the toes Tingling sensation in the foot Fiberglass cast that is damp after 4 hours
The delegatee is performing a task and in the process loses confidence in what he or she is doing. Which delegator's action may have contributed to the delegatee's loss of confidence?
Intervening when the delegatee is performing the task
Which actions in the delegation process represent accountability? Select all that apply. Correct1 Monitoring client care Correct2 Seeking the outcome report 3 Assessing the ability of the delegatee 4 Providing honest feedback to the delegatee Incorrect5 Assisting registered nurses with delegation decisions
Monitoring client care and seeking the outcome report represents accountability of the task in case of conflicts. Assessing the ability of the delegatee and educating about the task indicates responsibility. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions regarding safety issues, urgency to intervene, or potential negative client outcomes.
The nurse leader is monitoring a student nurse who is accessing various databases. Which search platform should the nurse leader suggest to access a variety of databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE? Select all that apply.
OVID EBSCO
Which strategy should be implemented by the registered nurse (RN) to achieve desirable client outcomes?
Offering
An infant with a congenital heart defect is returned to the unit after cardiac catheterization. The nurse manager is observing a nurse newly assigned to the unit. Which nursing intervention should the nurse manager interrupt?
Performing range-of-motion exercises
Which behavior of the nurse as a leader indicates Gardner's task of renewing at an executive level?
Providing self-care to enhance the ability to care for clients, families, staff, and the organization
A client with dehydration is prescribed an intravenous (IV) fluid infusion. Which healthcare professional would the nurse expect to be delegated this task?
Registered nurse
The nurse leader and the team received recognition because of a follower on the team. What could be the most important action of the nurse leader?
Sharing the appreciation with the team
The nurse manager is in charge of a relatively inexperienced nursing staff. The manager inspires followers through displayed optimism, by providing intellectual stimulation, and by encouraging follower creativity. Which leadership theory is most closely aligned with the manager's approach?
Transformational theory
Which healthcare team member is responsible for the coordination and assignments of client care?
charge nurse
Who is responsible for client outcomes in the functional model of care?
nurse manager
Which statement does the nurse recognize as true according to chaos theory?
Health-care organizations must be self-organizing.
A client is admitted to the medical unit with pulmonary edema. The registered nurse admits the client, writes a plan, and assigns the work to another registered nurse (RN). Which factors are transferable in this case? Select all that apply.
Responsibility Accountability
Which strategy of the nurse leader regarding the quality improvement (QI) process requires revising?
The quality improvement process mainly focuses on *preventing errors* rather than correcting them. The task of the QI process includes staff development. The team of the QI process involves the interprofessional team and the outcomes are set with the input of clients and the staff.
Which characteristics of a licensed practical nurse should be considered before delegation of tasks? Select all that apply.
Critical thinking Diagnostic reasoning Synthesizing information
Which activity performed by the registered nurse (RN) indicates effective supervision of the delegatee?
Guiding the delegatee while he or she is performing the task
Which of these is within the RN scope of practice? Starting IVs, Isolation placement, Problem w/NGs, and Room assignments.
All are within the RN scope of practice.
Who should ambulate a one day P/O patient?
An LPN or an NA
Who should do an assessment on a new admit and new P/O patient?
An RN
Which statement is correct regarding delegation? Select all that apply. Correct1 It involves transfer of authority. Correct2 The delegator retains accountability for the outcome. Incorrect3 The delegatee retains accountability for the outcome. 4 It is the transfer of both responsibility and accountability. Correct5 Principles of delegation outline what nurses need to know about the task.
Delegation involves two people—delegator and delegatee—with the transfer of authority to perform the task. The delegator retains accountability for the outcome of the task delegated. The delegatee holds responsibility but not accountability for the task. Assignment involves the transfer of both responsibility and accountability of the work to the delegatee. Principles of delegation outline what nurses need to know and do in relation to completing the task.
What does appropriate delegation do to a healthcare organization? Select all that apply. Correct1 Reduces stress 2 Decreases trust 3 Reduces client care Incorrect4 Decrease time efficiency Correct5 Improves treatment outcomes
Delegation requires empowerment of the delegatee to accomplish the task and, therefore, sharing functions reduces stress. As functions are distributed, it improves treatment outcomes. Appropriate delegation increases trust between the delegator and the delegates, increases client care, and increases time efficiency.
The registered nurse in a hospice is working with a new assistant who has prior experience working in a physician's office. Which action made by the registered nurse will promote a healthy working environment?
Encouraging the assistant to adopt the philosophy of the organization
What are the responsibilities of the nurse as a leader? Select all that apply.
Encouraging the direct care nurses to provide input into decisions Ensuring that day-to-day activities of the staff are correctly planned and executed
A nurse leader is promoted as nurse manager of a critical care unit. Which action would demonstrate the effectiveness of the nurse leader role as a manager?
Establishing the goals considering the staff expertise
A case manager telephones a client with lung disease to evaluate respiratory function with home oxygen use and then contacts the primary care provider. What is the purpose of this communication?
Evaluate expected outcomes
The nurse leader is focused on recognizing the dynamic, complex, and interdependent nature of systems in an organization. Which nursing action indicates an effective implementation of this principle of systems thinking theory?
Identifying and understanding the relationships between clients, families, communities, and local economies
Who should be isolated?
Pt with night sweats/temp/ and cough (TB), Pt with HA and stiff neck (meningitis), adult patient with rash or blisters (shingles), and any patient showing S&S of infection (increased temp, rash, increased WBCs) until verified. Follow CDC guidelines.
When evaluating a task performed by a delegatee, the registered nurse finds that the delegatee fails to provide appropriate feedback. Which right of delegation is compromised in this situation?
Right supervision
A group of clients who were in a bus accident is admitted to the emergency department with injuries. Which group is considered urgent according to the three-tier triage system?
Severe abdominal pain
What types of activities should a nurse delegate to NAs?
Standard unchanging procedures and Stable patients only. Always ask, which patient will die 1st.
The nurse as a leader obtains feedback from superiors, followers, and peers. Which leadership theory is the nurse putting into practice?
Style theories
A healthcare team is caring for a postsurgical client who underwent knee surgery. Which task is most suitable to be delegated to a licensed practical nurse (LPN) to provide effective client care? Select all that apply. Correct1 Changing the dressing 2 Ambulating the client Correct3 Administration of oral analgesics Correct4 Reinforcing leg exercise instructions 5 Administering intravenous antibiotics
The LPN scope of practice includes changing the dressing of the surgical site and administration of oral analgesics. Reinforcing leg exercise instructions may also be performed by the LPN. Ambulating the client who underwent knee surgery is usually performed by a physical therapist. Instructing the LPN to administer intravenous medication may not be appropriate according to guidelines.
Which activity performed by the registered nurse (RN) indicates effective delegation? 1 Following one-way communication with the delegatee 2 Assigning a task to a new licensed practical nurse(LPN) 3 Providing feedback to the delegatee while performing the task Correct4 Supervising and monitoring the licensed practical nurse (LPN) about the different activities
The delegator should supervise and monitor the delegatee when the work is being assigned to the delegatee. The communication between delegatee and delegator should always be two-way to get the expected outcome. The delegator should evaluate the ability of the delegatee and should supervise the different tasks before assigning the work to the new delegatee. The delegator should always provide feedback at the end of the task.
Which healthcare team member would the nurse expect can be delegated with the task of administering oral medication to a client per the functional model? 1 Registered nurse 2 Patient care associate Correct3 Licensed practical nurse 4 Unlicensed assistive personnel
The licensed practical nurse can give oral medication to a client. The registered nurse gives IV medication to a client. Patient care associates assist and monitor vital signs. Unlicensed assistive personnel perform all hygienic tasks.
While caring for a client with diabetes, the registered nurse delegates the task of administering oral medications to the licensed practitioner nurse (LPN), but the LPN is reluctant to take the assignment. What should be the most appropriate response of the registered nurse in this situation? Correct1 Evaluate the reason for the behavior. 2 Engage more actively in the delegated task. 3 Require the delegatee to complete the task. 4 Report the LPN's reluctance to higher authorities.
The registered nurse (RN) should first evaluate the reason for the behavior of the LPN and try to determine if the LPN has insufficient knowledge, a psychomotor deficit, or any other reason for the reluctance. If the LPN is unwilling to perform in a specific situation, the RN should engage more actively. Requiring the delegatee to complete the task despite reluctance may not be safe. Reporting the issue to higher authorities should not be the initial intervention.
The healthcare team is caring for a client with neutropenia. Which task is delegated to unlicensed assistive personnel? 1 Administering antibiotics Correct2 Assisting with personal hygiene Incorrect3 Monitoring for signs and symptoms of infection 4 Teaching the client and caregivers about how to avoid infection
Unlicensed assistive personnel assisting with the client's personal hygiene. The licensed practical nurse administers antibiotics. Monitoring for signs and symptoms is performed by the licensed practical nurse. The registered nurse teaches the client and caregivers how to avoid infection.
The registered nurse is evaluating the statements of the student nurse after teaching about the span of control in a group of individuals working in a healthcare organization. Which statement made by the student nurse indicates a need for correction?
"The unit secretary in a healthcare organization has legal recognition."
Which component of delegation is considered a "two way process"? 1. Authority 2. Supervision 3. Responsibility 4. Accountability
3. Responsibility Responsibility is a two way process. Authority is the ability to perform duties in a specific role. Supervision is defined as the "provision of guidance and oversight of a delegated nursing task." Accountability may not be a two-way process. It determines if the actions were appropriate and provides a detailed explanation of what occurred.
Which behavior of the registered nurse would be appropriate for a management position according to Gardner's tasks of leading/managing?
Assisting the staff to interpret organizational values
According to Kouzes and Posner, which key practices are involved when a leader takes an active role in the work of change and creative thinking about new solutions? Select all that apply.
modeling challenging
The registered nurse finds that the delegatee is only working for half a day in the healthcare unit. Which is the most appropriate leadership style in this situation?
Telling
During a feedback session, the nursing staff communicates that a recently appointed nurse is using "empowerment theory." Which statement of the nursing team members most supports this position? Select all that apply.
"He/she can share power with others." "He/she encourages others to provide input into decisions." "He/she provides considerable information about the decision-making process."
The registered nurse is teaching a newly hired nurse about communicating with delegatees during delegation. Which statement made by the newly hired nurse indicates the need for further learning?
"I should provide examples of each delegation."
Which questions should the delegator assess to determine the right task? Select all that apply.
"Is the task legally appropriate to delegate?" "Is the task appropriate to delegate based on institutional policies and procedures?"
After assigning a specific task, the registered nurse observes that the delegatee is unable to perform the task accurately. What will be the appropriate statement of the registered nurse in this situation?
"Just follow my steps and you can do it."
Which task can be safely delegated by a registered nurse (RN) to unlicensed nursing personnel (UNP) for a client with thrombocytopenia?
"Positioning the client" Clients with thrombocytopenia are at risk of bleeding with slight bruising. Therefore tasks that do not risk bruising the client may be delegated to the UNP. The RN should shave the client and maintain oral hygiene. Intravenous infusions should not be administered by a UNP to any client.
The registered nurse is evaluating the statements of the student nurse after teaching about delegation. Which statement made by the student nurse indicates a need for correction?
"Professional aspects of care can also be delegated."
The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a client with diarrhea. After 2 hours, the RN communicates with the UAP and decides that the client needs immediate assessment. Which statements by the UAP led the nurse to this conclusion? Select all that apply.
"Temperature of the client is 105° C." "I have administered intravenous fluids to the client."
The nurse leader teaches the student nurse about the quality assurance (QA) process. Which statement made by the student nurse indicates ineffective learning?
"The major task is staff development."
A registered nurse is educating a nursing student about the relationship between nursing theory and nursing research. What information should the nurse provide? Select all that apply.
"Theory-generating research helps to discover and describe relationships of phenomena." "Theory-testing research helps to determine the accuracy with which a theory describes a phenomenon." "The relationship between nursing theory and nursing research builds the scientific knowledge base of nursing."
Which element creates an integrative process that fosters effective delegation decisions by the registered nurse?
*Stability is the element that creates an integrative process that fosters effective delegation decisions.* Ability is the factor that needs to be assessed to determine the level the leaders determine. Liability is the person's responsibility and accountability for individual actions. Ethnicity does not play a role in the process of delegation.
Which nursing care delivery system works well in emergency situations that necessitate prioritization of care?
*The functional method of delivering care works well in emergency and disaster situations. Each care provider knows the expectations of the assigned role and completes the tasks quickly and efficiently.* Team nursing, primary nursing, and Patient-Centered nursing delivery systems are not supported by evidence as working well in emergency situations.
Rationale The unlicensed nursing personnel (UNP) can be delegated to care for a client in an acute care setting if the client is stable. So, the vital signs can be monitored by the unlicensed assistive personnel (UAP) if the client has stable vital signs. Client teaching is in the scope of the registered nurse (RN). Reinforcement of the teaching can be delegated to the UAP. Assessing laboratory reports is the role of the RN; this task may not be delegated to unlicensed personnel. Evaluating client status is the role of the RN; this task is outside the scope of practice of the UAP.
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Which type of behavior by the registered nurse results in a low-to-stable level of commitment? 1 Punitive 2 Charismatic 3 Inspirational 4 Intellectual stimulation
1 Punitive behavior is a type of transactional leadership behavior that results in a low-to-stable level of commitment as an organizational outcome. Charismatic, inspirational, and intellectual stimulation are transformational leadership behaviors that result in increased commitment as an organizational outcome.
A nurse leader, along with the team, is caring for a client who is scheduled for colonoscopy. Which delegated task requires the leader's supervision? 1 Assisting the client with an enema 2 Assisting the client with bathing 3 Assisting the client with feeding 4 Assisting the client with ambulating
1 Assisting the client with an enema A client who is scheduled for colonoscopy requires having the gastrointestinal tract emptied, mainly the colon. Before undergoing this procedure the client is assisted with an enema and other laxatives to expel all bowel contents present in the gastrointestinal tract. A nurse leader should supervise this procedure, as an inadequately emptied colon may cause complications. Assisting the client with bathing, feeding, and ambulating are easy tasks and may not require supervision.
Who acts as a delegator in the absence of the registered nurse? 1 Charge nurse 2 Patient care associate 3 Licensed practical nurse 4 Unlicensed nursing personnel
1 Charge nurse The charge nurses act as a delegator on the basis of knowledge and experience in clinical settings. In the absence of a registered nurse, the charge nurse usually delegates the tasks. A patient care associate assists and monitors vital signs. Licensed practical nurses and unlicensed nursing personnel are considered delegatees due to insufficient experience and training.
What aspect of total client care needs to be taken into consideration if used on a 24-bed care area? 1 Cost of nurses 2 Training needs 3 Documentation 4 Time commitment
1 Cost of nurses Since total client care is provided by a registered nurse (RN) it can be very expensive and not realistic to use a highly skilled and extremely knowledgeable professional nurse to provide all the care required in a unit of 24 clients. There are no particular issues with training, documentation, or time commitment with total client care.
Which statement describes the practice partnership model of care delivery? 1 Nurse and unlicensed assistive personnel work the same shifts and days. 2 Nurse provides unlicensed assistive personnel (UAP) report for a group of clients. 3 Unlicensed assistive personnel (UAP) perform the same task for a group of clients. 4 Unlicensed assistive personnel (UAP) measure vital signs and provide morning care.
1 Nurse and unlicensed assistive personnel work the same shifts and days. In the practice partnership model of providing client care, a registered nurse (RN) is paired with a technical assistant who works with the RN consistently, which means they are scheduled to work the same shifts and days. The nurse providing a report for a group of clients would be an action within team nursing. Unlicensed assistive personnel (UAP) performing the same task for a group of clients would be seen in functional nursing. Unlicensed assistive personnel (UAP) measuring vital signs and performing morning care would be a part of team or functional nursing. In the practice partnership model, the nurse and UAP would measure vital signs and perform care together.
Before assigning a task, the registered nurse makes sure that the prospective delegatee is willing to complete the task. Which delegation right does this situation reference? 1 Person 2 Supervision 3 Circumstance 4 Communication
1 Person Ensuring that the prospective delegatee is willing to complete the task refers to the delegation right person. Knowing whether the delegator is able to monitor and evaluate the client appropriately refers to the delegation right supervision. Ensuring whether the equipment and resources are available to complete the delegation process refers to circumstance. Ensuring whether the delegator and delegatee understand a common work-related language refers to the delegation right communication.
The nurse is caring for a pregnant client with hypertension. Which client care tasks are most suitable to be delegated to the patient care associate (PCA)? 1 Recording the vital signs 2 Monitoring the blood pressure 3 Administering intravenous fluids 4 Administering antihypertensive medications
1 Recording the vital signs A patient care associate (PCA) is an unlicensed assistive personnel whose scope of practice is very limited. A PCA can be delegated the task of recording the vital signs as communicated by the delegator even if the condition of the client is acute or unstable. In stable clients, the PCA may be instructed to monitor the blood pressure, but in this acute condition, only the registered nurse (RN) should monitor the blood pressure. Administration of intravenous fluids or medications is out of scope of practice of the PCA. A PCA is not suitable to be delegated the task of administering any medication to a client.
What is the priority nursing care for a client who is prescribed hydroxychloroquine (Plaquenil)? 1 Teaching the client to report blurred vision 2 Teaching the client to report signs of infection 3 Teaching the client to report shortness of breath 4 Teaching the client to report stomach discomfort
1 Teaching the client to report blurred vision Plaquenil is a hydroxychloroquine used to treat rheumatoid arthritis. The adverse effect of Plaquenil is retinal damage; therefore, a client on Plaquenil is taught to report blurred vision. A client on steroids is taught to report signs of infection. A client on infliximab is taught to report shortness of breath. Plaquenil causes mild stomach discomfort, which is normal and is not related to priority nursing care.
Which point should the nurse exclude when developing strategies to project a powerful image? 1 Using authoritative language 2 Maintaining good body posture 3 Making good eye contact with clients 4 Ensuring that clothing and hair are appropriate to the situation
1 Using authoritative language The nurse should treat people with courtesy and respect. The use of authoritative language does not help in developing a powerful image. The nurse should also maintain good body posture because it conveys self-confidence. Good eye contact helps in developing trust. Appropriate dress and hair help convey a powerful image.
Which characteristics of a licensed practical nurse should be considered before delegation of tasks? Select all that apply. 1 Critical thinking 2 Effective client care 3 Diagnostic reasoning 4 Synthesizing information 5 Accountability of assigned task
1, 3, 4 Critical thinking, diagnostic reasoning, and the ability to synthesize information from various sources are three factors that are characteristics of the licensed practical nurse that should be considered before delegating tasks. Planning effective client care is the role of a registered nurse. Accountability for an assigned task is the basic responsibility of a nurse.
The nursing manager wants to implement transformational leadership qualities. Which actions best describe this style of leadership? Select all that apply. 1 Providing intellectual stimulation 2 Intervening only when problems exist 3 Performing experiments with system redesign 4 Using motivator factors to inspire work performance 5 Monitoring performance and taking action to correct
1, 3, 4 Transformational leaders provide intellectual stimulation and encourage follower creativity. They experiment with systems redesign, empower staff, create enthusiasm for practice, and promote scholarship of practice in client care. They use motivator factors liberally to inspire work performance. Intervening only when problems exist is a behavior related to transactional leadership. Monitoring performance and taking corrective action is a transactional leadership quality.
A nurse educator is developing materials for a hospital-wide campaign about zero tolerance for lateral violence and bullying among staff. Which actions will the nurse educator include in teaching about what staff members should do if they experience workplace violence? Select all that apply. 1. Document the interactions with the bully 2. Ignore the bully's comments, remarks, and allegations 3. Observe interactions between the bully and other colleagues 4. Report the violent incidents to the hospital administrator 5. Tell the bully you will not tolerate the unprofessional behavior
1, 3, 5 Lateral violence (also known as horizontal violence) can be defined as acts of aggression carried out by a co-worker against another co-worker and designed to control, diminish, or devalue a colleague. These behaviors usually take the form of verbal abuse such as name-calling, unwarranted criticism, intimidation, and blaming. However, other acts, such as refusing to help someone, sabotage, exclusion, and unfair assignments, also fall under the category of lateral violence. Violence in the workplace should not be tolerated or ignored by either staff or management. Actions that staff members can take if they become victims of lateral violence include: - Documenting and keeping a file of all incidents (Option 1) - Reporting the incidents to the immediate supervisor - Letting the bully know that the behavior will not be tolerated (Option 5) - Observing interactions between the bully and other colleagues (may validate the victim's experiences and serve as a source of support) (Option 3) - Seek support from within the facility or from an external source (Option 2) Ignoring acts of lateral violence will perpetuate the bullying. (Option 4) The chain of command should be followed when reporting incidents of lateral violence. If the immediate supervisor takes no action, the employee can move up the chain. Educational objective: Lateral violence in the workplace (acts of aggression by an employee toward another employee) should not be tolerated or ignored. Victims can take action against bullying, including documenting and reporting incidents, standing up to the bully in a professional way, and seeking support.
Which are considered as nurse competencies within the synergy model of care delivery? Select all that apply. 1 Collaboration 2 Care planning 3 Communication 4 Clinical judgment 5 Cultural competency
1, 4, 5 The Synergy Model describes eight nurse competencies, which include collaboration, clinical judgment, advocacy and moral agency, caring practices, facilitation of learning, systems thinking, response to diversity (cultural competency), and clinical inquiry. Care planning and communication are skills that every nurse should demonstrate regardless of the care delivery system being implemented.
Which component of delegation is defined as the ability to perform duties in a specific role? 1. Authority 2. Supervision 3. Responsibility 4. Accountability
1. Authority Authority is the ability to perform duties in a specific role. Supervision is the provision of guidance and oversight of a delegated task. Responsibility refers to reliability, dependability, and obligation to accomplish work. Accountability involves determining whether the actions are appropriate and providing a detailed explanation of what has occurred.
The registered nurse delegates the tasks related to caring for a client who has undergone surgery. What are the benefits of delegation in this situation? Select all that apply. 1. Increased efficiency 2. Improved quality of client care 3. Improved supervision by the licensed practical nurse 4. Increased delegation authority by the licensed vocational nurse 5. Increased professional skills of the unlicensed assistive personnel
1. Increased efficiency 2. Improved quality of client care 5. Increased professional skills of the unlicensed assistive personnel The benefits of the delegation include direct client care and professional benefits. Delegating the task of providing care to the other members of the health care team helps conserve time and improve the quality of client care. Increasing the professional skills of unlicensed assistive personnel is also a benefit of delegating tasks. "Right supervision" dictates that the authority to supervise and delegate is only conferred to the registered nurse or another qualified delegator, not to the licensed practical nurse or licensed vocational nurse.
What are the overall purposes of delegation? Select all that apply. 1. To achieve nursing goals 2. To improve client outcomes 3. To develop critical judgment skills 4. To understand the art of delegation 5. To apply delegation decision in clinical nursing practice
1. To achieve nursing goals 2. To improve client outcomes The overall purpose of delegation is to achieve nursing goals and to improve client outcomes. The delegation process involves decision-making, which involves developing critical judgment skills, understanding the art of delegation, and applying this delegation in a clinical nursing practice.
What should be done 1st and 2nd if the event of a med error, pt injury, or attempted suicide?
1st provide care, and 2nd notify MD.
Which statement about the delegatee condition is true regarding "selling"? 1 The delegatee has established relationships and expertise. 2 The delegatee has ongoing relationships; however, the task is new. 3 The delegatee has limited knowledge and ability to perform the task. 4 The delegatee has willingness and ability, but the relationship is new.
2 "Selling" in context with delegation represents an ongoing relationship with a new task being delegated. "Participating" in the context of delegation includes willingness and ability to perform a task with a new relationship. "Telling" in the context of delegation includes limited knowledge and ability to perform the task by the delegatee. "Delegating" in context with delegation represents established relationships and expertise.
A nurse is assisting another registered nurse in the intensive care unit who is caring for a client with uncontrolled blood pressure. Which action on the part of the nurse indicates "offering" during delegation decisions? 1 "Did you check the client's blood pressure this morning?" 2 "You can use this stethoscope and sphygmomanometer to take the blood pressure." 3 "Would you fetch me the client's laboratory reports? I'll record the blood pressure." 4 "How is the client doing this morning? Let me look at yesterday's blood pressure report."
2 "You can use this stethoscope and sphygmomanometer to take the blood pressure." Offering involves making a suggestion to facilitate the achievement of a desirable client care outcome. The statement, "You can use this stethoscope and sphygmomanometer to take the blood pressure," is an example of offering. Asking begins with questions related to the problem or issue regarding client care. "Did you check the client's blood pressure this morning?" is an example of asking. Doing involves demonstrating the specific task or behavior needed to improve client care. "Would you fetch me the client's laboratory reports? I'll record the blood pressure," is an example of doing. "How is the client doing this morning? Let me look at yesterday's blood pressure report," is an example of supervision.
The chief operating officer (COO) discusses the performance of a newly appointed leader with the nursing staff. The team communicates that the practical approach of the leader fulfills the quantum theory. What type of work environment does the COO understand that the leader creates at the workplace? 1 An environment that promotes hygienic factors 2 An environment that is rapidly changing and dynamic 3 An environment that provides intellectual stimulation 4 An environment that develops trust between followers and leaders
2 An environment that is rapidly changing and dynamic "Quantum theory" lays its foundation on an environment that is rapidly changing. It does not focus on a single event. Hygienic factors in the environment are an aspect of the two-factor theory. The nurse leader, through the transformational theory, provides intellectual stimulation. An environment that develops trust between followers and leaders are aspects of the situational-contingency theory.
The nurse leader noticed that the staff nurse recently promoted to the surgical unit is lacking confidence at work and is worried about a pending review by the nursing director. Which source of power is applicable in this situation? 1 Reward power 2 Coercive power 3 Referent power 4 Connection power
2 Coercive power Coercive power stems from a real or perceived fear of another person. Reward power is perceived as being able to provide rewards or favors. Association with a powerful person grants referent power. Association with people who are powerful or who have links to powerful people gains connection power.
A client reports severe pain 2 days after surgery. After assessing the characteristics of the pain, which initial action should the nurse take next? 1 Encourage rest. 2 Obtain vital signs. 3 Administer the prescribed analgesic. 4 Document the client's pain response.
2 Obtain vital signs. Immediately before administration of an analgesic, an assessment of vital signs is necessary to determine whether any contraindications to the medication exist (e.g., hypotension, respirations ≤12 breaths/min). Pain prevents both psychological and physiologic rest. Before administration of an analgesic, the nurse must check the healthcare provider's prescription, the time of the last administration, and the client's vital signs. A complete assessment, including vital signs, should be done before documenting the client's pain response.
A hospital management team has conducted a randomized controlled trial to decrease the occurrence of ventilator-associated pneumonia. The trial was successful and had positive outcomes. The nurse manager, in collaboration with other hospital management staff, conducted the same trial in another hospital, but the results were different. Which research strategy implementation would the nurse manager consider to be beneficial in preventing dramatic differences in trial results? 1 Evidence-based practice (EBP) 2 Practice-based evidence (PBE) 3 Client-centered outcomes research 4 Comparative effectiveness research (CER)
2 Practice-based evidence (PBE) PBE is a research methodology that helps inform practice. It uses an observational cohort study design that compares clinically relevant interventions, includes diverse study participants, uses heterogeneous practice settings, collects data on a broad range of health outcomes, and includes frontline clinicians in study development. EBP is the integration of the best research evidence with clinical expertise and the client's unique values and circumstances in making decisions about the care of individual clients. Client-centered outcomes researchers conduct research to provide information about the best available evidence to help clients and their providers make decisions that are more informed. CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods.
Which aspects are considered when determining the willingness of a nursing assistant before delegating a task? Select all that apply. 1 Ability 2 Attitude 3 Personality 4 Confidence 5 Commitment
2, 4, 5 An individual's willingness is related to attitude, confidence, and commitment. Ability is related to knowledge and skills in a specific situation. Personality characteristics can influence the effectiveness of the delegator.
Which constructive aspects of conflict does the nurse leader identify? Select all that apply. 1 Polarizes groups 2 Releases pent-up emotions 3 Promotes ineffective communication 4 Helps individuals grow personally 5 Builds cohesiveness among people
2, 4, 5 Conflict serves as a release for pent-up emotion, anxiety, and stress. It helps individuals to grow personally and apply what they learn to future situations. It helps to build cohesiveness among people sharing the conflict, celebrating in its settlement and learning more about each other. It polarizes groups so they increase internal cohesiveness and reduce intergroup cooperation; this is a destructive aspect of conflict. Authentic communication is an aspect of conflict but not improbable communication.
What is a high-level cognitive process that the nurse recognizes can be improved with practice in delegation? 1. Creativity 2. Critical thinking 3. Problem solving 4. Decision making
2. Critical thinking Critical thinking is a high-level cognitive process that can be improved by practice. Creativity is essential for the generation of options or solutions. Problem solving mainly focuses on resolving an issue. Decision making is a purposeful and goal-directed effort that uses a systematic process to choose among options.
The registered nurse considers the qualification of the unlicensed nursing personnel (UNP) before delegating a task. Which right of delegation is followed by the nurse? 1. Task 2. Person 3. Direction 4. Supervision
2. Person The knowledge and experience to perform the specific task safely by the delegatee is assessed by the qualification of the delegatee, which determines whether he or she is the right person. The right task involves assessing whether the task is legally appropriate to delegate or whether it is appropriate under institutional policies. The right direction involves the delegator providing clear and concise directions to perform the task. The right supervision is determined by whether the delegator is able to monitor and evaluate the client appropriately.
The nurse notifies the health care provider of a change in client condition. Which of the following reports given by the nurse includes the most appropriate and complete information? 1. "A 43-year-old client with pneumonia in room 343 has wheezing, crackles, and diminished breath sounds. Temperature is 101.2 F (38.4 C), respirations are 36/min, and pulse oximeter shows 90%. I think the client may need arterial blood gas testing." 2. "A 75-year-old client in room 474 is in respiratory distress. The respiratory therapist (RT) gave a breathing treatment, but the client is deteriorating rapidly. The RT did not hear left side breath sounds and recommends a chest x-ray." 3. "An 80-year-old client in room 234 with a history of heart failure was admitted today for pneumonia and is receiving oxygen and antibiotics. The client is dyspneic and restless, and oxygen saturation is now 89%. Would you like me to increase the oxygen flow rate?" 4. "The client with pneumonia in room 265 is reporting shortness of breath. The RT gave the client a breathing treatment 30 minutes ago, but the client is no better. Would you like to prescribe any laboratory tests or make any changes to the treatment?"
3 The SBAR (Situation-Background-Assessment-Recommendation) provides a framework for communicating information about a change in client status to the health care provider (HCP). It includes the following information: S = Situation - what prompted the communication B = Background - pertinent information, relevant history, vital signs A = Assessment - the nurse's assessment of the situation R = Recommendation - request for prescription or action from the HCP The report given by the nurse in Option 3 contains the most appropriate and complete information. The nurse includes pertinent data related to history, admission, and present treatment (background); indicates when and what changes occurred (situation, assessment); and requests a prescription from the HCP (recommendation). (Option 1) This report does not include any information indicating a time frame for admission or when the change in condition occurred. (Option 2) This report does not include any information related to the admission time frame, current diagnosis, or pertinent data assessed by the nurse giving the report. (Option 4) This report does not include any information related to the admission time frame or pertinent data assessed by the nurse giving the report. Educational objective: Nurses commonly use the SBAR framework to report changes in client status to the health care provider, communicating the current situation, client background, nurse's assessment, and a recommendation for prescription or action.
An 84-year-old client with oxygen-dependent chronic obstructive pulmonary disease is admitted with an exacerbation and steady weight loss. The client has been in the hospital 4 times over the last several months and is "tired of being poked and prodded." Which topic would be most important for the nurse to discuss with this client's health care team? 1. Need for discharge to a skilled nursing facility 2. Nutritional consult with instructions on a high-calorie diet 3. Option of palliative care 4. Physical therapy prescription to promote activity
3 This client with advanced chronic obstructive pulmonary disease is approaching the end of life. The client has expressed the desire to avoid further tests, treatments, and hospitalizations. The goals of care should be consistent with the client's wishes and emphasize comfort and quality of life. Palliative care is appropriate for clients who wish to focus on quality of life and symptom management rather than life-prolonging treatments (Option 3). Palliative care may eventually include hospice care, after it is determined that the client has a life expectancy of less than 6 months. The nurse should advocate for the client and collaborate with members of the health care team to explore care options based on the client's wishes. (Option 1) This client has not clearly demonstrated a need for skilled nursing; additional assessment is needed to determine the most appropriate discharge setting. (Option 2) A high-calorie diet is appropriate for a client with weight loss, but many clients may have difficulty maintaining weight due to factors such as advanced disease and poor appetite. It is not the highest priority in this client, who is nearing the end of life and has expressed an interest in avoiding further testing and hospitalization. (Option 4) Physical therapy may be appropriate to help this client maintain current abilities. However, a client with disease this advanced is not likely to tolerate more activity or gain much additional functional capacity. Therefore, physical therapy is not the highest priority at this point. Educational objective: The client with an advanced, terminal disease (eg, chronic obstructive pulmonary disease) is often an appropriate candidate for palliative care. Palliative care emphasizes quality of life and symptom control and may eventually include hospice care based on the client's life expectancy.
A nurse leader is teaching about the functional model of nursing to a student nurse. Which statements made by the student nurse indicate effective learning? Select all that apply. 1 "I will focus on one nurse caring for one client." 2 "I will accentuate the use of team collaborations." 3 "I will focus on tasks and activities allotted to me." 4 "I will provide comprehensive and coordinated nursing service." 5 "I will coordinate the unlicensed personnel to provide care to a large group of clients."
3 "I will focus on tasks and activities allotted to me." 5 "I will coordinate the unlicensed personnel to provide care to a large group of clients." In the functional model of nursing, one mainly focuses on performing tasks and activities that are allotted to him or her. Coordinating with unlicensed personnel to provide care to a large group of clients indicates the functional model of nursing. Focusing on one nurse caring for one client is seen in the case method of client care delivery. Concentrating on the use of team collaborations indicates the model analysis of primary nursing of client care delivery. Providing comprehensive and coordinated nursing services indicates the primary nursing model.
The unit nurse manager comes to work obviously intoxicated. Which action is the staff nurse ethically obligated to take? 1 Call the security guard. 2 Tell the nurse manager to go home. 3 Have the supervisor validate the observation. 4 Offer the nurse manager a large cup of coffee
3 Have the supervisor validate the observation. The staff nurse should call the hospital supervisor to confirm and handle the problem. The security guard has no authority in this situation. Although sending the nurse manager home removes the nurse manager from the clinical setting, this action misses an opportunity for documenting the situation and the nurse manager is in no condition to drive safely. Drinking coffee does not make a person less intoxicated.
Which intervention should the charge nurse perform to manage a task when the unlicensed nursing personal (UNP) is lacking competence? 1 Provide constructive feedback and assign another task. 2 Provide open vocal feedback and withdraw the UNP from task. 3 Provide additional support and temporarily lower expectations. 4 Provide accountability to the organization and undergo training again.
3 Provide additional support and temporarily lower expectations. The charge nurse should manage a task by temporarily lowering expectations and providing additional support to an unlicensed nursing personal (UNP) who is lacking competence. This strategy allows the UNP to build on strengths, minimize weaknesses, and gain confidence. Providing constructive feedback and assigning another task may not improve the strategy of the UNP and may affect the productivity of the new task. Withdrawing the UNP from the task and providing open vocal feedback may weaken the working relationship and the UNP may lose confidence or become frustrated. The charge nurse should be aware of accountability to the organization in case of a failure of the delegation, but assigning the UNP for further training may lead to high risk for legal liability.
The charge nurse is assigning client care to oncoming staff. The new nurse on the unit expresses an inability to care for the assigned client and is requesting to be reassigned. What should the delegator do in this situation? 1 Provide little guidance to the delegatee 2 Evaluate the ability and willingness of the delegate. 3 Understand the delegatee's motivation in the situation. 4 Understand the kind of support needed to accomplish the task.
3 Understand the delegatee's motivation in the situation. An inability to care for the assigned client shows inability and/or unwillingness in the new nurse. The delegator needs to understand the delegatee's motivation related to the situation and should use selling leadership style, which leads to a supportive relationship. Little guidance should be provided to the delegatee when he or she has high ability and willingness to perform the task delegated efficiently. When a new team begins to work together, the delegator should evaluate the ability and willingness of the delegatee. In the application of practice before delegation, the delegator needs to understand the kind of support to be given to accomplish the task.
Which factors does the registered nurse consider in the decision to delegate process? Select all that apply. 1 Evaluation 2 Nursing judgment 3 Predictability of outcomes 4 Pervasive functions of assessment 5 Complexity of the task to be performed
3, 5 Two factors responsible for the decision to delegate process are predictability of outcomes and complexity of the task to be performed. Evaluation, nursing judgment, and pervasive functions are not factors in the decision to delegate process.
A major disaster involving hundreds of victims has occurred, and an emergency nurse is sent to assist with field triage. Which client should the nurse prioritize for transport to the hospital? 1. Client at 8 weeks gestation with spotting and pulse of 90/min 2. Client with a compound femoral fracture and an oozing laceration 3. Client with fixed and dilated pupils and no spontaneous respirations 4. Client with paradoxical chest movement throughout respirations
4 Disaster triage is based on the principle of providing the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system to categorize them from highest medical priority (emergent) to lowest (expectant). The client with flail chest (ie, paradoxical chest movement during respiration) from multiple fractured ribs is at risk for respiratory failure from impaired ventilation. In addition, mobile fractured ribs may puncture the pleura or vessels, causing hemothorax and/or pneumothorax at any time. Therefore, this client would be classified as emergent due to airway compromise, which requires immediate treatment (Option 4). (Option 1) Spotting at 8 weeks gestation may indicate complications of pregnancy (eg, miscarriage, ectopic pregnancy, hydatidiform mole). With stable vital signs, this client would be classified as nonurgent as the fetus is not at the age of viability and there is no evidence of risk to the mother's life. (Option 2) The client with a compound fracture and oozing laceration would be classified as urgent and require care within 2 hours to prevent life-threatening complications (eg, hemorrhagic shock). (Option 3) Absent respirations and fixed pupils indicate severe neurologic damage or death. Therefore, this client would be classified as expectant. Educational objective: During mass casualty events, the goal is the greatest good for the greatest number of people. Clients are triaged rapidly using a color-coded system that categorizes them from highest medical priority to lowest: red (emergent), yellow (urgent), green (nonurgent), and black (expectant).
Interdisciplinary client care rounds and hand-off communication are examples of strategies used to improve communication in health care settings. What is the most important outcome of effective communication among care givers? 1. Decreased length of hospital stay 2. Less obvious needs of clients met accordingly 3. Properly educated clients 4. Reduced number of medical errors
4 Miscommunication between health care providers may cause serious medical errors when clients are handed off or transferred. Medical errors can be effectively reduced by employing strategies (eg, Situation, Background, Assessment, and Recommendation [SBAR] reporting technique, nurse-to-nurse change of shift reports, multi-professional bedside rounds) to improve communication and collaboration. Nurses should be as proficient in their communication skills as they are in their clinical skills. (Options 1, 2, and 3) Improved communication may aid in assessing a client's educational needs and meeting less obvious needs; it can also contribute to a shorter length of stay. However, these are not the most important outcomes. Educational objective: Effective communication among caregivers is necessary to deliver safe client care and reduce the number of medical errors.
A charge nurse suspects that the unlicensed assistive personnel (UAP) is falsifying the documentation of clients' capillary glucose results rather than performing the test. What is the best action by the charge nurse to handle this situation? 1. Ask a client if the UAP has performed the test 2. Discuss the importance of task completion and accurate documentation in a staff meeting 3. Give the UAP a verbal warning not to falsify data 4. Take a client's capillary glucose personally and compare it to the recorded result
4 The best initial result is to assess and validate the charge nurse's perception. Doing the test and comparing results randomly/intermittently will give data to prove/disprove this concern. (Option 1) It could cause concern to involve a client when there may be an issue about inadequate provider care. The nurse should handle it independently. (Option 2) It is good to reinforce policies in general announcements to the entire staff, especially if wide-spread compliance is a concern. However, there is only one person that is suspected of not adhering in this case. Speaking out is often a general step taken, but the intended individuals usually don't hear the information. In addition, this is information that the staff has known/heard before. (Option 3) The normal discipline process is a verbal warning, a written warning, suspension, and termination. To initiate the process, there has to be evidence of wrong doing. However, it is only a suspicion at this point. Educational objective: When deliberate inaccurate documentation is suspected, gather evidence before confronting the staff member. One way of doing this is by checking the data personally and comparing it to what has been documented.
Which performance appraisal method is used by nurse managers to measure the performance of the nurse both qualitatively and quantitatively? 1 Narrative method 2 Critical incidents method 3 Graphic rating scale form 4 Behaviorally anchored rating scales
4 The behaviorally anchored rating scale is a performance appraisal method that provides an overview of nursing standards by determining performance both qualitatively and quantitatively. The narrative method requires a manager to write a statement about the nurse's performance. The critical incidents type is a performance appraisal method in which a manager keeps a written record of positive and negative performance. The graphic rating scale form is a performance appraisal checklist on which a manager rates the nurse's performance on a continuum such as excellent, good, average, and poor.
The registered nurse is caring for a client admitted to the hospital with chronic obstructive pulmonary disease. Which assessment by the registered nurse before delegating would help to determine the principle of "right person"? 1 "Is the environment conducive for completing the task safely?" 2 "Does the licensed practical nurse (LPN) know about polices of the institution?" 3 "Can the nursing assistive personnel (NAP) evaluate the client's' condition appropriately?" 4 "Does the nursing assistive personnel (NAP) have the knowledge and expertise to perform the task?"
4 "Does the nursing assistive personnel (NAP) have the knowledge and expertise to perform the task?" In this situation, "Does the NAP have knowledge and expertise to perform the task?" is related to the right person for delegation. The right person deals with expertise and experience, knowledge and skills. The assessment, "Is the environment conducive for completing the task safely?" is related to right circumstance. The assessment, "Does the LPN know about polices of the institution?" is related to right task. The assessment, "Can the NAP evaluate the client's condition appropriately?"is related to right supervision.
The registered nurse is evaluating the statements made by a student nurse after teaching about the delegation communication template. Which statement made by the student nurse indicates a need for correction? 1 "The delegation communication template should identify the priorities." 2 "The delegation communication template should specify the deviations." 3 "The delegation communication template should identify the appropriate resources." 4 "The delegation communication template should include only the work that is to be delegated."
4 "The delegation communication template should include only the work that is to be delegated." The delegation communication template should emphasize the work that is not to be delegated. T he delegation communication template should identify the priorities such as what is to be done first. The delegation communication template should specify deviations such as when to take an immediate action. The delegation communication template should identify the appropriate resources including the individual consultants.
The nurse as a leader assists multidisciplinary leaders to achieve optimal functioning to benefit client care delivery. Which Gardner's task is the nurse applying? 1 Managing 2 Developing trust 3 Serving as a symbol 4 Achieving workable unity
4 Achieving workable unity When the nurse assists multidisciplinary leaders to achieve optimal functioning to benefit client care delivery, it indicates the Gardner's task of achieving workable unity. Relating to and inspiring staff, management, and community leaders to achieve desired levels of health and well-being indicates Gardner's task of managing. When the nurse is honest in role performance, it indicates Gardner's task of developing trust. When the nurse represents the values and beliefs of the organization to internal and external constituents, it indicates Gardner's task of serving as a symbol.
The nurse is assisting a client out of bed. Which is the priority nursing action? 1 Monitoring the client's blood pressure 2 Assessing the client's level of consciousness 3 Ensuring the call bell is within the client's reach 4 Assisting the client from a supine to an upright position
4 Assisting the client from a supine to an upright position The priority action to ensure the client's safety when assisting a client during a transfer is to assist the client from a supine to an upright position. Monitoring blood pressure and assessing the level of consciousness nursing actions that should be completed prior to assisting the client out of bed. Ensuring the call bell is within the client's reach is a nursing action that should be completed each time the nurse leaves the client's room.
Which client's care is least likely to be delegated to unlicensed nursing personnel (UNP)? 1 Client A - paraplegia, home care 2 Client B - femur fracture in cast, extended care 3 Client C - Alzheimer's, long-term care 4 Client D - accidental poisoning, emergency care
4 Client D - accidental poisoning, emergency care UNP can safely care for clients in stable condition because these cases will not require critical nursing assessment and decision-making. In an emergency setting, the client with accidental poisoning should be kept under constant monitoring and any small detail of fluctuation should be noted. Therefore, client D cannot be safely delegated to UNP. Clients undergoing home care, extended care, or long-term care do not require exhaustive monitoring and do not have life-threatening conditions, so they can be safely delegated to UNP.
A case manager telephones a client with lung disease to evaluate respiratory function with home oxygen use and then contacts the primary care provider. What is the purpose of this communication? 1 Collect data 2 Plan activities 3 Validate interventions 4 Evaluate expected outcomes
4 Evaluate expected outcomes It is essential that the case manager have frequent interaction with the client and the healthcare provider to achieve and evaluate expected outcomes. The nurse is not phoning the client and care provider to collect data, plan activities, or validate interventions.
The emergency department (ED) nurse is providing care to a burn trauma client. Which is the priority for the nurse to monitor for after removing the client's clothing? 1 Bradypnea 2 Bradycardia 3 Hypotension 4 Hypothermia
4 Hypothermia After the removal of the burn client's clothing, the priority for the nurse is to monitor for hypothermia because burn trauma clients lose their ability to maintain body temperature due to the loss of skin which acts as an insulator. While the nurse will monitor for bradypnea, bradycardia, and hypotension, hypothermia is the priority.
A healthcare team is caring for a client with diabetes insipidus. According to the functional model, which healthcare personnel would the nurse state is qualified to perform all hygienic tasks? 1 Registered nurse 2 Licensed practical nurse 3 Licensed vocational nurse 4 Unlicensed assistive personnel
4 Unlicensed assistive personnel Unlicensed assistive personnel perform all the hygiene tasks. Per the functional model, intravenous (IV) medication administration is provided by the registered nurse. The licensed practical nurse and a licensed vocational nurse may be permitted to give IV administration of medications, but they maybe limited to giving oral medications.
What is discussed in Hersey's 2006 model related to delegation? 1. Five rights of delegation 2. Legal authorities for delegation 3. Characteristics of communication 4. Core competencies of a situational leader
4. Core competencies of a situational leader Hersey's model describes situational leadership, which include the core competencies of a situational leader. Anthony and Vidal described the five rights of delegation. Hersey's model does not include the legal authorities for delegation. Anthony and Vidal described characteristics of communication, such as information decay and information salience.
After assigning a task, the delegator makes sure that the instructions are clear to provide feedback related to the task. Which delegation right is referred in this situation? 1. Task 2. Person 3. Direction 4. Supervision
4. Supervision Ensuring that the delegatee is clear to provide feedback related to the task refers to the right supervision. Knowing whether the task is appropriate to delegatee based on institutional policies and procedures refers to the right task. Knowing whether the delegatee has the knowledge and experience to perform the specific task safely refers to the right person. Knowing whether the delegatee understands the assignment and directions of the task refers to the delegation right direction.
While caring for a post-operative client, the delegator has assigned a task to a delegatee. Which statements made by the delegator indicates that the delegatee has the experience to perform the task? Select all that apply.
A delegatee with good experience may need little guidance. He or she knows what to do and when to report. As the delegatee has experience, he or she should just remember that the delegator is available at all times; the delegate can report at any time. The delegator should also make it known that the delegatee's competencies are known. The delegator tells a delegatee who is new to a task what is necessary to perform that task. The delegator will share expectations about the delegatee's performance when that delegatee can do the work and when he or she is new in assisting the registered nurse (RN). When the delegatee can do the work and is new in assisting the RN, the delegator tells the delegatee the appropriate conditions for notifying one another.
Under a leader, a team of followers has failed to achieve success in conducting research. What does an effective leader do in this situation?
Accepts failure and gains experience from it
The nurse executive is seeking to improve client care by helping multidisciplinary leaders achieve optimal functioning. Which behavior related to Gardner's tasks of leading is the executive exhibiting?
Achieving workable unity
A preschool-aged child is about to be admitted to the pediatric intensive care unit after surgery for removal of a brain tumor. The nurse manager should intervene immediately when the child's nurse does what?
Adjusts the bed to the Trendelenburg position
The nurse manager enlists 10 direct care nurses for a project addressing the needs of the human immunodeficiency virus (HIV). The project successfully completes within the timeline. What would be the most essential factor for the success of the nursing manager?
Allowing the direct care nurse to share ideas
The registered nurse of a disaster management team teaches the staff nurse about Ebola. Which statements made by the staff nurse requires further teaching? Select all that apply.
Antiviral drug therapy is not yet available for Ebola infection, so it cannot be treated. Ebola is transmitted by direct contact with body fluids of the affected client. The vaccine for Ebola is not yet approved by the FDA for use in the market. Isolation of a client with Ebola is required to prevent the spread of the virus. The Ebola infection is suspected if the client experiences unexplained bleeding.
The leader has planned to assist staff in order to achieve workplace unity. Which of Gardner's tasks would the leader apply in practice?
Assisting clients to accomplish optimal functioning
A nurse leader, along with the team, is caring for a client who is scheduled for colonoscopy. Which delegated task requires the leader's supervision?
Assisting the client with an enema
Which component of delegation is suitable to all the members on the healthcare team?
Authority
The mental health nurse is facilitating a therapy group. How can the nurse further develop trust among the members of the group?
By reminding group members about the need for confidentiality within the group
A registered nurse is teaching a group of newly hired licensed registered nurses, licensed practical nurses, and unlicensed nursing professionals. Which teaching strategies would be appropriate to develop competencies? Select all that apply.
Case studies Online learning Clinical nursing practice
What should be included in change of shift report?
Changes in condition, new medications, complications, diagnostic procedures, treatments (lasix for crackles, etc.)
What should be done if a pressure ulcer vacuum device has no suction?
Check to see if the tape is loose.
What conditions require seizure precautions?
Cirrhosis encephalopathy, PIH (HTN), DTs, ICP, CVA, Meningitis, Brain surgery, and Head trauma.
Which client is most appropriate to be delegated to unlicensed assistive personnel (UAP) based on the given data?
Client D
A nurse who lacks confidence in her performance in a new position is worried about an upcoming review with the nursing director. What type of power does the nursing director hold in this scenario?
Coercive power
Which process involves transferring responsibility to multiple players, usually with varying degrees of education and experience, while retaining the ultimate accountability for providing the client care?
Delegation
The National Council of State Boards of Nursing (NCSBN) committee has realized that the job descriptions of some healthcare professionals are inconsistent. Which healthcare member is the NCSBN referring to?
Delegation can be challenging because UNPs are educated in a formal program of study but the educational preparation and job descriptions of UNPs are not consistent. Therefore, the NCSBN has expressed concern and recommended that these educational programs have greater public authority. The registered nurses' job descriptions are not inconsistent. Chief nursing officers have well-defined job descriptions. Licensed vocational nurses also do not have inconsistent job descriptions.
Which characteristic of the nurse as a delegator is reflected in the statement, "Let me show you how this procedure is done; then you can do it yourself"?
Doing
Which condition may lead to delegation failure due to malpractice?
Employing more unlicensed nursing personal (UNP) in the emergency department
The nurse manager asks the staff nurse to participate in creating new guidelines for providing services to the client. Which management strategy is utilized by the nurse manager?
Empowerment of staff
Which statement best describes a fundamental aspect of the clinical nurse leader (CNL)?
Evaluates care for evidence-based approaches
Which behavioral manifestations in the nursing staff should alert the nurse manager of moral distress? Select all that apply.
Failing to act as a client advocate Withdrawing from client care situations
What procedures are done non-sterile in the home?
Foley catheter, trach suctioning, insulin, injections, intermittent, and suprapublic catheters.
Which statement effectively describes the steps to be taken by healthcare personnel when responding to healthcare facility fires?
For clients on life support, the nurse should maintain their respiratory status manually until they are removed from the fire area. The nurse should discontinue oxygen for all clients who can breathe without it. After everyone is out of danger, the nurse can seek to contain the fire by closing doors and windows and using an ABC extinguisher, if possible. Bedridden clients can be moved from the fire area in bed, by stretcher, or in a wheelchair. If required, however, one or two staff members can move these clients on blankets or carry them.
The nurse manager is implementing a change in evening care for clients to include back rubs to promote sleep. The nurse manager convinces the managers of various nursing units and also supports nursing staff who are willing to implement the change. Which component of Kotter's eight step model is involved in this scenario?
Forming a powerful coalition
The registered nurse finds information decay during the process of delegation. What possible causes may have contributed to this? Select all that apply.
Frequent changes in the heart rate of the client Rapid change in the blood pressure of the client Frequent changes in the client's perception of pain
In a long-term care facility, the care tasks for a client who is suffering with liver disease are being delegated. Which statement made by the delegator indicates the responsibility for the tasks is with the registered nurse? Select all that apply.
In a long-term care facility, the registered nurse will be responsible for supervising the licensed nursing professionals who will be the performing the delegated tasks. The registered nurse takes the responsibility of assessing alleviation of symptoms and monitoring the client on an hourly basis. Admission of the client to the ICU is the responsibility of the registered nurse. The licensed practical nurse (LPN) or the licensed vocational nurse (LVN) is responsible for taking the responsibility for the whole nursing unit. The LPN or LVN will be delegated the task of providing the treatments that are prescribed by the primary healthcare provider.
The registered nurse is caring for a client admitted with sudden paralysis in the legs and an inability to walk. Which interventions made by the registered nurse (RN) indicates correct active delegation? Select all that apply.
In active delegation, the RN assesses the situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individual accountable. Instructing the LPN to report the client's vital signs is an active delegation that includes directing the assistive personnel to perform the task. Instructing the unlicensed nursing personnel to administer oral vitamin D3 is beyond their scope of practice. The RN assessing the client's diagnostic and laboratory findings does not involve delegation. The RN administering an intravenous calcium gluconate injection does not involve delegation. Instructing the LPN to administer a vitamin B12 injection is within the scope of practice for the LPN.
Which skills would be essential for an effective nurse manager to develop and improve collaboration with others? Select all that apply.
In order to collaborate effectively, the nurse should be flexible, must be willing to listen to others, and must share information and ideas with others. The nurse manager should plan a thoughtful response, consider others' perspective first, and not react hastily. The nurse manager should not share his or her own anger or frustration with other staff.
What kills the immunocompromised patients?
Infection, live viruses (oral polio or varicella), Pneumocystis Carnii Pneumonia (PCP) (danger to immcprd pts only).
The registered nurse (RN) delegates the collection of respiratory rate data to a licensed practical nurse (LPN) for a client who is experiencing severe dehydration and whose condition is unstable. The LPN reports the data to the RN. The RN rechecks the data and finds that the report no longer reflects the patient's current condition. Which characteristic of communication has interfered with the delegation process?
Information decay
A direct care nurse performs exceedingly well on a cancer project. As a result, the managerial team decides to promote the nurse to a managerial position. Which actions by the nurse would justify the decision of the panel? Select all that apply.
Inspiring new ideas Establishing short-term goals Demonstrating positive feelings Maximizing results from existing resources
The registered nurse (RN) is caring for a client with epilepsy. Which tasks delegated by the registered nurse (RN) to the assistive personnel indicates active delegation? Select all that apply.
Instructing the licensed practical nurse (LPN) to monitor the vital signs Instructing the unlicensed assistive personnel (UAP) to reposition the client Instructing the unlicensed assistive personnel (UAP) to place the oxygen mask
What should be your response when a patient will be harmed d/t lack of intervention?
Intervene immediately and do procedure correctly. (Ex: Staff contaminating foley).
What does it mean if a patients pacemaker is set at 75 and the patients rate is 80?
It OK and working fine. The patients heart can do better than the pacemaker just no worse!
What is important to remember about prioritizing in the ER?
It won't be the obvious answer and don't be swayed by adjectives.
What does it mean if there is no pulse ox reading?
It's on too fat of a finger or no light is seen through the finger. Put it on another location.
A hospital wants to implement the primary nursing model on the premises. Which challenges are likely to be faced by the management? Select all that apply.
Lack of nurse availability Lack of experienced nurse
Which healthcare team members began to increase in number during World War II and are delegated for providing care to clients at home? Select all that apply.
Licensed practical nurse Licensed vocational nurse Unlicensed nursing personnel
A healthcare team is caring for a client who is hospitalized with severe diarrhea. According to the principle of right of supervision of delegation, what does the RN do in this situation?
Monitor the hemodynamic status.
The direct care nurse is delegated the task of reviewing the informed consent form after being completed by the client. Who should the direct care nurse consult regarding queries related to client rights?
Nurse manager
How should Peds patients be transferred to the Med Surg floor?
Oldest child 1st, No communicable diseases, Not immunocompromised, and No teaching needed.
The nurse as a leader provides feedback to a newly recruited nursing student after checking the student's progress report. Which action of the registered nurse is most closely aligned with the application of two-factor theory during the feedback session?
Promoting job enrichment by creating job satisfaction
The nurse manager appointed a registered nurse (RN) to provide hospice care for a client and explained the tasks to be performed. Which tasks has the nurse manager delegated to the RN? Select all that apply.
Providing total client care Teaching the client and family members Teaching the client about personal hygiene
Who is most accountable for an initial assessment and the ongoing evaluation of client care? 1 Client Correct2 Registered nurse 3 Licensed practical nurse 4 Unlicensed nursing personnel
Registered nurses are accountable for initial assessment and the ongoing evaluation of client care. The client is not responsible for assessment and evaluation. The licensed practical nurse has a responsibility to assess and report client care. Unlicensed nursing personnel perform tasks as delegated by the registered nurse.
What happens when a registered nurse does not trust other individuals in the healthcare organization? Select all that apply. Correct1 Altered client care 2 Appropriate delegation Correct3 Compromised healthcare Correct4 Limited career opportunity 5 Efficient time management
Registered nurses who do not trust other individuals in a healthcare organization may choose to perform the tasks themselves and this leads to altered client care. Consistently choosing to perform tasks themselves may lead to compromised healthcare and limit career opportunities. Registered nurses who do not trust other individuals in a healthcare organization are unable to delegate appropriately because they choose to perform the tasks themselves. Doing the work themselves increases the time to complete client care and affects time management.
MISC: FACTS ON PSYCH WARD
SUICIDE: highest in patient with drinkand /or take drugs. ALWAYS bring the patient back to reality --- avoid selecting answers that advise----giving meds or using restrains When choosing nursing intervention for patient problems------STAY AWAY FROM CRY BABIES.
A nurse is precepting an orientee (newly hired nurse). The nurse observes the orientee caring for an unconscious client with increasing intracranial pressure. The nurse should question which intervention that the orientee performs?
Suctioning the oropharynx routinely
Which qualities of a nurse leader can move the organization in a forward direction to continue delivering the best possible care? Select all that apply.
Supporting the followers effectively Nurturing the followers with right knowledge and direction
With which conditions are airborne precautions important?
TB, varicella, or measles.
WHAT IS THE MEMONIC TO REMEMBER THE PROPER TRIAGE PRIORITIES? (NEED TO KNOW WHO TO HELP!)
TRIAGE= Trauma-no internal injuries (breathing, bleeding, broken bones, burns), Respiratory (1st)/ Cardiac (2nd), ICP (Head trauma, LOC/seizure-airway or numerous head and facial abrasions and lacerations), AN Infection (septic shock). NOT MPORTANT: meaning not priority GI (bleed, pain, and distention-not impt), Elimination- (pyelonephritis or trouble voiding) these client should be triaged.
The nurse manager evaluates the performance of a group of nurse leaders on a project. One nurse leader performs exceedingly well by assuring that change happens and is promoted as the leader. Which quality attributes would have been shown by the nurse? Select all that apply.
Taking initiative Going beyond the role Thinking outside the box
The registered nurse is delegating a task to a newly hired unlicensed nursing personnel (UNP) and feels that the UNP requires explanation. Why does the RN feel the need to provide explanation?
The UNP is familiar with the ongoing process but the task is new.
When delegating a task, the delegator says, "Please tell me how you are going to perform this procedure, and I will share my expectations regarding how we need to communicate with each other." What can be inferred about the delegatee?
The delegatee has willingness and ability, but the relationship is new.
When does delegation become more challenging? Select all that apply. Incorrect1 When the client is stable Correct2 When the client is pregnant Incorrect3 When the geographic area is small 4 When the resources are abundant Correct5 When school children are receiving care
The delegation process becomes more challenging when vulnerable populations such as pregnant women and school children are receiving care. Delegation can be safely and successfully carried out in the stable client. Delegation can be accomplished successfully when the geographical area is small and resources are abundant.
What are the elements integrated into delegacy? Select all that apply.
The four elements that foster effective delegation decisions are safety, critical thinking, stability, and time. Leadership, critical thinking, communication, and clinical practice are the competency skills of a charge nurse.
Which actions of a nurse as a leader demonstrate a hands-off approach in practice? Select all that apply.
The nurse leader avoids making conscious decisions. The nurse leader chooses to do nothing when an intervention is indicated.
A client with chronic asthma is being cared for in the inpatient care unit. To assess the client on a regular basis would be delegated to which healthcare team member?
The registered nurse is a licensed nursing professional and is responsible for assessing the asthmatic symptoms of the client for providing care. The charge nurse is responsible for the coordination and assignment of tasks for the client's care. The patient care associate is an unlicensed assistive personnel whose scope of practice is limited from assessing the client. The licensed practical nurse does not assess the client's condition, but rather is responsible for providing treatment prescribed by the healthcare provider and delegated by the RN.
The nurse is learning about the types of injuries caused by explosive devices used as agents of terrorism. Which statement about the injuries caused by explosive devices does the nurse know to be true?
The shock wave generated by an explosion primarily causes blast injuries to the lungs, GI tract, and middle ear. Penetrating injuries are caused when shrapnel from the explosive device penetrates the skin; damage to the middle ear is not typical of penetrating injuries. Blast injuries result from the supersonic over pressurization shock wave caused by the explosion. Crush injuries, such as blunt trauma, often result from explosions in confined spaces causing structural collapse.
What does it mean if the glucometer isn't giving a reading?
There isn't enough blood to get a reading.
A nurse group leader in a mental health center uses a variety of techniques in an effort to promote group cohesion. The nurse identifies group cohesion when the group members do what?
Use the phrase "our group" during discussions
What should be your response if a staff members action is incorrect but will not harm the patient?
Wait until they are finished then teach the correct procedure to them.
A critically injured client was brought to the hospital following a car accident and the client should be immediately triaged for determining the nature and acuity of the injuries. Who is delegated to perform the task? 1 Nurse manager Correct2 Registered nurse 3 Licensed practical nurse Incorrect4 Primary healthcare provider
When the client arrives at the hospital after a trauma, it is the responsibility of the registered nurse to determine the nature and acuity of injuries. The nurse manager should usually be the delegator for the registered nurses and healthcare providers. Licensed practical nurses' scope of practice does not include caring for critically ill emergency clients. A primary healthcare provider should treat the client by providing required medications and diagnoses.
A nurse leader is given an additional duty of nurse navigator. Which extra responsibilities does the nurse leader need to provide as a nurse navigator? Select all that apply.
address barriers to care provide psychosocial support provide health education about the disease
Which initiatives for leaders and managers are set forth in the Institute of Medicine's core relevance report "The Future of Nursing?" Select all that apply.
create state coalitions focused on nursing provide a framework for considering how nurses could determine staffing requirements
The nurse is relating to and inspiring the client who has a psychiatric disorder to achieve the client outcomes. Which of Gardner's leadership tasks is reflected in the nurse's actions?
motivating
During a peer review, the manager finds that a newly appointed nurse leader encourages "bottom up" interaction among the workers. To which statement of the staff does the manager relate this?
"He/she involves us in shaping policies for client care."
While caring for a post-operative client, the delegator has assigned a task to a delegatee. Which statements made by the delegator indicates that the delegatee has the experience to perform the task? Select all that apply.
"I am available to you at any time for report." "I am aware of your technical competencies."
A registered nurse as a leader is teaching novice leadership skills to a newly appointed leader. Which statements made by the new leader indicate effective learning? Select all that apply.
"I should resolve conflict." "I should deal with difficult people." "I should learn how to work in groups
The registered nurse (RN) has delegated a task to an unlicensed nursing personnel (UNP). After performing the task, the UNP reports to the RN for appraisal. Which statement by the UNP is related to individual accountability? Select all that apply.
"I take full responsibility for the action performed." "I have ensured that the action has achieved the desired outcome."
After observing a client waiting for food, the nurse leader instructs the nurse to make arrangements for food. Which statement used by the nurse to the client appropriately makes his or her positive intent explicit?
"I want to make you comfortable, here's your food."
The nurse leader suffers from headaches, hypertension, and gastrointestinal problems. Which affirmative statement by the leader reflects an appropriate way to manage the stress?
"I will get enough sleep."
Which statement made by a nurse indicates being an effective community opinion leader?
"I will try to build a society that treats males and females equally."
The nurse leader is teaching the staff nurses about whistleblowing in the hospital organization. Which statement of the staff nurse indicates effective learning? Select all that apply.
"It is an act that protects federal workers." "I understand the consequences of action and inaction." "This is a warning issued by a current employee of an organization."
During the second group meeting of regressed long-term clients, one of the members asks the nurse, "What do you want us to do today?" What is best response by the nurse?
"It is the group's responsibility, which includes me, to make that decision together."
The nurse organizes a meeting of health care team members after finding no improvement in the condition of a client recovering from major surgery. Which statement made by the nurse during the discussion signifies transformational leadership?
"My active participation will also be required moving forward."
While caring for a client with severe fever, the registered nurse (RN) delegated the task to a new delegatee to assist the RN in recording the temperature. Which instruction given by the RN indicates that the delegatee is new to working with that RN?
"Tell me how you record the temperature."
The registered nurse is evaluating the statements made by a student nurse after teaching about the delegation communication template. Which statement made by the student nurse indicates a need for correction?
"The delegation communication template should include only the work that is to be delegated."
The registered nurse is evaluating the statements made by a student nurse after teaching ways to make appropriate delegation decisions. Which statement made by the student nurse indicates a need for correction?
"The delegator should recheck and redo the work of the delegatee."
During an interview for the position of manager in the healthcare industry, the candidate is asked about the important qualities of a successful manager. Which responses would be appropriate? Select all that apply.
"A successful manager should take risks." "A successful manager should tolerate uncertainty." "A successful manager should experiment with ideas for a unique situation."
Which task can be delegated to the licensed vocational nurse (LVN)? Select all that apply.
Administering oral hypoglycemic agents administering intramuscular injections
The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task? 1 Time Incorrect2 Safety 3 Stability Correct4 Critical thinking
Critical thinking is of utmost importance for selecting a suitable nursing assistant for delegation of a task in a situation where a client requires more attention, as the delegatee should be able to perform the task effectively. Time, safety, and stability are also the elements for effective delegation, but these are suitable depending on the situation for assigning a task and delegation.
Which drawback indicates an improper follow-through on the part of a delegatee?
Improper follow-through on the part of a delegatee is failure to report results and findings. Improper follow-through occurs when the delegator does not understand the skills and abilities of the delegatee and does not provide clear and concise directions to the delegatee. The lack of cooperation with team members may be improved by educating, guiding, and monitoring the delegatee.
When a bedridden client complains that he or she is thirsty, the nurse leader says, "I want to make you comfortable. Here is a glass of water, please take it." Which communication skill is the nurse leader using to make caring visible?
Making explicit her or his positive intent
What types of patients should never be transferred from the OB floor to the med surg floor?
Moms c babies, in labor, or c complications
What does it mean if an O2 mask with a rebreather bag deflates during inspiration?
The bag should NEVER deflate so get new equipment.
A staff nurse states "I am sorry, I am responsible for the situation" while communicating to the nurse leader. Which communication pattern is the staff nurse using?
placation
Which type of behavior by the registered nurse results in a low-to-stable level of commitment?
punitive
Which theory states that leaders act as change catalysts and innovators?
quantum theory
The RN caring for a postoperative hysterectomy client is delegating tasks to the licensed practical nurse (LPN). Which statement made by the RN indicates the principle of right communication of delegation? 1. "Does the LPN understand when to report the vital signs?" 2. "Can the LPN monitor blood pressure of the client effectively?" 3. "Can the LPN provide effective feedback regarding the client's condition?" 4. "Does the LPN have enough knowledge regarding administration of intravenous (IV) fluids to the client?"
1. "Does the LPN understand when to report the vital signs?" The principle of right communication of delegation includes the qualities of the delegatee understanding when and how to report to the delegator. Monitoring and evaluating the client's condition falls under right supervision of delegation. Assessing the delegatee's ability to provide feedback in right situation indicates right supervision of delegation. Right task of delegation includes assessment of delegatee's knowledge and experience about performing the task.
RULE: ASSIGN OB FLOAT NURSE (telemetery)
1. Closed abdominal surgeries 2. Hypertension 3. Diabetes Mellitus 4. Epidurals 5. IV drips
Which statement is correct regarding delegation? Select all that apply. 1. It involves transfer of authority. 2. The delegator retains accountability for the outcome. 3. The delegatee retains accountability for the outcome. 4. It is the transfer of both responsibility and accountability. 5. Principles of delegation outline what nurses need to know about the task.
1. It involves transfer of authority. 2. The delegator retains accountability for the outcome. 5. Principles of delegation outline what nurses need to know about the task. Delegation involves two people—delegator and delegatee—with the transfer of authority to perform the task. The delegator retains accountability for the outcome of the task delegated. The delegatee holds responsibility but not accountability for the task. Assignment involves the transfer of both responsibility and accountability of the work to the delegatee. Principles of delegation outline what nurses need to know and do in relation to completing the task.
What does appropriate delegation do to a healthcare organization? Select all that apply. 1. Reduces stress 2. Decreases trust 3. Reduces client care 4. Decrease time efficiency 5. Improves treatment outcomes
1. Reduces stress 5. Improves treatment outcomes Delegation requires empowerment of the delegatee to accomplish the task and, therefore, sharing functions reduces stress. As functions are distributed, it improves treatment outcomes. Appropriate delegation increases trust between the delegator and the delegates, increases client care, and increases time efficiency.
For which situations would total client care be an appropriate delivery system? Select all that apply. 1 Client scheduled for lithotripsy for renal calculi 2 Client with an endotracheal tube for pulmonary sepsis 3 Client recovering from cardiovascular bypass graft surgery 4 Client recovering from the placement of a cerebrospinal fluid shunt 5 Client transferring to a rehabilitation unit after total hip replacement surgery
2, 3, 4 Total client care is used in critical care settings where one nurse provides total care to one or two critically ill clients. The client with an endotracheal tube for pulmonary sepsis and the client recovering from cardiovascular bypass graft surgery are considered acutely ill and will be receiving care in a critical care area. The client recovering from cranial surgery to place a cerebrospinal fluid shunt would be appropriate for total client care. Total client care would not be an ideal care approach for the client scheduled for lithotripsy or the client being transferred to a rehabilitation unit.
The registered nurse is teaching a student nurse about delegating tasks to the unlicensed assistive personnel (UAP) while caring for a client with a skin disease. Which delegation statement made by the student nurse requires a need for further teaching? 1. "I will ask the UAP to assist the client with bathing." 2. "I will advise the UAP to reinforce the client teaching." 3. "I will instruct the UAP to apply wet dressings to the client's skin." 4. "I will instruct the UAP to report if the client complains of discomfort."
2. "I will advise the UAP to reinforce the client teaching." Reinforcement of client teaching is a task to be performed by licensed practical nurses and licensed vocational nurses. This task should not be delegated to the UAP. The tasks to be performed by the UAP include assisting the client with bathing. The UAP can apply wet dressings to the client's skin. The UAP should report changes in skin appearance or if the client complains of discomfort.
The nurse manager is delegating tasks to the healthcare team to care for a client who underwent brain surgery. Which individuals on the team share accountability during delegation? Select all that apply. 1. Attendant 2. Nurse manager 3. Certified technician 4. Healthcare provider 5. Unlicensed nursing personnel (UNP)
2. Nurse manager 4. Healthcare provider The nurse manager and healthcare provider share accountability during delegation. An attendant is responsible for the delegated task but may not share accountability with the nurse manager as the attendant has little knowledge. Similarly, a certified technician and unlicensed nursing personnel (UNP) are also responsible for the delegated task but they do not share accountability with the nurse manager.
What factors are most important for the nurse to consider when delegating responsibilities? 1 Preferences of the clients and staff 2 Physical layout of the unit and client rooms 3 Staff member's level of education and expertise 4 Client's diagnosis and length of time in the hospital
3 Delegation should provide for client safety based on staff capabilities as determined by level of education and experience. Although client and staff preferences may be considered, they are not the most important criteria for determining delegation of tasks. Although geographic factors may be considered when tasks are delegated, these are not the most significant criteria to consider. The client's acuity, not diagnosis or length of time in the hospital, is the most important client factor to consider when appropriate staff members are assigned to provide care.
A nurse delegator assigns work to a delegatee who has the ability and willingness to do the work but the relationship between the delegator and delegatee is relatively new. How is the delegator's behavior described according to Hersey's Model? 1 Selling 2 Telling 3 Delegating Correct4 Participating
According to Hersey's Model, if the delegatee has the ability and willingness, but the relationship between the delegator and delegatee is relatively new, they need to establish mutual expectations and conditions of performance. Hersey's model describes this behavior of the leader as participating. If a situation involves a new task and the relationship is ongoing, Hersey's model describes this behavior of the leader as selling. If the delegatee has limited knowledge and ability to perform a task, the delegator needs to provide more guidance. Hersey's model describes this behavior of the leader as telling. If the delegatee has the ability and willingness, the expertise to accomplish the work, and an established relationship, Hersey's model describes this behavior of the leader as delegating.
Which behavior does the delegator adopt when communicating with the delegatee if the relationship between them is new, the delegatee has limited knowledge, and the delegator does not expect the relationship to be ongoing? Correct1 Telling 2 Selling 3 Delegating 4 Participating
According to Hersey's Situational Leadership Model, if the relationship between a delegator and a delegatee with limited knowledge is new and is not going to be ongoing, the delegator's behavior is characterized as "telling." Delegator's behavior is characterized as "selling" if the delegatee and delegator have an ongoing relationship and a new task is being delegated. The delegator's behavior is characterized as "delegating" when the delegatee has expertise and an established relationship with the delegator. If the delegatee has willingness and ability, but the relationship with the delegator is new, then the delegator's behavior is characterized as "participating."
Which factors should be assessed to determine the level of followers' readiness according to Hersey's model? Select all that apply.
According to Hersey's model, the delegator should check the ability and willingness of the delegatee before delegating any task. Information about family history may not be required for delegating a task. According to Hersey's model, work experience and educational qualifications are not considered as factors required to determine followers' readiness.
Which care activities would be involved in a correct delegation process? Select all that apply.
Activities such as cleaning the client's body and assisting the client with oral feeding can be performed by the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). It is always the responsibility of the registered nurse (RN) to guide the UAP while performing any activity. The UAP is not allowed to perform activities such as providing medication. The LPN should not evaluate the client condition; it is the responsibility of the RN. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.
The registered nurse (RN) is caring for a pregnant client with malnutrition due to morning sickness. Which task can be safely performed by the licensed practical nurse (LPN) in this condition? 1 Assessing hemoglobin levels 2 Evaluating nutritional status Correct3 Administering oral antiemetics 4 Administering intravenous fluids
Administering oral antiemetics is a task that can be safely performed by the licensed practical nurse (LPN). Assessing the hemoglobin levels is the role of the RN; this task may not be delegated to the LPN. Evaluating the nutritional status is also the role of the RN. Intravenous fluids are only administered by a registered nurse (RN).
The registered nurse (RN) is caring for a client with renal calculi. Which healthcare professional is most suitable to be delegated the task of administering urinary alkalinizer by mouth to the client? 1 Certified technician 2 Patient care associate Correct3 Licensed practical nurse 4 Unlicensed assistive personnel
Administering oral medications such as urinary alkalinizer can be safely delegated to a licensed practical nurse (LPN) or licensed vocational nurse (LVN) as per guidelines. Certified technician is a licensed assistive personnel whose scope of practice is limited for administering medications. The scope of practice of the patient care associate and unlicensed assistive personnel is limited to performing basic care, feeding, and hygiene.
Who should take care of patients with airborne, droplet, or contact precautions?
An LPN
Who should ambulate a stable medical & surgical patient?
An RN
Who should evaluate an initial post op patient's pain?
An RN
What does the nurse say is the advantage of an appropriate delegation? 1 Assistance 2 Accountability Incorrect3 Empowerment Correct4 Reduced stress
Appropriate delegation reduces stress and increases time efficiency by providing timely care to the client. Assistance or direction is asked by the delegatee to complete the task if the nurse provides limited information on an assigned task. The nurse is accountable and responsible for the task assigned to the delegatee if the delegation does not work properly. Delegation requires empowerment of the delegatee to accomplish a task.
A licensed practical nurse (LPN) was hired recently. Which strategy should be applied by the registered nurse (RN) to open lines of communication between them? 1 Telling 2 Selling Correct3 Asking 4 Offering
Asking is the first strategy and begins with questions that open lines of communication between the newly hired LPN and RN. Telling is helpful when the delegatee and delegator have a new relationship. Selling is the supervision by the delegator when the delegator and delegatee have a long relationship and have been working together for a while. Offering is also a strategy that can be followed after using the asking strategy by making a suggestion.
The registered nurse is assigning tasks to a healthcare team to provide care for a group of clients in hospice care. How should the registered nurse help the healthcare team attain an effective outcome in the hospice care? Correct1 Assisting the healthcare team in planning 2 Assisting the healthcare team in interpreting 3 Assisting the healthcare team to enhance the ability Incorrect4 Assisting the healthcare team to achieve optimal functioning
Assisting the healthcare team in planning a task by the registered nurse can be beneficial in managing the effective outcome of the hospice care. Assisting in interpreting is beneficial in affirming of the outcome. Assisting to enhance ability will help in renewing the outcome. Assisting to achieve optimal functioning will be beneficial in achieving workable unity.
What is the most appropriate time for a nurse manager to schedule a 30-minute nursing education class?
At the overlap of each shift
Which component of delegation is defined as the ability to perform duties in a specific role? Correct1 Authority 2 Supervision 3 Responsibility 4 Accountability
Authority is the ability to perform duties in a specific role. Supervision is the provision of guidance and oversight of a delegated task. Responsibility refers to reliability, dependability, and obligation to accomplish work. Accountability involves determining whether the actions are appropriate and providing a detailed explanation of what has occurred.
What information do you need to know prior to starting your shift?
Blood sugars, pre-ops, post-ops, change of condition on last shift, and new admits.
Which healthcare team member is responsible for the coordination and assignments of client care?
Charge nurse
What types of conditions doesn't the interdisciplinary team not meet for?
Chronic stable conditions that are compliant and/or resolved by surgery or medical management (Ex: Pyloric stenosis, cleft lip, nephritis, glomerulonephritis, multiple fx after MVA, and acute leukemia on chemo).
What is a high-level cognitive process that the nurse recognizes can be improved with practice in delegation?
Critical thinking
The registered nurse (RN) is getting ready to leave the client care unit for a lunch break. The RN asks the LPN to take care of a client during the lunch break. Which concept is emphasized in this situation? 1 Leadership Correct2 Delegation 3 Supervision 4 Assignment
Delegation is the concept of a transfer of authority between two people to perform some type of task, e.g., between an RN and licensed staff. Leadership is the action of leading a group or an organization. Supervision is defined as the active process of directing, guiding, and influencing the outcome of an individual's performance. Assignment is the transfer of both accountability and responsibility.
Which characteristic of a manager should the nurse leader exclude while addressing the complex issues of the hospital?
Developing a vision
What is the status of the unit secretary as a member of the healthcare team, which is in the span of control of a registered nurse (RN)?
Devoid of legal authority
The nurse as a leader provides feedback to a recently recruited student nurse after checking performance reports that show a disregard for the Organizational Behavior Modification (OB Mod) theory. Which activity of a student nurse would the nurse leader mention during the feedback session?
Discussing the past mistakes of a subordinate
Which characteristic of the nurse as a delegator is reflected in the statement, "Let me show you how this procedure is done; then you can do it yourself"? Correct1 Doing 2 Asking Incorrect3 Offering 4 Delegating
Doing occurs by demonstrating the specific task or behavior to improve client care. The statement, "Let me show you how this procedure is done; then you can do it yourself," indicates doing. Asking begins with questions related to the problem or issue regarding client care and can open lines of communication between the delegator and the delegatee. Offering involves making a suggestion to facilitate the achievement of a desirable outcome. Delegating refers to transferring responsibility for the performance of a task nurse or delegator to the delegatee while retaining the accountability for the outcome.
After assigning a task, the delegator makes sure that the instructions are clear to provide feedback related to the task. Which delegation right is referred in this situation? 1 Task 2 Person 3 Direction Correct4 Supervision
Ensuring that the delegatee is clear to provide feedback related to the task refers to the right supervision. Knowing whether the task is appropriate to delegatee based on institutional policies and procedures refers to the right task. Knowing whether the delegatee has the knowledge and experience to perform the specific task safely refers to the right person. Knowing whether the delegatee understands the assignment and directions of the task refers to the delegation right direction.
Which characteristics of the delegatee should be considered to determine that he or she is the "right person"? Select all that apply.
Experience Willingness Competence
What should be done if the pyxis doesn't deliver a stat medication?
Filled Q24 hours so call the pharmacy for the med.
The nurse is explaining behavior to a nursing assistant. Which characteristic of a behavior usually results in that behavior being viewed and accepted as normal?
Fitting within standards accepted by one's society
What skills are essential for an effective nurse leader to develop collaboration with others? Select all that apply.
Flexibility ability to share ideas ability to listen to others possession of a string self-concept
The nurse administrator for a long-term care facility is implementing a disaster response plan for staff and residents. Which staff member statements indicate correct understanding of the plan? Select all that apply.
Hospitals are not the only health care agencies that are required to practice disaster drills. Long-term care (LTC) facilities are also mandated to have annual drills to prepare for mass casualty events. Part of the response plan must include a method for evacuation of residents from the facility in a timely and safe manner. Nursing homes are also required to have a disaster response plan. Long-term care facilities are not held to the same standards as hospital facilities. Insurance payment for medical care is not contingent on the implementation of a disaster response plan.
A patient care associate (PCA) is delegated a task that can be completed in 2 hours. The PCA has limited knowledge and willingness regarding that particular task. Which leadership style should be implemented by the delegator in this situation? 1 Selling Correct2 Telling Incorrect3 Monitoring 4 Participating
If the ability and willingness of the delegatee is low and the work assigned to the delegatee can be completed in 2 hours, it means the nature of relationship between delegator and delegatee is limited. In such situation, the leadership style of the delegator should be telling, because it provides a fair amount of guidance and also limits the time spent on the interactions. The selling style of leadership should be used when the relationship is ongoing; that is, individuals who usually work together continue to work together. The monitoring style should be used when the delegatee has the ability and willingness, and has an established relationship with the delegator. The participating style can be implemented when the delegatee is willing to perform the task.
A registered nurse (RN) delegates the task of foot care for a client to an unlicensed nursing personnel (UNP). The UNP is skillful and willing to perform the given task, but was recently hired and is unfamiliar with the client's condition. What should the RN do in this situation? 1 Provide guidance to the UNP. 2 Observe and motivate the UNP. Correct3 Establish mutual expectations and conditions. Incorrect4 Explain what to do and how to perform the task.
If the delegatee is new to the workplace, but has the ability and willingness to perform a task, the RN should establish mutual expectations and conditions of performance to establish a good relationship. If the delegatee has limited knowledge and ability to perform a task, the delegator is expected to guide the UNP. The RN is expected to observe and monitor the task performed by the delegate to ensure the delegatee has the ability and willingness to establish a relationship and accomplish the work. The RN can also explain the task and how to execute it if the situation involves a new task and relationship is ongoing.
In a long-term care facility, the care tasks for a client who is suffering with liver disease are being delegated. Which statement made by the delegator indicates the responsibility for the tasks is with the registered nurse? Select all that apply. 1 "You will be responsible for the whole nursing unit." 2 "You will provide the treatment that is prescribed." Correct3 "You will assess alleviation of the client's symptoms." Correct4 "You will be monitoring the client care on an hourly basis." Correct5 "You will admit the client to the intensive care unit (ICU) if her condition deteriorates."
In a long-term care facility, the registered nurse will be responsible for supervising the licensed nursing professionals who will be the performing the delegated tasks. The registered nurse takes the responsibility of assessing alleviation of symptoms and monitoring the client on an hourly basis. Admission of the client to the ICU is the responsibility of the registered nurse. The licensed practical nurse (LPN) or the licensed vocational nurse (LVN) is responsible for taking the responsibility for the whole nursing unit. The LPN or LVN will be delegated the task of providing the treatments that are prescribed by the primary healthcare provider.
The registered nurse (RN) is caring for a client who has severe abdominal pain. The RN plans to work with the assistance of an unlicensed nursing personnel (UNP). The RN starts the client care. What should the RN consider during the process of active delegation? Select all that apply. Correct1 Assessing the level of the client's abdominal pain Correct2 Directing the UNP to assist the client while toileting 3 Advising the client to take pain medication when needed Correct4 Ensuring that the UNP is accountable for successful completion of the task 5 Explaining to the client about the reason and cause of abdominal pain
In active delegation the RN assesses the client's situation to ensure the client is stable enough to be handed over to the UNP. The RN can then delegate specific basic tasks to the UNP such as oral care and toileting. The RN then holds the UNP accountable for successful completion of the task. It is within the scope of practice of the RN to advise the client to take pain medication in accordance with the primary health care provider's prescription. Likewise, the RN can explain the reason and cause of the condition diagnosed by the primary health care provider. These tasks are considered passive delegation.
A client with postural hypotension requires nursing care. Which task can be safely delegated by the registered nurse to unlicensed nursing personnel (UNP)? Select all that apply. Incorrect1 Mobilizing the client 2 Assessing the pulse rate 3 Assessing the blood pressure Correct4 Managing foot care of the client Correct5 Maintaining oral hygiene of the client
In postural hypotension, any sudden change in posture will lower the blood pressure. Therefore, the client should be carefully evaluated before delegation. Managing foot care and maintaining oral hygiene can be done by the UNP because there is no foreseeable risk associated with the condition. Mobilizing the client and assessing vital signs such as pulse rate and blood pressure should be carefully monitored and performed by the registered nurse.
Which actions make the nurse a transformational leader?
Introducing a vision for the future nurses A transformational leader creates and shares a vision or goal for future nurses. Gaining higher education does not indicate leadership. Effective implementation of client-centered care indicates professionalism but not leadership. A transformational leader corrects the errors of followers by coaching and mentoring, not by using a reactive manner.
Which statement is correct regarding delegation? Select all that apply.
It involves transfer of authority. The delegator retains accountability for the outcome. Principles of delegation outline what nurses need to know about the task.
The nursing manager is preparing a schedule for delegating appropriate tasks to different health care team members. Which health care team member can be delegated the task of administering oral medications? Select all that apply.
Licensed practical nurse Licensed vocational nurse
While caring for a client with urinary tract infection, the nurse manager delegated the work of administering oral medications. Which delegatee would be appropriate for this task? Select all that apply.
Licensed practical nurse (LPN) Licensed vocational nurse (LVN)
Which task can be delegated to the licensed vocational nurse (LVN)? Select all that apply. 1 Analyzing vital signs 2 Maintaining oral hygiene 3 Administering intravenous drugs Correct4 Administering oral hypoglycemic agents Correct5 Administering intramuscular medications
Licensed vocational nurses and licensed practical nurses are authorized to administer drugs through oral and intramuscular routes. Analyzing vital signs should be performed by the registered nurse. Hygiene maintenance can be delegated to unlicensed nursing practitioners (UNP). Administering intravenous drugs should be done by the registered nurse.
Which action by the nurse leader is indicative of transactional leadership?
Motivating the self-interest of the employees by offering external rewards
What should be done if someone is brought in with fixed and dilated pupils, not breathing and no heart rate present?
Nothing they are dead so go to the next person.
A client is admitted to the hospital with severe backache and chest discomfort. After reviewing the client's condition, there is a need for 24-hour client care by the registered nurse (RN). Which healthcare professional is responsible for assigning the task to a registered nurse when 24-hour client care is needed?
Nurse manager
Which statement is true regarding delegation? Select all that apply. 1 The delegatees are accountable for effective client care. Correct2 Open lines of communication must occur between delegator and delegatee. Correct3 Delegation occurs only when at least two people are involved in a mutual work situation. Incorrect4 The delegation potentials are significantly lower when caregivers such as UNPs are partnered. Correct5 Delegation involves sharing activities with other appropriate authority to accomplish the work.
Open lines of communication between delegator and delegatee helps to eliminate any misunderstanding regarding delegated tasks. Delegation occurs only when at least two people are involved in a mutual work situation; one who has the authority to perform specific tasks and other who holds accountability for the task being performed. Delegation involves sharing activities with other appropriate authority to accomplish the work. When delegating a task to delegatee, the delegator retains accountability for effective client care by ensuring that the task is completed by the right person and that the person is supervised appropriately. The delegation potentials are significantly higher when caregivers such as UNPs are partnered.
While reviewing the work of a team, the nurse observes a conflict among the members. How should the nurse build in consultation before and feedback after the negotiations in a conflict resolution?
Providing a forum for open discussion
What is the memonic to help you prioritize steps in the event of a fire?
RACE= Remove, Activate, Contain, and Extinguish. Remove the client, Activate the fire alarm, confine the fire and extinguish the fire).
What patients are NOT a priority?
RUQ (gallbladder) pain, Pain in the(CVA) costovertebral angle= (kidney stones), head trauma, bleeding, pain butt to ankle (sciatica), straining to urinate with bloody urine, menieres disease (these people always dizzy), chronic conditions, COPD, cystic fibrosis, laprascopy c chest or shoulder pain, Paperwork (document wait end of shift), calling doctor, teaching, bleeding, high or low BS, Poop, FXs, obtaining lab studies, and Pain.
The student nurse is performing a rapid baseline assessment using a disability mnemonic (AVPU) in a client with drug abuse. Which parameters should the student nurse consider for proper assessment? Select all that apply.
Reaction to pain Response to voice
Which two factors would the nurse state influence the effectiveness of the leader? Select all that apply.
Readiness and assessment are two of the factors that influence the effectiveness of the leader. Ability and willingness are the two factors that need to be assessed to determine the level of the leader's readiness. The attitude is related to the individual's willingness.
What needs to be done prior to transferring patient to another unit?
Receiving unit must be familiar with the disease/treatment, be alert for gender specific wards (OB), don't transfer (unstable pts, unknown diagnosis pts, or pt whose condition is made worse with stress (addisons, lupus, RA, raynauds, asthma, etc.).
who is accountable for the ongoing evaluation of a client's care?
Registered nurses are accountable for the initial assessment and the ongoing evaluation of a client's care. CNOs are accountable for establishing systems to communicate competency requirements related to delegation. The LPN directly provides care to the client. UNPs provide client care under the supervision of a registered nurse. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there is no pattern to the answers.
While working with a delegatee, the registered nurse says to the delegate, "It's easy; you can do the procedure tomorrow after watching me do it today. Just follow the steps I have demonstrated." What is the behavior of the registered nurse in this situation?
Selling
The registered nurse (RN) is evaluating the student nurse in the aspect of leadership qualities. Which behaviors of the student nurse express emotional intelligence in leadership? Select all that apply.
Supporting the team Motivating the other nurse Using skills to expand social network
A patient care associate (PCA) is delegated a task that can be completed in 2 hours. The PCA has limited knowledge and willingness regarding that particular task. Which leadership style should be implemented by the delegator in this situation?
Telling
While delegating a specific task, the registered nurse says to the delegatee, "It is important that you measure the client's blood pressure every 15 minutes." What does this situation indicate?
Telling the delegatee that it is important to take the client's blood pressure every 15 minutes indicates that the delegatee has limited knowledge and the delegator is providing guidance. Telling a delegatee that he or she knows what to do and when to report indicates that the delegatee requires little guidance. Telling the delegatee that this is what is needed to accomplish a task indicates that the delegator is providing guidance to the delegatee. If the delegator and delegatee share mutual experiences, it indicates that the delegator and delegatee are creating mutual expectations.
While working with a delegatee, the registered nurse says to the delegate, "It's easy; you can do the procedure tomorrow after watching me do it today. Just follow the steps I have demonstrated." What is the behavior of the registered nurse in this situation? 1 Telling Correct2 Selling 3 Delegating 4 Participating
Telling the delegatee that the procedure is easy and he or she can do it by following the demonstrated steps utilizes persuasion. According to Hersey's model, persuading statements of a delegator indicates selling behavior. According to Hersey's model, directing statements indicate telling behavior. According to Hersey's model, monitoring statements indicate delegating behavior. According to Hersey's model, problem-solving statements indicate participating behavior.
The registered nurse, while teaching a group of nursing students about the characteristics of a good team player, states, "A good team player should work with determination and refuse to stop until the goal has been accomplished." Which characteristic is the registered nurse describing?
Tenacity
The registered nurse is organizing a community health care program for administering tetanus vaccinations. Which member of the health care team is most suitable for being delegated the task of administering vaccinations? 1 Nursing aide 2 Certified technician 3 Patient care associate Correct4 Licensed practical nurse
Tetanus vaccination is administered through the intramuscular route. The licensed practical nurse can administer oral, topical, and intramuscular medications, except for intravenous. The nursing aide, certified technician, and patient care associate are unlicensed assistive personnel whose scope of practice is limited for administering medications.
The registered nurse (RN) is teaching a newly hired nurse about delegating tasks to the healthcare team. When asked what the rights of delegation are, which right listed by the hired nurse indicates the need for further teaching? Select all that apply. 1 Right task Incorrect2 Right direction 3 Right person Correct4 Right drug name 5 Right circumstance
The 5 rights of delegation are right task, right circumstance, right person, right directions and communication, right supervision and evaluation.
A client underwent angioplasty and is hospitalized for several days for observation. Which task can be delegated by the registered nurse (RN) to a licensed practical nurse (LPN)? Incorrect1 Assisting 2 Assessing 3 Evaluating Correct4 Monitoring
The LPN is eligible to monitor the client who underwent angioplasty. Any change in the condition of the client should be reported to the RN in an emergency. Assistance can be given by unlicensed nursing professional (UPN). Assessment of the client's reports is done by the RN. The LPN and UNP are not eligible for assessing reports. Evaluation of the client's reports can be done only by the physician.
The charge nurse is teaching the newly-hired registered nurse (RN) about delegating tasks to unlicensed nursing personnel (UNPs). Which statement made by the newly hired RN indicates the need for further teaching? 1 "I should assist the staff in interpreting." Incorrect2 "I should assist the staff in decision-making." 3 "I should assist the staff in achieving optimal functioning." Correct4 "I should assist the staff in sorting out and articulating values."
The RN does not assist the staff in sorting out and articulating the values, the healthcare provider or the physicians do. The RN should assist the staff in interpreting to achieve better outcomes. As a delegator, it is the duty of the RN to help the staff in decision-making. The RN should assist the staff in achieving optimal functioning because the allotted task can have a better outcome only under the supervision of the RN.
A healthcare team is caring for a client with dental pain. Which task is most suitable to be delegated to unlicensed assistive personnel (UAP) to provide effective client care? 1 Administering analgesics 2 Administering intravenous antibiotics 3 Administering nerve block anesthesia Correct4 Administering mouth wash for oral hygiene
The UAP scope of practice includes administering mouth wash to the client. Instructing the UAP to administer medications such as antibiotics and anesthetics is inappropriate because the UAP is not eligible to do so and may not have the knowledge to administer medications. Administering nerve block anesthesia should be performed by the anesthesiologist.
Which quality of the nursing assistant should be known by the delegator when assigning a task? Correct1 Ability 2 Willingness 3 Interaction 4 Relationship
The ability of the nursing assistant to perform a task should be known by the delegator before assigning a task. The willingness of the delegatee to work on a task can be understood by the delegator while communicating with the delegatee. Interaction is the quality of a delegatee, which can determine the effectiveness of the delegatee to perform a task. Relationship between the delegator and delegatee is not an aspect that should be known by the delegator before assigning a task.
Which statements are true regarding the primary nursing care developed by Marie Manthey as a method for organizing client care? Select all that apply. Correct1 The associate nurse provides input into the client's plan of care. 2 The charge nurse will be accountable for the care from admission to discharge. Correct3 If the client develops complications, the associate nurse should notify the primary nurse. Incorrect4 According to the associate nurse's care specifications, the primary nurse should provide care. Correct5 The registered nurse functions autonomously as the primary nurse throughout the client's hospital stay.
The associate nurse cares for the client according to the care specifications provided by the primary nurse in the care plan. The associate nurse provides input to the client's plan care if the associate nurse notices any complications and also notifies the primary nurse for alterations in the care plan. The registered nurse functions autonomously as the client's primary nurse by taking the responsibility and accountability of the client care from admission through discharge. It is the primary nurse, rather than the charge nurse, who will be accountable for the care of the client from the admission through discharge. According to the primary nurse's care specifications, the associate nurse should provide care.
Which performance appraisal method is used by nurse managers to measure the performance of the nurse both qualitatively and quantitatively?
The behaviorally anchored rating scale is a performance appraisal method that provides an overview of nursing standards by determining performance both qualitatively and quantitatively. The narrative method requires a manager to write a statement about the nurse`s performance. The critical incidents type is a performance appraisal method in which a manager keeps a written record of positive and negative performance. The graphic rating scale form is a performance appraisal checklist on which a manager rates the nurse's performance on a continuum such as excellent, good, average, and poor.
The registered nurse is caring for an elderly client who is admitted with severe asthma. Which task delegated by the nurse is most suitable to be performed by the client attendant? Incorrect1 Assessing the vital signs 2 Monitoring respiratory rate 3 Administering inhalational medications Correct4 Assisting the client during nebulization
The client attendant is the unlicensed assistive personnel whose scope of practice is limited to providing basic care and comfort to the client. Assisting the client during nebulization is considered basic care and comfort and can be safely carried out by the client attendant. Assessing vital signs should be performed by the registered nurse. Monitoring respiratory rate can be delegated to the client attendant if the client condition is stable; however, since this client's condition is not stable, this task should not be delegated. Administering inhalational medications is not performed by unlicensed personnel such as a client attendant.
Which priority interventions should be followed by the nurse when caring for a client with malignant hyperthermia? Select all that apply.
The client should be ventilated with 100% oxygen using the highest possible flow rate when malignant hyperthermia is evident. The client should be intubated immediately with an endotracheal tube. All inhalation anesthetic agents should be stopped immediately as the client's condition may worsen. The core body temperature should be monitored on an ongoing basis (wrong). An indwelling urinary catheter is inserted to monitor urine output, which is part of ongoing monitoring (wrong).
What order should the nurse follow during the delegation decision-making process when delegating client care? 1.Assessing the health needs exhibited by the client 2.Assessing the abilities demonstrated by unlicensed personnel 3.Seeking client care issues 4.Ensuring the stability of the client 5. Monitoring the task 6.Providing feedback to unlicensed personnel
The delegation process starts with assessing the health needs of the client and the skills of unlicensed personnel (UNP). The key component of delegation decision-making is assessing the UNP's ability to perform the work, including, safety, critical thinking, stability, and time. It is also vital to make client care decisions at the same time. The nurse has to make sure that the client is stable and steady to ensure the best care. The greater the stability of a client, the more likely the UNP can provide safe client care. The nurse should then monitor the task being performed by the UNP. The nurse should also maintain an open line of communication with the UNP to seek client care updates and limitations. The nurse should always provide direct feedback to the UNP for professional growth and development to improve client care outcomes.
The registered nurse delegates a task to the unlicensed assistive personnel (UAP). After the UAP starts the task, the registered nurse (RN) asks for feedback related to the task. Which right of delegation is the RN following? 1 Task Correct2 Supervision 3 Circumstance Incorrect4 Communication
The delegation right of supervision refers to obtaining feedback, monitoring, and evaluating the delegatee appropriately. Right task refers to the delegation of an appropriate task based on institutional policies and procedures. Right circumstance refers to evaluation of the working environment and ensuring adequate supervision of delegatees. To ensure right communication, the RN should communicate properly and accurately to the delegatee and provide clear and concise directions for the task.
A registered nurse delegates the task of administering oral antibiotics for a client with diabetes. Which statements are true in this scenario? Select all that apply. Correct1 The registered nurse (RN) is accountable for the delegatee's work. Correct2 The licensed practical nurse (LPN) should report to the RN once the task is completed. 3 The unlicensed nursing practitioner (UNP) can also be delegated the task of administering oral antibiotics. Correct4 The licensed practical nurse (LPN) can be held responsible for any failure in administration of oral medication. 5 The licensed practical nurse (LPN) can change the medication dosage according to the client's physiological needs in the absence of the RN.
The delegator (RN in this case) is accountable for the tasks of the delegatee. The LPN should report the completion of tasks to the RN. The LPN is responsible for tasks delegated by the RN. UNPs are not authorized to administer oral antibiotics to clients, since their role is limited only to hygiene maintenance and assessing vital signs under the supervision of the RN. The duty of the LPN is only to administer the prescribed drug dosage.
The registered nurse (RN) is delegating tasks to several health care team members caring for a client with a bacterial infection and high fever. Which statements by the registered nurse would be most appropriate for the licensed practical nurse (LPN)? Select all that apply. Correct1 "You should administer an antipyretic after the meal." 2 "You should assess the client's condition." 3 "You should change the bed sheets and dress the client every day." Correct4 "You should administer prescribed antibiotics to the client twice a day." Correct5 "You should collect data that can be used in the assessment of client's condition."
The delegator can delegate tasks such as administration of antipyretic for the client who has fever. This particular task should be delegated only to the licensed nursing personnel, such as LPN. The delegator can delegate the task such as administration of antiallergic medication to the licensed professional, such as LPN. The RN is responsible for all the assessments performed, but the UAP or LPN can collect the data that can be used for the assessment. The RN is responsible for assessing the client's condition. The RN should delegate basic tasks such as changing the bed sheets and dressing the client to unlicensed nursing personnel.
Which questions should the delegator assess to determine the right task? Select all that apply. Correct1 "Is the task legally appropriate to delegate?" 2 "Is the environment conducive to completing the task safely?" 3 "Does the delegator provide clear and concise directions for the task?" Correct4 "Is the task appropriate to delegate based on institutional policies and procedures?" 5 "Does the delegatee have the knowledge and experience to perform the specific task safely?"
The delegator has to determine right task by assessing whether the task is legally appropriate to delegate. The delegator must also check that the task is appropriate to delegate based on institutional policies and procedures. The right circumstance can be assessed by asking, "Is the environment conducive to completing the task safely?" The right direction and communication is assessed by asking, "Does the delegator provide clear and concise directions for the task?" The right person eligible to accomplish the task is assessed by asking, "Does the delegatee have the knowledge and experience to perform the specific task safely?"
Which condition may increase the potential for nursing malpractice? 1 When the client care is satisfactorily provided 2 When the delegatee is unable to perform the specified task 3 When the nursing assistant adapts to the changing situation Correct4 When the delegation task is not within acceptable standards
The delegator is personally responsible for prudent action. A potential for nursing malpractice emerges when the delegation task is not performed within acceptable standards. Satisfactory client care results from successful delegation. The expected outcome of a specified task may be affected when the delegatee is unable to perform the specified task. The nursing assistant usually adapts to the changing situation; if not, a gap in the delivery of client care will be generated.
A healthcare team is caring for clients after a fire. The charge nurse delegates different tasks to the healthcare team according to the functional model of nursing. Which team member is eligible and accessible to provide oral medications to any clients? 1 Nursing manager 2 Chief nursing officer Correct3 Licensed practical nurse 4 Unlicensed nursing professional
The licensed practical nurse is eligible and accessible to provide oral medications to clients. The nursing manager is responsible for more than one unit and has other managerial responsibilities and may not be available for providing oral medications to the clients. The chief nursing officer is busy assessing, monitoring, and verifying requirements. The unlicensed nursing professional is not eligible to provide oral medications; they can only monitor and assist the clients.
The registered nurse (RN) assigns a task to a licensed practical nurse (LPN) to take care of a client admitted with severe burns. Which tasks are being performed by the LPN in this situation? Select all that apply. Incorrect1 Performing hygiene tasks Correct2 Monitoring the heart rate 3 Evaluating the medical reports Correct4 Monitoring the blood pressure Correct5 Administering the oral medication
The licensed practical nurse monitors the heart rate, monitors blood pressure, and administers oral medications. Hygienic tasks are performed by the unlicensed assistive personnel. Evaluating medical reports is performed by the RN, not by the LPN.
The registered nurse (RN) delegates a task to a licensed practical nurse (LPN) to take care of the client who underwent a tracheostomy. Which task should be performed by the LPN in this situation? 1 Developing a plan to avoid aspiration 2 Assessing the client's condition after tracheostomy Correct3 Providing tracheostomy care using sterile techniques 4 Teaching a client and caregiver about home tracheostomy care
The licensed practical nurse provides tracheostomy care using sterile techniques. Developing a plan to avoid aspiration in a client with tracheostomy is done by the registered nurse. Assessing the client's condition after tracheostomy is done by the registered nurse. Teaching a client and caregiver about home tracheostomy care is done by the registered nurse.
The nurse is teaching breathing exercises to a client who underwent surgery. Which member of the healthcare team is most suitable for reinforcement of teaching in the client? 1 Certified technician 2 Case manager 3 Cross-trained technician Correct4 Licensed vocational nurse (LVN)
The licensed practical nurses (LPN) are most suitable to be delegated the task of reinforcement teaching. A certified technician is an unlicensed member who can only record the vital signs or provide basic hygiene to the client. A case manager can provide primary education to the client. These personnel can delegate the task of reinforcement teaching to the assistive nursing personnel. Cross-trained technicians may perform respiratory therapy, draw blood samples, and monitor electrocardiography.
While assessing the airway patency of a client after a bomb blast, the nurse suspects severe brain injury and gives a score of 7 using the Glasgow Coma Scale (GCS). Which intervention is most appropriate for the client?
The most appropriate intervention for a client with a GCS score of 7 is preparing for endotracheal intubation and mechanical ventilation. The jaw-thrust maneuver is performed in a client if there is any risk of spinal injury. The use of large-bore catheters to maintain vascular access is done to perform resuscitation in traumatic conditions. Observing for chest wall trauma or other physical abnormalities may not be the appropriate intervention for a client with brain injury.
A client requires emergency cardiac surgery. The leader nurse wants to make the client aware of the situation and wants the client to decide what should be done. Which ethical model does the leader nurse follow here?
The patient-benefit model uses substituted judgment, that is, what the client would want for himself or herself if capable of making these issues known. The autonomy model facilitates making decisions for competent clients. In the paternalistic model the managers decide what is best for their team. The social justice model considers broad social issues and is accountable to the overall institution.
Which activity performed by the licensed practical nurse (LPN) would be appropriate while caring for a client based on the principle of right task of delegation? 1 Willing to perform the task 2 Providing feedback to the delegator Correct3 Performing the task based on institutional policies 4 Following appropriate supervision while performing the task
The principle of right task of delegation indicates if the task is appropriate to delegate based on institutional policies and procedures. Assessing whether the delegatee is willing to perform the task indicates the principle of right person. Providing feedback to the delegator and following supervision of the delegator indicates right supervision of delegation.
Which priority assessments should be included by the nurse when caring for a client who is experiencing depression? Select all that apply.
The priority assessment for a client experiencing depression is to inquire about appetite, activity status, and emotional status. These helps determine the level of depression. Irritability and restlessness are secondary assessments for determining the depression level of a client.
A green-tagged client arrives at the emergency department (ED) after a mass casualty incident (MCI) involving radiation. Which is the priority nursing action for this client?
The priority nursing action for a green-tagged client who arrives at the ED after exposure to radiation is implementing decontamination measures. This measure is the priority because it is essential that members of the healthcare team, and clients, are not exposed to the radiation while providing care. While the other nursing actions (performing a head to toe physical examination, placing a special bracelet with a disaster number, and taking a digital photo and placing it on the medication record) should occur during the admission process to the ED, these are not the priority actions.
After delegating the task of administering oral medications to a licensed practical nurse (LPN), the registered nurse (RN) ensures that the LPN is supervised until the task is accomplished. Which right of delegation does the scenario reflect? 1 The right task 2 The right person Incorrect3 The right direction Correct4 The right circumstance
The right circumstance is indicated by the appropriate supervision, availability of equipment and resources, and appropriateness of the given situation. If the task is appropriate to the delegate based on institutional policies and is legal then it represents the right task of delegation. If the delegatee has adequate knowledge and experience to perform a task safely and effectively, it represents the right person of delegation. The right direction is indicated by the clear and concise directions provided for the task.
Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply. Correct1 Is the prospective delegatee a willing and able employee? 2 Does the delegatee understand the directions and expected results of the task? 3 Does the delegatee understand how, what, and when to report to the delegator? 4 Is it clear that the delegatee will provide feedback related to the task when appropriate? Correct5 Does the delegatee have the knowledge and experience to perform the specific task safely?
The right delegatee is chosen on the basis of the person's willingness and ability. The nurse should assess the knowledge and experience of the prospective delegatee to perform the specific task safely and fulfill the expected outcomes. Right direction and documentation are assessed by the delegatee's ability to understand the directions and expected results of the task. It can also be assessed on the basis of the delegatee's understanding of how, what, and when to report to the delegator. The right supervision is providing feedback to the delegatee, related to the task, when appropriate.
The registered nurse (RN) is caring for a client with severe diarrhea. Which task of the client care plan can be safely delegated to the unlicensed assistive personnel (UAP) by the registered nurse? 1 Administration of oral antidiarrheal 2 Administration of intravenous antibiotics Correct3 Administration of oral replacement fluids 4 Administration of intravenous antiemetics
The scope of practice of the UAP is limited to perform basic care, feeding, and hygiene. Administering oral replacement fluids can be safely performed by the UAP, as it is a basic care that may also be included under feeding. Administering oral medications such as antidiarrheal drugs can be safely delegated to a licensed practical nurse (LPN) or a licensed vocational nurse (LVN) according to guidelines but not to the UAP. Administering intravenous medication such as antibiotics or antiemetics is the role of the registered nurse.
The registered nurse (RN) delegated a task to a licensed practical nurse (LPN). The LPN completed the task effectively. Which statement made by the RN is appropriate feedback? 1 "Nice job." 2 "Well done." 3 "Your performance was good." Correct4 "You performed that procedure safely and professionally."
The statement, "You performed that procedure safely and professionally," clearly identifies what the LPN did well, so it can shape the future behavior positively. The RN should not include vague statements, such as, "Nice job," or, "Well done." The statement, "Your performance was good," could have a positive impact, but a specific behavior is not mentioned in the statement.
The registered nurse (RN) is caring for a client who underwent a hysterectomy. Which tasks can be delegated to the unlicensed assistive personnel (UAP) to provide quality care to the client? Select all that apply. Correct1 Recording vital signs Correct2 Assisting the client with bathing 3 Administering oral medications 4 Preparing the care plan for the client 5 Administering intravenous antibiotics
The tasks within the scope of unlicensed assistive personnel (UAP) include recording vital signs and providing basic hygiene, such as assisting the client with activities of daily life such as bathing. Administering oral medications is under the scope of licensed practical nurse (LPN) or licensed vocational nurse (LVN), but not the UAP. Depending on the state, administering intravenous antibiotics can be performed by either the RN or an LPN/LVN. Preparing the care plan for the client should be performed by the registered nurse only.
Five victims of a shooting are identified as needing urgent care. What should the triage officer do first when these victims arrive in the emergency department?
The triage officer rapidly evaluates each person who presents to the hospital, even those who come in with triage tags in place. Client acuity is re-evaluated for appropriate disposition to the area within the ED or hospital best suited to meet the client's medical needs. The clients will need to be triaged before being sent to the operating room. The triage officer would not be responsible for conducting laboratory testing or notifying the next of kin of the victims.
The registered nurse is delegating a task for unlicensed assistive personnel l (UAP). Which client's care would be suitable for delegation to the UAP?
The unlicensed assistive personnel (UAP) can monitor the temperature of client B every hour. Discharges from the surgical site of client A should be monitored, but the UAP may not have appropriate knowledge. Abdominal pain should be monitored in client C, but the UAP is not qualified to understand the condition of the client. Respiratory rate cannot be monitored by the UAP as it is the responsibility of the more qualified UNP.
The nurse manager is explaining how intramuscular (IM) injection techniques are an example of the theory of diversion of innovation. Which statement made by the nurse manger is accurate?
The use of IM injections for pain management has decreased with the use of intravenous and epidural routes.
Which phase in the disaster management continuum does the nurse understand as including the attempt to limit a disaster's impact on human health and community function?
There are five phases in the disaster management continuum, which include preparedness, mitigation, response, recovery, and evaluation. In mitigation, there will be plans for attempting to limit a disaster's impact on human health and community function. Recovery includes focusing on stabilizing the community and returning it to the previous status. Response includes implementation of the disaster plan. Preparedness is the preparation of a protective plan that is designed before the event has occurred.
What does it mean if there is continuous bubbling in the H20 seal chamber of a chest tube?
There is an air leak so a new Plurovac should be used.
The registered nurse (RN) who delegates work to a newly hired licensed practical nurse (LPN) says, "Please tell me how you will go about performing this procedure, and I will share my expectations with you." Which behavior strategy of Hersey's model is being applied? 1 Telling 2 Selling 3 Delegating Correct4 Participating
When the LPN has the willingness and ability to perform a task, but the relationship is new, the RN will share his or her expectations and conditions with the LPN. This is a clinical example of participating. Participating is encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task. If the LPN has limited knowledge and ability to perform a task, the RN will provide more guidance, which is an example of telling what is the task to be done and how it is to be performed. If the LPN is delegated a new task, it requires explanation from the RN. This is termed as selling in Hersey's model, which is the process of explaining and persuading; this happens if a situation involves a new task and the relationship is ongoing. If the LPN has an established relationship and experience, he or she requires a little guidance and this is called delegation.
While assigning a task, the registered nurse finds that one of the delegatees is not competent to hold the current position. Which strategy does the nurse follow for managing this issue during delegation? 1 Attacking the delegate verbally 2 Doing the task himself or herself Incorrect3 Adjusting the quality of client care Correct4 Lowering the expectations temporarily
When the delegatee is not competent to hold the current position, the registered nurse temporarily lowers expectations. Temporarily lowering the expectations helps the delegatee to build strengths, minimize weaknesses, and gain confidence. Verbal attacking does not help in the situation but will only undermine the relationship between the delegatee and the registered nurse. If the registered nurse does the task herself or himself, the delegatee will not improve. Delegation is a process meant to improve the quality of client care but it is not a strategy to overcome the situation.
Which right is applicable when the delegator and delegatee understand a common work-related language?
When the delegator and delegatee understand a common work-related language, then right communication is applicable. Right person is applicable when the delegatee has appropriate knowledge and experience to perform a task. Right supervision is applicable when the delegator is able to monitor and evaluate the client appropriately. Right circumstance is applicable when the delegation process is applicable for the situation.
Which right is applicable when the delegator and delegatee understand a common work-related language? Incorrect1 Right of person 2 Right of supervision 3 Righty of circumstance Correct4 Right of communication
When the delegator and delegatee understand a common work-related language, then right communication is applicable. Right person is applicable when the delegatee has appropriate knowledge and experience to perform a task. Right supervision is applicable when the delegator is able to monitor and evaluate the client appropriately. Right circumstance is applicable when the delegation process is applicable for the situation.
The nursing manager issued orders to take the utmost care of a client with myocardial infarction and expects the staff to obey and follow the rules immediately. Which type of decision making is the manager using?
autocratic
The nurse is teaching breathing exercises to a client who underwent surgery. Which member of the healthcare team is most suitable for reinforcement of teaching in the client? 1 Certified technician 2 Case manager 3 Cross-trained technician 4 Licensed vocational nurse (LVN)
4 Licensed vocational nurse (LVN) The licensed practical nurses (LPN) are most suitable to be delegated the task of reinforcement teaching. A certified technician is an unlicensed member who can only record the vital signs or provide basic hygiene to the client. A case manager can provide primary education to the client. These personnel can delegate the task of reinforcement teaching to the assistive nursing personnel. Cross-trained technicians may perform respiratory therapy, draw blood samples, and monitor electrocardiography.
The registered nurse (RN) delegates a task to the licensed practical nurse (LPN). If the LPN fails to perform the task within acceptable standards, what would happen? Select all that apply.
A potential for nursing malpractice emerges. The institution remains legally responsible for the situation. The accountability for care remains with the registered nurse (RN).
What adults should be transferred to the Peds ward if necessary?
Adult with condition/tx similar to that which is seen in the pediatric population. (COPD is like cystic fibrosis, pneumonia is pneumonia).
Who should feed a new trach patient?
An RN
Who should feed a patient with an acute CVA?
An RN
Who should manage a patient's on a vent for the first week (acute)?
An RN
Which performance appraisal method is used by nurse managers to measure the performance of the nurse both qualitatively and quantitatively?
Behaviorally anchored rating scales
Who would the registered nurse state is accountable for establishing systems to communicate competency requirements related to delegation?
Chief nursing officer (CNO)
Which health care professional is accountable for establishing systems to assess and communicate competency requirements related to delegation?
Chief nursing officers
Which nursing model includes a registered nurse (RN) paired with technical assistance?
Co-primary nursing model
The nurse is learning about the rules of leaders. Which actions of the nurse indicate effective implementation of these rules in the profession? Select all that apply.
Communicating in a simple language with followers Giving a chance to the followers to express their views Ensuring proper eye contact while communicating with followers
Which theory related to leadership is a nontraditional theory that has emerged from the physical and social sciences?
Complexity theory
The nurse leader is teaching the nursing staff about conflicts in an organization. Which statement is inaccurate regarding conflict in an organization?
Conflict can be constructive if the conflict is excessive.
The registered nurse (RN) delegates obtaining and recording a client's pulse every 30 minutes. During the last hour, the licensed practical nurse (LPN) fails to report the client's elevated heart rate to the RN. Which factor best explains the situation?
Decayed information
The nurse says to the licensed practical nurse (LPN), "I know that you can accomplish the task with dedication. Report to me the expected outcomes and approach me for further assistance if needed." Which relationship is the nurse maintaining with the LPN?
Delegating
Which of the nurse's statements are true regarding delegation? Select all that apply.
Delegation is a complex process. Delegation improves client care outcomes when used effectively.
Which conditions make a delegation more challenging for the registered nurses, delegatees, and clients? Select all that apply. Correct1 Limited resources 2 More staff availability 3 More client care time Correct4 Greater geographical area Correct5 Vulnerable populations receiving care
Delegation is a multifaceted decision-making process which involves a nurse directing another person to perform nursing tasks and activities. Delegation is more challenging when other resources are limited because it is difficult to care for all clients when resources are limited. Delegation is more challenging when the geographic area is greater because of more population. Delegation is more challenging when vulnerable populations are receiving care because they are economically uninsured. Delegation is better when more staff is available and when more time is allotted to care for clients.
What are the three strategies that the nurse can perform while assisting other nurses in making delegation decisions? Select all that apply.
Doing Asking Offering
What is the memonic for remembering who to see first (prioritizing patients)?
FIRST= Find hypoxia (oxygenation first-anxiousness and cardiac patient). Immunocompromised (prevent infection). Rectal bleeding (hemorrhaging from major artery otherwise don't care- VS changes) Safety, and Try Infection (Ex: septic and high temperature, need to take blood culture before start the antibiotics).
Which element of the healthcare system is the registered nurse (RN) practicing when the delegator shares accountability with the RN? Correct1 Delegation 2 Leadership 3 Supervision 4 Assignment
In delegation, the delegator and delegatee share accountability for certain tasks. In leadership, the delegator, as leader, manages the healthcare team and delegates tasks to members of the team. In supervision, the delegator supervises the delegatee as he or she completes a task. In assignment, both accountability and responsibility are transferred from one person to another on the healthcare team.
Which statement is true regarding the satisficing decision model?
It allows for a quick decision, which is important when lack of time is an issue.
Hierarchy of Needs Theory
Motivating staff by providing hierarchy of human needs indicates the application of hierarchy of needs theory of leadership.
Which model of nursing care would include working "within the walls" as well as "beyond the walls" of the hospital?
Nursing case-management model
The registered nurse (RN) who delegates work to a newly hired licensed practical nurse (LPN) says, "Please tell me how you will go about performing this procedure, and I will share my expectations with you." Which behavior strategy of Hersey's model is being applied?
Participating
The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction?
Providing constructive feedback about client care management
Who is accountable for the ongoing evaluation of a client's care?
Registered Nurse (RN)
A healthcare team is delegated the task of assisting a client with bathing. Which member of the healthcare team is responsible and accountable for this aspect of client care?
Registered nurse (RN)
A registered nurse is planning to delegate various tasks. What does the registered nurse do to delegate appropriately? Select all that apply.
Select an experienced nurse as a delegatee. Ask open-ended questions to the delegatee. Provide constructive feedback to the delegatee.
What should be done if a cooling blanket is on a patient with a temp of 38 C (100.4 F), then after three hours their temp is 102F?
Send to biomed engineering and obtain a new cooling blanket.
What should be done if an IV pump (IVAC) set to run 1 liter of fluid at 150 ml/hr after 6 hours there is 200 ml left in the bag?
Send to biomed engineering and obtain another pump.
The nurse is making rounds and stops to check a client who has had a total hip arthroplasty. Which action by the unlicensed assistive personnel (UAP) ([continuing care assistant (CCA]) will cause the nurse to intervene?
The UAP (CCA) elevates the client's affected leg on a pillow.
The nursing manager issued orders to take the utmost care of a client with myocardial infarction and expects the staff to obey and follow the rules immediately. Which type of decision making is the manager using?
The autocratic method results in rapid decision-making and is more appropriate in a crisis situation. Optimizing decision making is when the nurse considers both pros and cons of each position. Laissez-faire is a "hands-off" approach, which is taken by manager who chooses to do nothing when intervention is indicated. The bureaucratic style is focused on organizational rules and policies.
Which healthcare team member is familiar with all the needs of any individual client?
The charge nurse is involved in the coordination and assignment of care to individual clients. Therefore, the charge nurse is the only person familiar with all the needs of any individual client who is under care. Orderlies are unlicensed assistive personnel who are delegated to care for the client's basic needs and do not have complete knowledge of a client's condition. Nursing aides are not familiar with all client needs, but care for the client according to the tasks delegated to them. The patient care associate is an unlicensed nursing professional involved in basic care of the client.
Which characteristics of the delegatee should be considered to determine that he or she is the "right person"? Select all that apply. Correct1 Experience 2 Supervision Correct3 Willingness Correct4 Competence 5 Communication
The delegatee should be assigned a task if he or she has experience that would allow the delegator to provide minimal guidance. The willingness of the delegatee is also important to consider before assigning the task. The competence of the delegatee must be assessed before assigning the task. The delegator should supervise the tasks performed by the delegatee. The delegatee's communication skills are assessed to ensure right direction and communication.
The nurse manager is teaching the nursing team about funds allocated to health departments for personal health services by local, state, and federal governments. Which statement made by a member of the team would indicate effective learning? Select all that apply.
The funds provide care for newborns." "The funds provide care for clients with tuberculosis." "The funds provide care for children with birth defects
A client is hospitalized with dehydration. Which tasks are appropriate to delegate to a licensed practical nurse? Select all that apply.
The licensed practical nurse records the vital signs, administers fluids orally, and performs oral-rehydration therapy and may be under the supervision of the registered nurse. Feeding the hospitalized client and helping the client to change clothes are performed by the unlicensed nursing personnel.
A registered nurse (RN) is sent to a rehabilitation center because of chemical impairment issues. Which member of the healthcare team will be asked to provide feedback about the RN's progress? Correct1 Nurse manager 2 Healthcare provider 3 Patient care associate 4 Cross-trained technician
The nurse manager, who is the delegator for the healthcare team, will be asked to provide feedback about the progress of the RN in the rehabilitation center. The healthcare provider will not be asked to provide feedback about the RN's progress. The patient care associate and cross-trained technician also do not provide feedback about the RN because they do not supervise the RN.
The nurse is caring for clients who were brought to the hospital following a large-scale disaster. Which client would be suitable for the nurse to triage with a "green" tag?
The nurse will triage the clients according to priority for providing care. The client who is injured and is able to walk may not require immediate treatment and would be issued a green tag. The client who is severely injured and who has no chances of survival is tagged black. The client who is stable and requires re-triage after observation is tagged with a yellow tag, indicating that the client is not in immediate danger. A red tag issued to the client indicates that the client requires immediate care.
What is the status of the primary healthcare provider as a member of the healthcare team that is in the span of control of a registered nurse (RN)? Incorrect1 Devoid of legal authority 2 Devoid of delegation authority Correct3 Answerable to the nurse manager 4 Answerable to the registered nurse
The primary healthcare provider as a team member is designated to be answerable to a delegator such as the nurse manager. The unit secretary is devoid of legal authority or formal preparation. The primary healthcare provider may delegate tasks to the members of the healthcare team who have dependent status, such as unlicensed assistive personnel (UAP), licensed practical nurses (LPN), or licensed vocational nurses (LVN). Generally, those with dependent status are answerable to the RN.
Which right does the question, "Do staffing ratios demand the use of high-level delegation strategies?" indicate? 1 The right task 2 The right person Incorrect3 The right supervision Correct4 The right circumstance
The right circumstance can be assessed by asking, "Do staffing ratios demand the use of high-level delegation strategies?" The right task is assessed by the legally appropriate delegate, using institutional policies and procedures. The right person is selected when the delegatee has the knowledge and experience to perform the specific task safely. Providing feedback related to the task and monitoring the client promote right supervision.
The registered nurse delegates a task to the unlicensed nursing personnel (UNP). Which client care is suitable for UNP? 1 Client A 2 Client B Correct3 Client C 4 Client D
The task of delivering care to client C is delegated to the UNP because the UNP can monitor the wound discharge in clients who have undergone surgery. Severe burns are an acute condition where the vitals are unstable. Therefore, the UNP is not authorized to provide care to client A with severe burns. UNP's scope of practice is limited for administration of intravenous fluids or medications, so the UNP is not authorized to provide care to client B, who has diabetes insipidus and requires intravenous administration of medications. Cardiogenic shock is an acute condition where the vitals are unstable, so the UNP is not qualified to provide care to client D with cardiogenic shock, and acute condition which may require continuous monitoring of vital signs.
What does it mean if the vent is beeping with a low pressure alarm?
There is a problem with the machine so get a new one and send the broken one to biomed engineering to have it fixed.
Who is at risk for falling blind/deaf patients or those with canes/walkers/or small animals?
Those with canes/walkers/small animals (geriatrics) are at risk for falling.
Which behavior would the nurse consider suitable for an executive position according to Gardner's tasks of leading/managing?
To assist corporate leaders with planning and priority setting
After assessing the delegatee's inability to perform an assigned task, the delegator explains the procedure and demonstrates the task to the delegatee. What can be inferred about the delegatee? 1 The delegatee may have limited knowledge and ability to perform the task. 2 The delegatee has an established relationship with the delegator and expertise. Incorrect3 The delegatee has the willingness and ability, but the relationship with the delegator is new. Correct4 The delegatee may have an ongoing relationship with the delegator, but a new task is assigned.
When the delegatee has an ongoing relationship with the delegator, but a new task is assigned, the delegator should explain and demonstrate the procedure. When the delegatee has limited knowledge and ability to perform the task, the delegator should provide more guidance. When the delegatee has an established relationship with the delegator and the expertise, little guidance is needed from the delegator to perform the task. When the delegatee has the willingness and ability to perform a task, but the relationship is new, it requires both individuals to create mutual expectations and the conditions for performance.
In which situation would activation of the emergency preparedness plan be necessary? Select all that apply.
When the number of casualties exceeds the usual resource capabilities, a disaster situation exists. The pleasure boat victims are being taken to a community hospital on a Saturday night when staffing is typically lower. Likewise, the victims of a manufacturing plant explosion are being taken to an urban hospital during the time of lower staffing. The victims of a bus accident are being taken to a community hospital on a holiday, during which staffing is generally lower. The number of victims from a senior citizen's housing facility fire is large and could overwhelm available resources at the community hospital. The victims of food poisoning can easily be taken care of by existing staff and resources at an urban hospital on a weekday afternoon.
A healthcare provider writes prescriptions for a young child with a tentative diagnosis of Wilms tumor. Which prescription should the nurse question?
renal biposy
Several individuals who sustained urgent but nonemergent injuries are seated in the emergency department when an ambulance arrives with a client suspected of having a myocardial infarction. The nurse must explain to the waiting clients that they will have to wait longer for care. Which is the best explanation for the nurse to give?
"I know you have been waiting, but a client's life depends on immediate treatment. You will receive the same attention when you are seen."
The nurse leader taught the student nurse the principles of quality management and quality improvement. Which statement made by the student nurse indicates ineffective learning?
"Managers define the quality."
A registered nurse (RN) is sent to a rehabilitation center because of chemical impairment issues. Which member of the healthcare team will be asked to provide feedback about the RN's progress? 1 Nurse manager 2 Healthcare provider 3 Patient care associate 4 Cross-trained technician
1 The nurse manager, who is the delegator for the healthcare team, will be asked to provide feedback about the progress of the RN in the rehabilitation center. The healthcare provider will not be asked to provide feedback about the RN's progress. The patient care associate and cross-trained technician also do not provide feedback about the RN because they do not supervise the RN.
Which component of delegation is defined as the ability to perform duties in a specific role? 1 Authority 2 Supervision 3 Responsibility 4 Accountability
1 Authority is the ability to perform duties in a specific role. Supervision is the provision of guidance and oversight of a delegated task. Responsibility refers to reliability, dependability, and obligation to accomplish work. Accountability involves determining whether the actions are appropriate and providing a detailed explanation of what has occurred.
The registered nurse assigns a task to a newly hired licensed practical nurse (LPN) to monitor a client's blood pressure. Which is relevant to the delegator in this situation? 1 Requires explanation 2 Requires little guidance 3 Requires more guidance 4 Requires creating mutual expectations
3 Requires more guidance When the task is assigned to a newly hired LPN, the registered nurse should provide more guidance to the LPN. The LPN requires explanation when there is an ongoing process and the task is already assigned. The LPN requires little guidance when the LPN has expertise in work and performs in a correct way. The delegator and the delegatee should have mutual expectations when there is ability and willingness but the relationship is new.
The registered nurse is teaching a newly hired nurse about communicating with delegatees during delegation. Which statement made by the newly hired nurse indicates the need for further learning? 1. "I should identify priorities." 2. "I should specify deviations." 3. "I should provide examples of each delegation." 4. "I should specify any performance limitations to the delegatee."
3. "I should provide examples of each delegation." The delegator should ask the delegatee to provide examples of each delegation in order to understand his or her knowledge level. The delegator should identify priorities before delegating the task to the delegatee. The delegator should specify deviations, such as when the delegatee must take an immediate action while performing the task. The delegator should specify the performance limitations to the delegatee, which can help in performing the task effectively.
Which component of delegation is retained while the delegator is delegating the client's care task to the nursing aide? 1. Authority 2. Supervision 3. Responsibility 4. Accountability
4. Accountability Accountability is retained by the delegator while delegating a client's care task to the nursing aide. Every individual on the healthcare team has authority for the delegated task. The nursing aide is just responsible for the delegated task, so the delegator retains the accountability. Supervision is a right of delegation.
While assigning a task, the registered nurse finds that one of the delegatees is not competent to hold the current position. Which strategy does the nurse follow for managing this issue during delegation? 1. Attacking the delegate verbally 2. Doing the task himself or herself 3. Adjusting the quality of client care 4. Lowering the expectations temporarily
4. Lowering the expectations temporarily When the delegatee is not competent to hold the current position, the registered nurse temporarily lowers expectations. Temporarily lowering the expectations helps the delegatee to build strengths, minimize weaknesses, and gain confidence. Verbal attacking does not help in the situation but will only undermine the relationship between the delegatee and the registered nurse. If the registered nurse does the task herself or himself, the delegatee will not improve. Delegation is a process meant to improve the quality of client care but it is not a strategy to overcome the situation.
Which right of delegation refers to the giving of clear, concise descriptions of a task to the delegatee? 1. Right task 2. Right person 3. Right supervision 4. Right communication
4. Right communication Right communication refers to the giving of clear and concise descriptions of a task, including its objectives, limits, and expectations while delegating a task. Right task refers to delegating a task that is repetitive, requires less supervision, and has predictable results. Right person is delegating a task to the correct person who has the ability to perform said task. Right supervision refers to providing appropriate monitoring, evaluation, and feedback of the delegated task.
The nurse is working with a group of clients in a community health center. Which client should the nurse consider at highest risk for developing pneumonia?
A blood urea nitrogen level of 25 mg/dL, a respiratory rate of 38 breaths/min, and a blood pressure of 80/60 mm Hg are symptoms of pneumonia. Therefore client C has the highest risk for pneumonia. A 55-year-old client with abnormal uterine bleeding and tumors of 8 mm in uterus has uterine fibroids. They are benign and do not affect client A's respiratory status. Client B, a 28-year-old with a carotene level of 90mcg/dL, creatine level of 1.8 mg/dL, and a folate level of 23 ng/mL may have hyperthyroidism but is not at risk for pneumonia. A folate level of 3 ng/mL and a haptoglobin of 16 mg/dL in client D, who is 33-years old, indicates hemolytic anemia and is not a risk for pneumonia.
A nurse is evaluating different situations related to Maslow's hierarchy of needs. Which situations come under the second level of needs? Select all that apply.
A client tells the nurse that he or she is taunted by his or her boss every day. A client tells the nurse that his or her spouse belongs to a criminal gang. A client tells the nurse that he or she lives beside a factory that manufactures harmful chemicals.
While caring for an 8-year-old victim of an earthquake, the nurse finds that the child has trouble sleeping, startles easily, and experiences "flashbacks" of the disaster. What is the appropriate nursing intervention in this situation?
A client who is unable to sleep, startles easily, and experiences "flashbacks" of disasters displays symptoms of posttraumatic stress disorder (PTSD). Therefore the nurse should refer the child to a clinical psychologist or psychiatrist. Restraining the child does not address the PTSD and would be unethical. Administering sedatives may help the child sleep but would not address the PTSD. Placing the child's favorite toy beside him or her in bed may provide comfort but would not address the underlying PTSD. Test-Taking Tip: Disasters can disturb the victims physically and mentally. Use this information to answer this question accurately.
The nurse is caring for a client with a platelet count of 50,000 cells per microliter. Which recommendation is inappropriate for the client?
A client with platelet count of 50,000 cells per microliter has thrombocytopenia. The client should be encouraged to shave with an electric razor, rather than with a straight blade. Walking with sturdy shoes or slippers preserves foot skin tissue and helps to reduce the chances of cuts. Forceful blowing of the nose can result in bleeding. The use of a soft-bristle toothbrush helps to prevent injury to the gums.
The nurse is caring for a pregnant client with hypertension. Which client care tasks are most suitable to be delegated to the patient care associate (PCA)? Correct1 Recording the vital signs 2 Monitoring the blood pressure 3 Administering intravenous fluids 4 Administering antihypertensive medications
A patient care associate (PCA) is an unlicensed assistive personnel whose scope of practice is very limited. A PCA can be delegated the task of recording the vital signs as communicated by the delegator even if the condition of the client is acute or unstable. In stable clients, the PCA may be instructed to monitor the blood pressure, but in this acute condition, only the registered nurse (RN) should monitor the blood pressure. Administration of intravenous fluids or medications is out of scope of practice of the PCA. A PCA is not suitable to be delegated the task of administering any medication to a client.
Which activity performed by the registered nurse (RN) indicates effective delegation?
Supervising and monitoring the licensed practical nurse (LPN) about the different activities
A client is concerned about not receiving treatment due to a Medicare policy change. What is the accurate response of a nurse as a leader?
"The change will not affect your treatment."
Which characteristic should the nurse use during the nursing process as a guide for delegation?
Critical analysis
The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task?
Critical thinking
What is contraindicated with an allergy to iodine/shellfish?
Diagnostic test with dye/ cleaning solution for foleys/surgery.
The delegator delegates tasks but no what?
Responsibility. Still legally responsible for the outcomes.
What are some challenges faced in the process of delegation? Select all that apply.
Limited resources, vulnerable populations receiving care, and large geographic area Delegation is a complex process. Delegating a task when resources are limited is a great challenge. Delegation is also more challenging the larger the geographic area is where the task should be performed. The process of delegation also becomes more challenging when care is being delivered to vulnerable populations. Time conservation is a benefit of the delegation process even if the decision to delegate may not be based on time-saving considerations. Providing assistance with the client's activities of daily living is a benefit rather than a challenge of delegation.
The registered nurse is delegating tasks to the healthcare team. Which team member is most suitable for achieving an effective outcome in the care of a client who is bedridden for long periods with seizures?
Licensed practical nurse
What should the nurse educator emphasize when teaching about mass casualty incidents (MCIs)? Select all that apply
Mass casualty incidents (MCIs) involve large numbers of victims. An MCI is a man-made or natural event or disaster that causes permanent changes within a community. It overwhelms a community's ability to respond with existing resources. MCIs always require significant assistance from resources outside the affected community.
Which actions of the nurse exhibit transactional leadership? Select all that apply.
Meeting the targets within the deadline Working according to organizational rules Correcting the errors in a reactive manner
The legal authority has delegated the tasks according to the model of analysis type of care. Which statements are true regarding the model analysis? Select all that apply.
Model analysis improves client satisfaction. Model analysis is a cost-effective idea for client care. Model analysis promotes organizational decision-making at lower levels.
What is the role of unlicensed assistive personnel in intravenous (IV) therapy for a client?
Monitoring clinical manifestations
The registered nurse (RN) assigns a task to a licensed practical nurse (LPN) to take care of a client admitted with severe burns. Which tasks are being performed by the LPN in this situation? Select all that apply.
Monitoring the heart rate Monitoring the blood pressure Administering the oral medication
A healthcare team is caring for a 68-year-old client with diabetes insipidus. Which task is most suitable to be delegated to licensed practical nurse (LPN) to provide effective client care? Select all that apply.
Monitoring urine output Administering oral rehydration medication
A registered nurse (RN) is sent to a rehabilitation center because of chemical impairment issues. Which member of the healthcare team will be asked to provide feedback about the RN's progress?
Nurse manager
Who is the designated delegator?
Nurse manager
At a staff meeting, the question of a staff nurse's returning to work after completing a drug rehabilitation program is discussed. What is the most therapeutic way for the staff to handle the nurse's return?
Offering the nurse support in a straightforward manner
What patients are on bleeding precautions?
On coumadin/heparin, hemophilia, problems with bone marrow, chemo, liver disease, HIV, DIC, ASA/NSAIDS, and Cancer.
The nurse is caring for a client who underwent a hysterectomy and who is admitted to a general medical-surgical unit. Which tasks can be delegated to the unlicensed assistive personnel (UAP)? Select all that apply.
Oral hygeine; assistance with bathing
The nurse leader as a manager makes a decision regarding the method of documentation that benefits the nursing team. Which type of decision-making style does the nurse leader utilize?
Paternalistic
A critically injured client was brought to the hospital following a car accident and the client should be immediately triaged for determining the nature and acuity of the injuries. Who is delegated to perform the task?
Registered nurse
The client is experiencing postoperative pain and requests a pain shot. Which of the following healthcare providers are legally permitted to administer an intramuscular (IM) injection to the client? Select all that apply.
Registered nurse (RN) Licensed practical nurse (LPN) Licensed vocational nurse (LVN)
The registered nurse is delegating tasks for the care of a vulnerable population. Which healthcare team would be appropriate for the delegation of tasks?
Registered nurse (RN), licensed practical nurse (LPN), and unlicensed nursing professional (UNP)
What should be done if a peritoneal dialysis machine (CAPD) shows 2000 ml in and 1500 ml cloudy output?
Reposition patient and call MD.
A registered nurse (RN) diagnosed with chemical impairment issues is transferred to work at a rehabilitation center as a part of treatment. Which actions performed by the nurse manager at the new work place result in effective outcome of treatment for chemical impairment? Select all that apply.
Restricting the RN from working near the abused chemical Restricting the RN from administering any controlled substances
Which right of delegation would the nurse describe as most instrumental in shaping quality and safety outcomes according to Anthony and Vidal? 1 Right task 2 Right person 3 Right supervision Correct4 Right communication and direction
Right communication and direction is most instrumental in shaping quality and safety outcomes because timely and effective communication enhances the safety and quality of client care. Right task is important to prevent legal issues. Right person is important for ensuring the delegatee has the knowledge and experience to perform the specific task safely. Right supervision is important for monitoring and evaluating appropriately.
The nurse is delegating someone to care for a client with diabetes mellitus. Which instruction given by the nurse better explains the selling relationship with the delegatee? 1 "Record the client's blood glucose level each morning." 2 "You may approach me for further assistance and questions. Thank you." 3 "I will guide and assist you while you learn how to check the client's blood glucose." Correct4 "You will take complete care of the client with diabetes and make sure to record the blood glucose level."
Selling includes ongoing relationships with an explanation of the delegated new task. This is better explained in the statement, "You have to take complete care of the client with diabetes and make sure that you record the blood glucose level." Telling is ordering the delegate to record the client's blood glucose level each morning. Delegation, involving established relationships and expertise, is better explained by, "You may approach me for further assistance and questions. Thank you." Participation is mutual involvement to accomplish the task. It is better explained by the statement, "I will guide and assist you while you learn how to check the client's blood glucose."
A nurse educator is presenting information about the nursing process to a class of nursing students. What definition of the nursing process should be included in the presentation?
Sequence of steps used to meet the client's needs
Which action of the leader signifies the implementation phase of the nursing process to teaching?
Sequencing different tasks
Which statement reflects the concept of "referent power" to the nurse?
The nurse manager hires the student nurse she advised to work in the agency after graduation.
The nurse manager assigned 5 visits per day to a home health nurse, but the weekly average of the home health nurse is 4.8 visits per day. What reason does the nurse manager expect is the cause for this discrepancy?
The time for one visit took twice the amount of time normally.
What two things should you use to help determine appropriate delegation tasks for a UAP?
Their ability and demonstration of the task.
A nursing student compares the pathophysiology of submersion injury in victims of freshwater drowning and victims of saltwater drowning. Which statement made by the nursing student indicates effective learning?
There is a difference in tonicity of both saltwater and freshwater with that of normal body fluids. When either saltwater or freshwater is aspirated by the submerged victim, the osmotic gradient caused by the aspirated fluid causes fluid imbalances in the body. Freshwater is hypotonic and saltwater is hypertonic. Only hypertonic saltwater draws fluid from the vascular space into the alveoli. Destruction of surfactant and alveolar-capillary membrane occurs in case of both saltwater and freshwater aspiration.
The nurse manager is promoting a nurse who has the qualities to become a team leader. What responsibilities are allotted to a team leader? Select all that apply.
To be prepared for daily changes in team membership To evaluate the quality of care for the clients assigned to his or her team
Two-factor theory
Using motivator factors liberally to inspire work performance indicates the application of two-factor theory.
What should you NEVER Massage?
Veins, Z-track, Pressure ulcers, SQ heparin, Wilm's tumor, and intradural (PPD TB test).
The nurse as a leader is sharing organizational information openly and honestly. Which of Gardner's tasks of leadership is the nurse manager applying in practice?
developing trust
Which characteristics should the nurse possess as a leader, according to theories of transformational leadership? Select all that apply.
empowering staff creating enthusiasm for practice promoting scholarship of practice at the client side
Which transformational leadership practices are involved when a leader empowers people and offers praise for the work done by one of the team members? Select all that apply.
enabling encouraging
The registered nurse (RN) is caring for a client who underwent ileostomy. Which activity performed by the nurse indicates following the principle of right circumstance of delegation? Select all that apply. 1. Assessing the willingness of the delegatee 2. Assessing the equipment to determine vital signs 3. Providing supervision of the delegatee during the task 4. Teaching institutional policies about caring for a client with ileostomy 5. Communicating with the delegatee about care management of the client
2. Assessing the equipment to determine vital signs 3. Providing supervision of the delegatee during the task Assessing the equipment and resources available to perform the task determines right circumstance of delegation. Supervising the delegatee during the task indicates right circumstance of delegation. Assessing the willingness of the delegatee determines the principle of right person of delegation. Determining if the task can be performed based on institutional policies indicates principle of right task of delegation. Communicating with the delegatee falls under right communication of delegation.
How should a student nurse be trained for implementing delegation in practice? 1. By reinforcing delegation to the student nurse only during academics 2. By interacting with highly qualified, clinically experienced nursing mentors 3. By improving didactic content by theoretically educating the student nurse 4. By considering the student nurse's opinions for the master delegation decisions
2. By interacting with highly qualified, clinically experienced nursing mentors Interaction with highly qualified, clinically experienced nursing mentors fosters professional self-confidence in the student nurse. These experiences allow student nurses to build up their ability to be successful delegators. Delegation knowledge should also be reinforced in nursing continuing education programs. Didactic content about delegacy can be improved by pairing the education and the clinical experience from the healthcare practice site. The student nurse does not have enough knowledge to make master delegation decisions without adequate training.
Who would the registered nurse state is accountable for establishing systems to communicate competency requirements related to delegation? 1. Registered nurse (RN) 2. Chief nursing officer (CNO) 3. Licensed practical nurse (LPN) 4. Unlicensed assistive personnel (UAP)
2. Chief nursing officer (CNO) CNOs are accountable for establishing systems to communicate competency related to delegation. The registered nurse delegates the task to LPN and UAP. In delegation, the RN implements in clinical practice to improve the safety and quality of client care. LPNs provide direct care to the client. UAP provide direct care to the client under the supervision of the registered nurse who retains accountability for client care outcomes.
Which health care professional is accountable for establishing systems to assess and communicate competency requirements related to delegation? 1. Registered nurses 2. Chief nursing officers 3. Licensed practical nurses 4. Unlicensed nursing personnel
2. Chief nursing officers Chief nursing officers are expected to establish the systems to assess and communicate the competencies required for delegation. Registered nurses are accountable for client care. The licensed practical nurse and unlicensed nursing personnel act as delegatees for various tasks.
Who is responsible for establishing systems to monitor and verify the competency requirements related to delegation in an organization? 1. Primary healthcare team 2. Chief nursing officers (CNOs) 3. American Nursing Association 4. National Council of State Boards of Nursing (NCSBN)
2. Chief nursing officers (CNOs) The chief nursing officers (CNOs) are accountable and responsible for establishing systems to assess, monitor, verify, and communicate competency requirements related to delegation. The primary healthcare team may not establish the principles of delegation. The American Nursing Association and National Council of State Boards of Nursing (NCSBN) mainly helped in outlining the principles of delegation to the registered nurse (RN).
Which characteristic should the nurse use during the nursing process as a guide for delegation? 1. Leadership 2. Critical analysis 3. Psychomotor task 4. Time management
2. Critical analysis Critical analysis by the registered nurse serves as a guide for delegation in the nursing process. It is applied in assessment, planning, implementation, and evaluation for safe and effective client care. Leadership is a role in which a nurse has charge of the personnel as they perform their tasks. Psychomotor tasks are the common characteristics and essential components that a nurse should possess to provide client care. Time management is essential in performing tasks within specified deadlines during delegacy.
The registered nurse is teaching the student nurse about the concepts of delegation. Which response given by the student nurse indicates the need for further teaching? 1. Delegation always involves two individuals. 2. Delegation is the transfer of accountability while retaining responsibility. 3. Delegation is an important strategy for client safety and quality of client care. 4. Delegation has five rights that should be followed in the process of delegation.
2. Delegation is the transfer of accountability while retaining responsibility. Delegation is the transfer of the responsibility for the task, while the final accountability is always retained with the delegator. Delegation involves the delegator and the delegatee. Delegation is an important strategy for ensuring client safety and quality of client care. Delegation has five rights that are to be followed throughout the delegation process: right task, right person, right circumstance, right direction/communication, and right supervision.
The registered nurse (RN) is communicating with a healthcare team regarding the delegation of tasks. Which factors can determine the quality of communication between the RN and healthcare team? Select all that apply. 1. Accuracy 2. Effectiveness 3. Responsiveness 4. Meaningfulness 5. Understandability
2. Effectiveness 4. Meaningfulness 5. Understandability Effectiveness is a factor that determines the quality of the communication in delivering the appropriate information. The communication should be meaningful to improve the quality of the information. The communication should be understood by all the team members to perform a task properly. Accuracy of the assigned task can be known only after the result. Response to the communication reveals the ability of the healthcare team to understand the task.
During the process of delegation, the delegator's behavior is noted to be observing and monitoring. How is the relationship between the delegator and delagatee in this situation? 1. Limited 2. Established 3. New or developing 4. Developing or ongoing
2. Established Observing and monitoring behavior of the delegator indicates delegating, which is done when the relationship between the delegator and delegatee is established. The delegator's behavior is guiding or directing when the relationship between the delegator and delegatee is limited. The delegator's behavior is encouraging or problem solving when the relationship between the delegator and delegatee is new or developing. The delegator's behavior is explaining or persuading when the relationship between the delegator and delegatee is developing or ongoing.
A newly promoted registered nurse (RN) is about to start delegation for the first time in her career. Which experiences foster professional self-confidence in the early career stage for an RN? Select all that apply. 1. Inability to comprehend 2. Experience in clinical delegation 3. Application of theory to practice 4. Development of clinical judgment 5. Engagement with a nursing mentor
2. Experience in clinical delegation 3. Application of theory to practice 4. Development of clinical judgment 5. Engagement with a nursing mentor Clinical delegation experiences foster professional self-confidence in the early career of an RN. The nursing practicum experiences of applying theory to practice and developing clinical judgment will also advance the RN's ability to become a successful delegator and foster professional self-confidence. Engagement with a nursing mentor fosters professional self-confidence in the early career of an RN. The RN must have the ability to comprehend the legal authority of delegation decisions.
A nurse is educating a patient about Maslow's hierarchy of needs by citing examples. Which examples mentioned by the nurse belong to the third level of needs? Select all that apply.
"A client is depressed because his/her spouse has passed away." "A client wants to reconnect with old friends after being diagnosed with cancer." "A client never goes to family gatherings because he/she is not accepted by family members."
A nurse leader honors the team members who use new equipment effectively and ensure clients' safety. Which step of Kotter's eight-step change model does a nurse implement in this situation?
"Anchor the changes in the culture"
After communicating with the follower of a nurse leader, the senior nurse assumes that the nurse leader is following the transactional leadership approach. Which statements of the follower support the senior nurse's assumption? Select all that apply.
"I have to face penalties for poor performance." "I have to meet the deadlines of my work at any cost." "I am getting my errors corrected in a reactive manner.
Which statements indicate that the nurse leader is adapting to changes in leadership practices to adjust to complex changes in healthcare systems? Select all that apply.
"I will be clear about purpose and process." "I will involve stakeholders and listen to them." "I will align systems and processes to support the change."
During a group meeting a client tells everyone, "I'm about to be discharged from the hospital, and I'm afraid." What is the most appropriate response by the nurse facilitator?
"Maybe others in the group have similar feelings that they would share."
The nurse manager reviews the performance report of a direct care nurse and asks the nurse to focus on "emotional intelligence" in order to be promoted as the nurse leader. Which statement would the nurse leader most likely use while advising the nurse on areas for improvement?
"Try to be more sensitive to the experiences of others." Emotional intelligence is advising the nurse to be more sensitive to the experiences of others. The process of thinking systematically requires the nurse to balance short-term and long-term objectives. Under the "explaining" process of Gardner's tasks of leading/managing, the information type to be shared is determined. The involvement of the nurse in shaping the policies and practices of client care is an example of shared governance.
The night nurse receives a call at 4 AM from the laboratory regarding a client's blood cultures that have tested positive for bacteria. Which action by the nurse is appropriate at this time? 1. Call the answering service and speak to the health care provider now 2. Document the results of the culture in the client's medical record 3. Leave a message on the health care provider's office phone 4. Speak to the health care provider on rounds in the morning
1 Critical laboratory results (eg, positive blood cultures, severe electrolyte derangements) require immediate intervention for client safety. The nurse receiving a critical laboratory result should notify the health care provider (HCP) as soon as possible. Hospital organizations have individual policies regarding the time frame for notification of the HCP and HCP response, usually ≤60 minutes. Bacteremia requires timely treatment to prevent further complications (eg, septic shock) (Option 1). (Option 2) The critical laboratory result should be documented in the client's medical record, but only after immediate communication with the HCP. (Option 3) The nurse must make direct contact, either via telephone or in person, when reporting a critical result. A telephone message may not be received promptly, and a critical value requires immediate intervention. (Option 4) Even if the HCP usually makes rounds early in the morning, a critical value requires immediate, real-time notification to prevent delay of potentially urgent intervention. Educational objective: Critical laboratory results, such as positive blood cultures, require immediate communication with the health care provider (HCP) and timely intervention for client safety. The nurse must contact the HCP directly as soon as possible to avoid life-threatening complications (eg, septic shock).
The nurse is caring for a client with chronic pain who just had surgery and is receiving patient-controlled analgesia (PCA) morphine. The client is in severe pain, with a rating of 10/10, despite receiving the maximum ordered dose. The nurse calls the health care provider, saying that the client is still having pain and recommending a higher PCA dose. Which nursing role is being implemented in this situation? 1. Advocate 2. Caregiver 3. Educator 4. Manager
1 The role of the nurse as advocate is to protect the rights of the client, including the right to adequate pain control. The nurse acting as advocate speaks up for clients when they cannot easily speak for themselves. (Option 2) In the role of caregiver, the nurse promotes healing and well-being by helping the client and family set and achieve goals through the nursing process. (Option 3) In the role of educator, the nurse helps the client and family learn about topics relevant to their health. (Option 4) In the role of manager, the nurse coordinates the care of the client among different members of the interdisciplinary team and across care settings. Educational objective: An important nursing role is client advocacy, which involves speaking up for clients to protect their rights and improve their health outcomes and experiences.
After caring for a client who underwent a cesarean section, the delegatee failed to report results and findings of vital signs to the delegator due to improper understanding. Which action of the delegator is the reason for the delegatee's failure? 1 Unclear directions to the delegatee 2 Inappropriate selection of delegatee 3 Inappropriate feedback related to task 4 Inappropriate supervision by the delegator
1 Unclear directions to the delegatee by the delegator may result in failure to report results and findings of vitals by the delegatee. As per the rights of delegation, the delegator may not assign the task to an inappropriate delegatee. Inappropriate feedback related to the task may be due to an information delay that may cause adverse effects in the client. Inappropriate supervision by the delegator may lead to unexpected outcomes.
A client with a 10-year history of methadone use for chronic leg pain is being treated with azithromycin for pneumonia. On the third hospital day, both medications are discontinued as the QT interval on EKG has lengthened, increasing arrhythmia risk. The client wants to be discharged against medical advice to return home and take the client's own medications to prevent going into withdrawal without the methadone. Which is the most appropriate nursing response? 1. "I will ask the HCP to come talk with us so that we can develop a plan to prevent withdrawal while reducing your risk of heart problems." 2. "I will talk with the HCP about your concerns, but in the meantime it's important that you stay here." 3. "It's important that you stay in the hospital so that we can treat you quickly if you have problems." 4. "You have the right to make your own decisions, but you are at high risk of having heart problems if you go home right now."
1 When clients are hospitalized, they lose control of many things, including their medication management. This loss of control can be frightening for the client, especially one who has had control of medications for many years. This client, who has a decade of experience taking methadone for chronic pain, is afraid that suddenly stopping this medication may precipitate withdrawal. The client is trying to regain control and avoid this problem by leaving the hospital against medical advice. However, the client remains at risk of life-threatening arrhythmias. Therefore, the nurse should promote negotiation between the client and HCP to develop a plan of care that will address the concerns of each. The plan should advocate for the client to ensure that the concerns are addressed. Care planning should be a collaborative, shared process informed by the knowledge and preferences of the client and evidence-based recommendations by the HCP that are appropriate to the situation. (Option 2) This response is based on the idea of the nurse and HCP being in control, but it fails to include the client in the decision-making team. (Option 3) This statement provides a rationale for the client to remain in the hospital, but it does not address the client's concerns about going into withdrawal. (Option 4) This response is based on the idea of client autonomy, but it does not propose a solution to the problem. Educational objective: A plan of care should be developed collaboratively, informed by the client's knowledge, beliefs, and preferences, and the expertise and evidence-based recommendations of HCPs.
Which task followed by the executive nurse is a leadership development task? 1 Maintaining balance 2 Having a clear vision 3 Listening to constituents 4 Maintaining a positive attitude
1 Having a clear vision and seeing beyond where one is and where one is going is a leadership development task. Maintaining balance, listening to constituents, and maintaining a positive attitude are rules for a leader.
A nurse manager proposes to change a protocol regarding the care of postoperative clients. However, the nursing staff openly expresses their resistance to the change and wants to continue with the original protocol. Which behavioral pattern in response to change best describes the nursing staff? 1 Laggards 2 Rejectors 3 Early majority 4 Late majority
1 Laggards value their traditional practices and may openly express their resistance to the change. Rejectors actively resist the change and may use sabotage to avoid the change. An early majority may prefer a conventional approach but accept the change gradually. A late majority is openly resistant to change and does not accept the change until all others have accepted it.
The registered nurse (RN) is teaching a student nurse about the qualities of a transactional leader. Which statement made by the student indicates effective learning? 1 "I will penalize team members for poor performance." 2 "I will motivate employees by articulating an inspirational vision." 3 "I will encourage employees to transcend their own self-interests." 4 "I will challenge the process that involves new solutions to old problems."
1 "I will penalize team members for poor performance." A transactional leader is responsible for penalizing a nurse executive for poor performance. This type of leader influences followers to fulfill their contracts or get penalized. Motivating employees by articulating an inspirational vision is the behavior of a transformational leader. Encouraging employees to transcend their own self-interests to increase job satisfaction is the behavior of a transformational leader. Challenging the process that involves new solutions to old problems is the behavior of a transformational leader.
Which question does the registered nurse recognize as related to the right of circumstance when delegating? 1 "Is the delegation appropriate to the situation?" 2 "Is the task within the delegatee's scope of practice?" 3 "Is the prospective delegate a willing and able employee?" 4 "Is the delegator able to monitor and evaluate the client appropriately?"
1 "Is the delegation appropriate to the situation?" The question, "Is the delegation appropriate to the situation?" is related to right circumstance. The question, "Is the task within the delegatee's scope of practice?" is related to right task. The question, "Is the prospective delegate a willing and able employee?" is related to right person. The question, "Is the delegator able to monitor and evaluate the client appropriately?" is related to right supervision.
The leader encounters a situation where the nursing outcomes are unpredictable. Which attributes or approaches should the leader utilize to navigate this situation? Select all that apply. 1 Creativity 2 Experience 3 Enthusiasm 4 Group process 5 Independent decision making
1 Creativity, 2 Experience, 4 Group process A situation with unpredictable results requires creativity, experience, and group process. Enthusiasm is an important quality of a follower but it would be a secondary factor to be considered in this situation. Independent decision making would not be appropriate to this situation. Rather, the leader should seek expert opinion and involve key stakeholders.
The registered nurse (RN) delegates the collection of respiratory rate data to a licensed practical nurse (LPN) for a client who is experiencing severe dehydration and whose condition is unstable. The LPN reports the data to the RN. The RN rechecks the data and finds that the report no longer reflects the client's current condition. Which characteristic of communication has interfered with the delegation process? 1 Information decay 2 Information salience 3 Confidence in abilities 4 Synergy between team members
1 Information decay Information decay can occur in a rapidly changing situation when reported information is no longer relevant to a client's condition. Information salience describes the different ways individuals from different backgrounds might assess the quality, meaning, and clarity of certain information. Trust is developed when there is confidence in the abilities and capabilities of the team members. Healthy relationships among members of the health care team promote synergy between the team members.
Which actions indicate that a manager is helping staff adjust to functional nursing? Select all that apply. 1 Staff meeting conducted every Tuesday at 1 pm 2 Charge nurse assigned to analyze client outcomes 3 Staff assigned to make out daily assignments sheet 4 Assigned tasks rotated among same category of care providers 5 Staff nurses assigned to review research studies for evidence-based care
1 Staff meeting conducted every Tuesday at 1 pm 4 Assigned tasks rotated among same category of care providers Since functional nursing can appear to be autocratic, the nurse manager can improve the staff's lack of independence by conducting frequent staff meetings and rotating assigned tasks among members of the same category of care providers. The nurse manager should analyze client outcomes. The charge nurse makes out daily assignment sheets. Reviewing research studies is not a client-focused task in functional nursing. The functional model of nursing is a method of providing client care by which each licensed and unlicensed staff member performs specific tasks for a large group of clients.
The charge nurse is reviewing clients' medical records on the cardiovascular care unit. Which client care outcomes are appropriate? Select all that apply. 1. Client receiving a continuous heparin infusion for a deep venous thrombosis remains free of petechiae or purpura 2. Client who had a carotid endarterectomy maintains a heart rate <100/min and blood pressure >90/60 mm Hg with no neurological changes 3. Client who had a percutaneous coronary intervention maintains a chest pain level of <4 on a scale of 0-10 while at rest 4. Client with hypertension receiving IV furosemide remains free from muscle cramping in the extremities 5. Client with peripheral arterial disease following a femoral-popliteal angioplasty remains free of leg pain during ambulation
1, 2, 4, 5 Clients receiving IV heparin should maintain therapeutic clotting times, avoid developing embolic events, and remain free from signs of heparin-induced thrombocytopenia (eg, petechiae, purpura) (Option 1). Clients having undergone a carotid endarterectomy, a surgical procedure removing plaque from carotid arteries, would be expected to show no evidence of hemorrhage (eg, hypotension, tachycardia) or neurological impairment (eg, decreased level of consciousness, altered mental status) (Option 2). Clients receiving IV furosemide, a loop diuretic, should maintain adequate blood pressure and avoid developing symptoms of electrolyte imbalance (eg, muscle weakness, cramps, cardiac arrhythmia) (Option 4). A femoral-popliteal angioplasty is a surgical procedure to restore perfusion to the legs of clients with peripheral arterial disease. After the procedure, the client should be able to ambulate without evidence of extremity ischemia (eg, leg pain) (Option 5). (Option 3) A percutaneous coronary intervention (PCI) is a procedure used to restore coronary perfusion to prevent or treat ischemia or infarction. Clients having undergone a PCI would be expected to have no chest pain at rest. Chest pain at rest indicates myocardial ischemia. Educational objective: Clients receiving heparin should remain free from heparin-induced thrombocytopenia. After carotid endarterectomy, clients should remain free from hemorrhage and neurological impairment. Those receiving loop diuretics should maintain electrolytes within normal limits. After a femoral-popliteal angioplasty, clients should be able to ambulate without leg pain. They should have no chest pain at rest after a percutaneous coronary intervention.
There has been a major community disaster. Stable clients need to be discharged to make more beds available for the victims. Which clients could be discharged safely? Select all that apply. 1. Diagnosed with endocarditis on antibiotics with a peripherally inserted central catheter (PICC) line 2. History of multiple sclerosis with ataxia and diplopia 3. One day postoperative from a hemicolectomy 4. Reporting abdominal pain with coffee ground emesis 5. Taking warfarin with prothrombin time/International Normalized Ratio of 2x control value
1, 2, 5 Ataxia and diplopia are expected signs/symptoms of multiple sclerosis. Two times the control value demonstrates that warfarin has reached a therapeutic level. The long-term antibiotic course (and follow-up lab work) can continue at home through the PICC line (Options 1, 2, and 5). (Option 3) Large intestine peristalsis does not return for up to 3-5 days. The client cannot be discharged until able to tolerate oral intake with normal elimination. The client has to at least be passing flatus. (Option 4) Coffee ground emesis indicates upper gastrointestinal bleeding. The etiology and treatment need to be determined before the client is discharged. Educational objective: Those who are stable for discharge include the client with multiple sclerosis with ataxia and diplopia, the client on warfarin (Coumadin) that has reached the therapeutic effect, and the client with a PICC line for a long-term antibiotic course.
The nurse leader arranges a meeting with the staff members to learn how satisfied they are with their jobs. Which approach by the nurse leader would outline effective leadership? Select all that apply. 1 Seeking feedback from the team 2 Allotting work schedules to the team 3 Penalizing the team for poor performance 4 Motivating the team to reach the desired goals 5 Asking the team to participate in decision making
1, 4, 5 Seeking feedback from the team will help the team members in reaching the organizational goals and a shared vision. The most important leadership quality is to motivate the team members in such a way that they are satisfied with their jobs and helped in reaching their goals. Asking team members to participate in decision making will improve their job satisfaction. Allotting the work schedules and penalizing team members for poor performance are the duties of a nurse manager.
Which statements involve acceptable use of an abbreviation, symbol, or dose designation in documentation? Select all that apply. 1. "2 cm × 3 cm × 1 cm stage II decubitus noted on left shin." 2. "4.0 u SSRI administered to cover capillary glucose of 160 mg/dL." 3. "Dose of .5 mg hydromorphone administered and the client feels 'better.'" 4. "Maalox 5 mL PO administered pc as requested for c/o heartburn." 5. "Spouse voiced understanding of home urinary catheterization QID."
1, 4, 5 The Joint Commission (2004) and Institute for Safe Medication Practices prohibit error-prone or "dangerous" abbreviations, descriptions of symptoms, and dose designations in medical documentation. "Cm" (centimeters) and "II" (2) (eg, decubitus staging) are acceptable abbreviations/notations (Option 1). The abbreviations "ac" (before meals), "pc" (after meals), and "c/o" (complains of) are acceptable (Option 4). "QID" (4 times a day) is acceptable. Abbreviations that are not acceptable include "qd" (daily) and "q1d" (daily), which can be mistaken for "qid" (4 times a day), and "qod" (every other day), which can be mistaken for "qd" (daily) (Option 5). (Option 2) A trailing zero after the decimal point is not acceptable as it could be interpreted as 40 instead of 4 if the decimal point is not noted. The use of "u" for unit is not acceptable as it can be mistaken for the number 0 or 4 (eg, 4u seen as 40). "SSRI" (sliding-scale regular insulin) is not acceptable to indicate insulin as it can be mistaken for selective serotonin reuptake inhibitor. "Mg" for milligrams is acceptable. (Option 3) A zero must precede the decimal dose. If the decimal point is missed, ".5" could be mistaken for 5 mg. Educational objective: Acceptable abbreviations include "ac," "pc," "QID," and "cm." Unacceptable abbreviations include "qd," "q1d," and "qod"; "SSRI" for insulin; and "u" for units. There must be a zero before a decimal dose and no trailing zero after a decimal point.
According to the three-tiered triage system, which client requires urgent treatment? Select all that apply. 1 A client with renal colic 2 A client with strains and sprains 3 A client with respiratory distress 4 A client with severe abdominal pain 5 A client with multiple displaced fractures
1, 4, 5 According to the three-tiered triage system, renal colic, severe abdominal pain, and multiple displaced fractures require urgent treatment. Strains and sprains require nonurgent treatment and respiratory distress requires emergent treatment.
Which are the highest priorities when conducting a primary client survey during the emergency assessment? Select all that apply. 1 Airway 2 Disability 3 Breathing 4 Circulation 5 Cervical spine
1, 5 Airway and stabilization of the cervical spine are the top priorities when conducting a primary client survey during the emergency assessment. The nurse will then focus on breathing, circulation, and disability.
The nurse manager is teaching newly assigned delegators about the limitations of delegation. Which statements made by the delegators indicate effective teaching? Select all that apply. 1. "Personal hygiene activities can be delegated to unlicensed assistive personnel (UAP)." 2. "Administration of oral medication can be delegated to the licensed practical nurse (LPN)." 3. "Administration of intravenous medication can be delegated to the licensed practical nurse (LPN)." 4. "Tasks related to caring for diabetic clients can be delegated to unlicensed assistive personnel (UAP)." 5. "Tasks related to caring for clients in a hospice care setting can be delegated to licensed vocational nurses (LVNs)."
1. "Personal hygiene activities can be delegated to unlicensed assistive personnel (UAP)." 2. "Administration of oral medication can be delegated to the licensed practical nurse (LPN)." 5. "Tasks related to caring for clients in a hospice care setting can be delegated to licensed vocational nurses (LVNs)." Activities related to client hygiene can be delegated to unlicensed assistive personnel (UAP). Administration of oral medication can be done by the licensed practical nurse (LPN). Licensed vocational nurses (LVNs) can care for the clients in a hospice care setting. Administration of intravenous medication cannot be done by LPNs as they are not eligible. Diabetic clients cannot be cared by UAP as this group does not have sufficient knowledge about how to care for clients with diabetes.
When assigning a task, the delegator should understand the delegatee's personal values and align them with the organizational values. Which task can be achieved from this delegation? 1. Affirming 2. Managing 3. Renewing 4. Motivating
1. Affirming In the task of affirming values, sharing the personal values of the delegatee and aligning them with organizational values enables the delegatee to achieve an outcome. In managing, the delegator assists the delegatee with planning. In renewing, the outcome is achieved by enhancing the ability to care for the delegatee. In motivating, the delegatee is inspired to achieve the outcome.
Arrange in order the series of tasks to be performed by the registered nurse (RN) to determine active delegation?
1. Assessing the situation 2. Determining the care plan 3. Directing the unlicensed assistive personnel (UAP) to perform the task 4.Monitoring the client In active delegation, the registered nurse (RN) assesses the situation, determines which condition is appropriate for client care, makes a care plan, and then directs an unlicensed assistive personnel (UAP) to perform required tasks. When the UAP has completed the task, the RN monitors the condition of the client once again.
Which component of delegation is suitable to all the members on the healthcare team? 1. Authority 2. Supervision 3. Accountability 4. Communication
1. Authority Authority is the component of delegation that is suitable for all the members on the healthcare team. Supervision is a right of delegation in which the delegator supervises the other assistive personnel to perform the task. Accountability is the component of delegation that is suitable for delegators such as registered nurses (RNs). Communication is the right of delegation in which the delegator gives the directions to perform the task.
While caring for a client with asthma, the delegator assigns the client to a registered nurse (RN) and to a licensed practical nurse (LPN). Which component of delegation is transferable to the RN? Select all that apply. 1. Authority 2. Supervision 3. Responsibility 4. Accountability 5. Communication
1. Authority 3. Responsibility 4. Accountability Authority, a component of delegation, is transferred to the registered nurse (RN) by the delegator. Responsibility is the component of delegation that is transferable to the RN. Accountability is also a component of delegation that is transferable to the RN. Supervision and communication are rights of delegation.
In a health care setting, there are a limited number of unlicensed nursing personnel. Who would take up the responsibility of delegation in place of the registered nurse? 1. Charge nurse 2. Chief nursing officer 3. Patient care associate 4. Licensed practical nurse
1. Charge nurse Charge nurses act as delegators as they also have knowledge and expertise in the clinical setting. In cases where there are a limited number of unlicensed nursing personnel, the registered nurse does not delegate tasks. In this instance the charge nurse usually becomes a delegator and delegates the tasks. The chief nursing officer is not the immediate person to delegate the tasks in such instances. Patient care associates and licensed practical nurses act as delegatees.
During the delegation process, which healthcare professional acts as a liaison between the team leader and healthcare provider? 1. Charge nurse 2. Nurse manager 3. Nursing supervisor 4. Chief nursing officer
1. Charge nurse The charge nurse is responsible for acting as a liaison between the team leaders and healthcare providers. Nurse managers cannot act as a liaison between the team leader and other healthcare providers because they are often responsible for more than one unit and have other managerial responsibilities. The nursing supervisor will be delegated to supervise and ensure effective outcomes for the tasks delegated to the delegatees. The chief nursing officer is responsible for establishing the systems for assessment.
Which characteristics of a licensed practical nurse should be considered before delegation of tasks? Select all that apply. 1. Critical thinking 2. Effective client care 3. Diagnostic reasoning 4. Synthesizing information 5. Accountability of assigned task
1. Critical thinking 3. Diagnostic reasoning 4. Synthesizing information Critical thinking, diagnostic reasoning, and the ability to synthesize information from various sources are three factors that are characteristics of the licensed practical nurse that should be considered before delegating tasks. Planning effective client care is the role of a registered nurse. Accountability for an assigned task is the basic responsibility of a nurse.
Which of the nurse's statements are true regarding delegation? Select all that apply. 1. Delegation is a complex process. 2. Delegation involves a single individual to achieve the goals. 3. Delegation involves transfer of responsibility and accountability. 4. Delegation improves client care outcomes when used effectively. 5. Delegation includes delegatees who allocate a portion of work to others.
1. Delegation is a complex process. 4. Delegation improves client care outcomes when used effectively. Delegation is a complex decision-making strategy implemented to the work-related performance of the staff employed in healthcare organizations. Therefore, when used effectively, delegation improves client care outcomes. Delegation always involves at least two individuals such as the delegator and the delegatee, who engage in open communication to achieve a goal. Delegation involves the transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome. Delegation includes delegators who allocate a portion of work to others.
What are the three strategies that the nurse can perform while assisting other nurses in making delegation decisions? Select all that apply. 1. Doing 2. Telling 3. Asking 4. Offering 5. Participating
1. Doing 3. Asking 4. Offering The nurse can assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Telling and participating are the strategies used by the nurse to communicate with the delegatee.
What are the purposes of applying the four elements of safety, critical thinking, stability, and time in delegation? Select all that apply. 1. Encouraging effective delegation decisions 2. Ensuring effectiveness in performing elements of care 3. Determining the level of readiness according to Hersey 4. Developing the expectations of individuals to accomplish safety 5. Assessing the ability of unlicensed nursing personnel (UNP) to perform the task
1. Encouraging effective delegation decisions 2. Ensuring effectiveness in performing elements of care 5. Assessing the ability of unlicensed nursing personnel (UNP) to perform the task Applying the four elements of safety, critical thinking, stability, and time creates an integrative process that encourages effective delegation decisions. Elements of implementation should be understood to ensure effectiveness in performing elements of care. These elements must be considered while assessing the ability of unlicensed nursing personnel (UNP) to perform the task. To determine the readiness of a delegate, factors such as ability and willingness should be assessed according to Hersey's model of leadership. Practice acts, position descriptions, and policies are the elements required to form the expectations for which the individuals in certain conditions are expected to be able to accomplish safety.
How can registered nurses develop delegation and supervisory strategies to adapt to their changing roles? Select all that apply. 1. Engage a nurse mentor for guidance. 2. Practice the nursing care process in various clinical settings. 3. Reinforce delegation knowledge through continuing education. 4. Become familiar with the hierarchy of authority in the health care organization. 5. Seek high-quality clinical delegation experience early in their career.
1. Engage a nurse mentor for guidance. 3. Reinforce delegation knowledge through continuing education. 5. Seek high-quality clinical delegation experience early in their career. Engaging a nurse mentor helps provide guidance and facilitate problem-solving related to delegation and supervision. Reinforcing delegation knowledge through continuing education helps nurses become familiar with the changing trends in health care delivery in context of delegation. Seeking high-quality clinical delegation experience early in a nurse's career helps nurses gain confidence in delegation skills. Practicing the nursing care process in various clinical settings helps the nurses to improve client outcomes, but would not specifically help develop delegation and supervisory strategies. Becoming familiar with the hierarchy of authority in the health care organization may help nurses understand management-related issues. However, this knowledge would not directly help nurses develop delegation and supervisory strategies.
The registered nurse finds information decay during the process of delegation. What possible causes may have contributed to this? Select all that apply. 1. Frequent changes in the heart rate of the client 2. Rapid change in the blood pressure of the client 3. Frequent changes in the client's perception of pain 4. Diverse cultural background of the delegator and delegatee 5. Different educational background of the delegator and delegatee
1. Frequent changes in the heart rate of the client 2. Rapid change in the blood pressure of the client 3. Frequent changes in the client's perception of pain Information decay is a characteristic of communication that occurs when the client's health status changes rapidly and specific information loses its value or becomes irrelevant to the client's condition. Rapid change in the blood pressure, frequent changes in the heart rate, and frequent changes in the client's perception to pain can all cause rapid changes in information and lead to information decay. Diverse cultural backgrounds of the delegator and delegatee refer to another characteristic of communication, "information salience." Different educational backgrounds of the delegator and delegatee refer to another characteristic of communication, "information salience."
What is an important consideration for delegation of care by the nurse when the delegatee has limited knowledge and ability to perform the task? 1. Guidance 2. Expectation 3. Explanation 4. Responsibility
1. Guidance Guidance is needed by the delegatee from the delegator to complete a task properly when the delegatee has limited knowledge and ability to perform the task. Communicating mutual expectations and conditions of performance should be given to a delegatee who has willingness and ability, but the relationship is new. The delegator should give an explanation of the task to a delegatee if they have an ongoing relationship but the task assigned is new. During the delegation process, the delegator assigns the work and gives the delegate the responsibility to perform the task.
The nurse leader actively participates in the quality improvement process. Arrange the steps in a sequence that the nurse leader will follow while implementing the quality improvement process? 1. Select a plan to meet the outcomes. 2. Collect the data for evaluating the plan. 3. Establish the outcomes and quality indicators. 4. Identify the important needs of the consumer. 5. Collect the data on the current status of the service. 6. Collaborate with the interprofessional team to review needs.
1. Identify the important needs of the consumer. 2. Collaborate with the interprofessional team to review needs. 3. Collect the data on the current status of the service. 4. Establish the outcomes and quality indicators. 5. Select a plan to meet the outcomes. 6. Collect the data for evaluating the plan. The first step of the quality improvement process involves identifying the needs that are important to the consumer of healthcare services. Collaborating with the interprofessional team to review the needs that are identified is done to avoid bias. The next step is confirming the needs and collecting the data on the current position of the service that helps in the improvised plan. This is followed by implementing the process and establishing the outcomes for which quality indicators are required. Then the next step is to select and implement the plan to meet the outcomes and objectives of quality improvement. Evaluating the plan is the last step and is necessary for quality improvement.
The registered nurse (RN) assigned a task to the licensed practical nurse (LPN) to monitor the vital signs of the client. The LPN monitored and reported the information to the RN. Which characteristic of communication may interfere in this delegation process? 1. Information decay 2. Information quality 3. Information salience 4. Information of mutual trust
1. Information decay When the information is not properly reported and when there is a chance of missing information, then the characteristic of communication is information decay. When the information is reported with quality and clarity then the characteristic of communication in the delegation process is information salience. Information quality is giving the right message in a timely manner. Mutual trust improves the effectiveness of delegation.
Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply. 1. Is the prospective delegatee a willing and able employee? 2. Does the delegatee understand the directions and expected results of the task? 3. Does the delegatee understand how, what, and when to report to the delegator? 4. Is it clear that the delegatee will provide feedback related to the task when appropriate? 5. Does the delegatee have the knowledge and experience to perform the specific task safely?
1. Is the prospective delegatee a willing and able employee? 5. Does the delegatee have the knowledge and experience to perform the specific task safely? The right delegatee is chosen on the basis of the person's willingness and ability. The nurse should assess the knowledge and experience of the prospective delegatee to perform the specific task safely and fulfill the expected outcomes. Right direction and documentation are assessed by the delegatee's ability to understand the directions and expected results of the task. It can also be assessed on the basis of the delegatee's understanding of how, what, and when to report to the delegator. The right supervision is providing feedback to the delegatee, related to the task, when appropriate.
Which care activities would be involved in a correct delegation process? Select all that apply. 1. Licensed practical nurse (LPN) cleans the client's body. 2. Unlicensed assistive personnel (UAP) provides medication to the client. 3. Unlicensed assistive personnel (UAP) assist the client with oral feedings. 4. Licensed practical nurse(LPN) evaluates the client's temperature condition. 5. Registered nurse (RN) guides the unlicensed assistive personnel (UAP) while recording client's temperature.
1. Licensed practical nurse (LPN) cleans the client's body. 3. Unlicensed assistive personnel (UAP) assist the client with oral feedings. 5. Registered nurse (RN) guides the unlicensed assistive personnel (UAP) while recording client's temperature. Activities such as cleaning the client's body and assisting the client with oral feeding can be performed by the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). It is always the responsibility of the registered nurse (RN) to guide the UAP while performing any activity. The UAP is not allowed to perform activities such as providing medication. The LPN should not evaluate the client condition; it is the responsibility of the RN.
What are some challenges faced in the process of delegation? Select all that apply. 1. Limited resources 2. Large geographic area 3. Time-saving considerations 4. Vulnerable populations receiving care 5. Provision of assistance with activities of daily living
1. Limited resources 2. Large geographic area 4. Vulnerable populations receiving care Delegation is a complex process. Delegating a task when resources are limited is a great challenge. Delegation is also more challenging the larger the geographic area is where the task should be performed. The process of delegation also becomes more challenging when care is being delivered to vulnerable populations. Time conservation is a benefit of the delegation process even if the decision to delegate may not be based on time-saving considerations. Providing assistance with the client's activities of daily living is a benefit rather than a challenge of delegation.
What would the nurse describe as the challenges of delegation? Select all that apply. 1. Limited resources 2. More staff availability 3. Larger geographic area 4. Care for vulnerable populations 5. Deciding if delegating is time-saving
1. Limited resources 3. Larger geographic area 4. Care for vulnerable populations Delegation can be more challenging when the resources are limited, when the geographic area is greater, and when care is given for vulnerable populations. Availability of more staff is a benefit of delegation. Decisions for delegation should not be solely based on time-saving considerations; they should also be based on the abilities of the nursing staff to complete the tasks effectively and safely.
Which actions in the delegation process represent accountability? Select all that apply. 1. Monitoring client care 2. Seeking the outcome report 3. Assessing the ability of the delegatee 4. Providing honest feedback to the delegatee 5. Assisting registered nurses with delegation decisions
1. Monitoring client care 2. Seeking the outcome report Monitoring client care and seeking the outcome report represents accountability of the task in case of conflicts. Assessing the ability of the delegatee and educating about the task indicates responsibility. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions regarding safety issues, urgency to intervene, or potential negative client outcomes.
Before assigning a task, the registered nurse makes sure that the prospective delegatee is willing to complete the task. Which delegation right does this situation reference? 1. Person 2. Supervision 3. Circumstance 4. Communication
1. Person Ensuring that the prospective delegatee is willing to complete the task refers to the delegation right person. Knowing whether the delegator is able to monitor and evaluate the client appropriately refers to the delegation right supervision. Ensuring whether the equipment and resources are available to complete the delegation process refers to circumstance. Ensuring whether the delegator and delegatee understand a common work-related language refers to the delegation right communication.
Which member of the healthcare team would the nurse claim performs functions through passive delegation? 1. Pharmacist 2. Unit secretary 3. Licensed practical nurse 4. Unlicensed assistive personnel
1. Pharmacist A pharmacist performs functions through passive delegation. Unit secretaries may not be eligible to perform any activity because they do not have formal preparation and legal recognition. The licensed practical nurse does not delegate, but rather acts as a delegatee. The unlicensed assistive personnel are also delegatees.
What are the various challenges related to delegation? Select all that apply. 1. Providing clear direction to the delegatee 2. Understanding the skill set of the delegatee 3. Providing verbal attack feedback to the delegatee 4. Maintaining an open line of communication with the delegatee 5. Creating a working environment in collaboration with the delegatee
1. Providing clear direction to the delegatee 2. Understanding the skill set of the delegatee 4. Maintaining an open line of communication with the delegatee Providing clear direction to the delegatee aids accomplishment of the specified task in the given time. Understanding the specific skill set and capabilities of the delegatee is a crucial element in the delegation process. Selecting a delegatee with the specific skill set for the particular task is more productive than just selecting a competent individual. Maintaining an open line of communication with the delegatee, without any derogatory or offensive comments, yields a collaborative and productive work environment. Providing verbal attack feedback may not produce effective change and could undermine any long-term working relationship. Creating a working environment is an essential and easy delegation task that is essential to promoting positive work output.
Which description by the nurse is a correct explanation of delegation? 1. The transfer of responsibility for the performance of an activity 2. The person's responsibility and accountability for individual actions or omissions 3. The active process of directing, guiding, and influencing the outcome of an individual 4. The transfer of both the accountability and responsibility from one person to another
1. The transfer of responsibility for the performance of an activity Delegation is the transfer of responsibility for the performance of an activity. Personal liability defines each person's responsibility and accountability for individual actions or omissions. Supervision is defined as the active process of directing, guiding, and influencing the outcome of an individual. Assignment is the transfer of both the accountability and the responsibility from one person to another.
The nurse is teaching a client how to teach the supraglottic method of swallowing. Arrange the prioritizing order of statements by the nurse for teaching the client. 1. "Swallow twice." 2. "Hold your breath." 3. "Clear your throat." 4. "Take a deep breath." 5. "Place yourself in an upright position." 6. "Place a half to 1 teaspoon of food into your mouth."
1."Place yourself in an upright position." 2."Clear your throat." 3."Take a deep breath." 4."Place a half to 1 teaspoon of food into your mouth." 5."Hold your breath." 6."Swallow twice." The order of steps to be followed in instructing the client in the supraglottic method of swallowing is first to place the client in an upright position, secondly to tell the client to clear the throat, and then to take a deep breath. The fourth step is for the client to place a half or one teaspoon of food into the mouth. The client should hold his or her breath and then swallow twice. This method exaggerates the normal protective mechanisms with cessation of respiration during the swallow.
The nurse is performing resuscitation interventions for airway, breathing, and circulation as part of a primary survey in a client. Which order of actions should the nurse follow for this client? 1. Use direct pressure for external bleeding. 2. Prepare for chest decompression if needed. 3. Assess breath sounds and respiratory effort. 4. Establish airway by positioning, suctioning, and oxygen as needed. 5. Maintain vascular access using a large-bore catheter.
1.Establish airway by positioning, suctioning, and oxygen as needed. 2.Assess breath sounds and respiratory effort. 3.Prepare for chest decompression if needed. 4.Maintain vascular access using a large-bore catheter. 5.Use direct pressure for external bleeding. The primary survey includes assessment of airway/cervical spine, breathing, circulation, disability, and exposure. First, the nurse should establish airway patency by positioning, suctioning, and providing oxygen as needed. Assess breath sounds and respiratory effort and provide chest decompression if needed in order to assess breathing. Maintain vascular access using a large-bore catheter and use direct pressure for any external bleeding.
Which order of steps would the nurse teach the client to follow while performing expansion breathing? 1. Place hands on each side of lower ribcage, just above the waist. 2. Sit in an upright position with knees slightly bent. 3. Exhale, first moving the chest and then lower ribs inward while gently squeezing the ribcage, forcing air out of the base of lungs. 4. Take a deep breath through your nose, using shoulder muscles to expand your lower ribcage outward during inhalation.
1.Sit in an upright position with knees slightly bent. 2.Place hands on each side of lower ribcage, just above the waist. 3.Take a deep breath through your nose, using shoulder muscles to expand your lower ribcage outward during inhalation. 4.Exhale, first moving the chest and then lower ribs inward while gently squeezing the ribcage, forcing air out of the base of lungs. While performing expansion breathing, the client should sit in an upright position with slightly bent knees because it decreases tension on the abdominal muscles and respiratory resistance and discomfort. Then the client should place hands on each side of the lower ribcage, just above the waist. A deep breath through the nose is taken, using shoulder muscles to expand the lower ribcage outward during inhalation. The client then exhales by first moving the chest and then lower ribs inward while gently squeezing the ribcage, forcing air out of the lungs.
After receiving the shift report, the nurse should assess which infant first? 1. An infant born 6 hours ago after 38 weeks gestation who has a respiratory rate of 52/min 2. An infant born 12 hours ago who is jittery and has a blood glucose level of 40 mg/dL (2.2 mmol/L) 3. An infant with bilateral crackles who was delivered vaginally 30 minutes ago 4. An infant wrapped in a warm blanket 15 minutes ago due to a temperature of 97.7 F (36.5 C)
2 A normal blood glucose range for an infant is 40-60 mg/dL (2.2-3.3 mmol/L) within the first 24 hours after delivery. A blood glucose level <40 mg/dL (2.2 mmol/L) indicates hypoglycemia. Symptoms of hypoglycemia include jitters, cyanosis, tremors, pallor, poor feeding, retractions, lethargy, low oxygen saturation, and seizures. This infant with borderline-low glucose level is symptomatic and should be assessed first. (Option 1) A normal respiratory rate for an infant is 30-60/min. This infant is currently stable. (Option 3) It is normal to auscultate crackles in an infant during the first hour of life. This is because fluid is still being pushed out of and absorbed by the lungs. This infant is currently stable. (Option 4) A normal temperature range for an infant is 97.7-99.7 F (36.5-37.6 C). This infant is currently stable. Educational objective: The nurse should monitor infants for hypoglycemia by assessing for symptoms and monitoring the blood glucose level. A blood glucose level <40 mg/dL (2.2 mmol/L) indicates hypoglycemia and should be treated immediately by feeding or administering a glucose bolus.
The charge nurse must assign a semi-private room to a client with diabetes mellitus admitted for IV antibiotic therapy to treat leg cellulitis. Which of the 4 room assignments is the best option for this client? 1. Room 1: Client 1 day postoperative laparoscopic cholecystectomy who is awaiting discharge 2. Room 2: Client with dementia and urinary incontinence wearing an external urine collection device 3. Room 3: Client with history of splenectomy 15 years ago, now admitted for pulmonary embolism 4. Room 4: Client with lupus nephritis who is prescribed treatment with azathioprine
2 Cellulitis is a common skin bacterial infection that is usually treated with IV antibiotics in clients with diabetes mellitus. Room 2 is the best assignment option for this client with cellulitis. The client with dementia and urinary incontinence who has an external urinary condom catheter is the least susceptible to infection compared to those in rooms 1, 3, and 4. (Option 1) The client who is 1 day postoperative laparoscopic cholecystectomy (surgical procedure with small incisions) is at increased risk for infection. The client with cellulitis should not be placed in room 1. (Option 3) Although this client has pulmonary embolism, the history of prior splenectomy leads to a very high lifelong risk of rapid sepsis. Splenectomy clients need vaccination against encapsulated organisms (eg, pneumococcus, meningococcus, and Haemophilus influenzae type B). Even a low-grade fever should be taken seriously in these clients. The client with cellulitis should not be placed in room 3. (Option 4) Lupus nephritis is a serious renal complication of systemic lupus erythematosus (SLE), an inflammatory autoimmune disease that can lead to end-stage kidney disease. The systemic disease and the immunosuppressant (azathioprine [Imuran]) prescribed to slow its progression increase infection risk. The client with cellulitis should not be placed in room 4. Educational objective: A client with an infection should not be assigned to a semi-private room with a client who had surgery or is immunocompromised and receiving immunosuppressants as these clients are highly susceptible to infection. Post-splenectomy clients are also at lifelong risk for rapid sepsis.
The registered nurse (RN) is getting ready to leave the client care unit for a lunch break. The RN asks the LPN to take care of a client during the lunch break. Which concept is emphasized in this situation? 1 Leadership 2 Delegation 3 Supervision 4 Assignment
2 Delegation is the concept of a transfer of authority between two people to perform some type of task, e.g., between an RN and licensed staff. Leadership is the action of leading a group or an organization. Supervision is defined as the active process of directing, guiding, and influencing the outcome of an individual's performance. Assignment is the transfer of both accountability and responsibility.
The healthcare team is caring for a client with neutropenia. Which task is delegated to unlicensed assistive personnel? 1 Administering antibiotics 2 Assisting with personal hygiene 3 Monitoring for signs and symptoms of infection 4 Teaching the client and caregivers about how to avoid infection
2 Unlicensed assistive personnel assisting with the client's personal hygiene. The licensed practical nurse administers antibiotics. Monitoring for signs and symptoms is performed by the licensed practical nurse. The registered nurse teaches the client and caregivers how to avoid infection.
A client's serum potassium level has increased to 5.8 mEq/L (5.8 mmol/L). What action should the nurse implement first? 1 Call the laboratory to repeat the test. 2 Take vital signs and notify the healthcare provider. 3 Inform the cardiac arrest team to place them on alert. 4 Take an electrocardiogram and have lidocaine available.
2 Vital signs monitor cardiorespiratory status; hyperkalemia causes cardiac dysrhythmias. The healthcare provider should be notified because medical intervention may be necessary. A repeat laboratory test will take time and probably reaffirm the original results; the client needs immediate attention. The cardiac arrest team is always on alert and will respond when called for a cardiac arrest. Taking an electrocardiogram and having lidocaine available are insufficient interventions.
Which comment by a team leader exemplifies team nursing the way it was intended? 1 "(Unlicensed assistive personnel), I need you to measure all vital signs." 2 "(Registered Nurse 1), check all of the intravenous (IV) sites and give the IV medications." 3 "(Licensed Practical Nurse), you pass all of the oral medications to the clients today." 4 "(Registered Nurse 2), Mr. Jones has a foot wound, two IV meds, and needs morning insulin."
2 "(Registered Nurse 1), check all of the intravenous (IV) sites and give the IV medications." The team leader must have excellent communication skills, delegation, and effective decision-making abilities to provide a working "team" environment for members. When the team leader is not prepared for this role, the team method becomes a miniature version of the functional method. The assignment given to RN 1 takes the nurse's experience and skills into consideration and exemplifies team nursing. The statements made to the UAP, LPN, and RN 2 exemplify functional nursing.
Which statement of the nurse leader reflects the actions suggested by the Joint Commission for disruptive behavior by a direct care nurse? 1 "This is the last warning for you." 2 "You are terminated, effective now." 3 "This will affect your assessment markings." 4 "You should not behave this way because you are very talented."
2 "You are terminated, effective now." According to the actions suggested by the Joint Commission, there is "zero" tolerance for an intimidating and/or disruptive behavior. The action to be taken for this type of behavior should be suspension, termination, loss of clinical privileges, and reporting to professional licensure bodies. The actions suggested by the Joint Commission do not include giving last a warning. The nurse who has behaved disruptively is not eligible for any assessment. By saying, "You should not behave this way because as you are very talented," the actions suggested by Joint Commission are not being carried out.
The registered nurse (RN) and unlicensed assistive personnel (UAP) have been working together for two years. Which statement made by the RN would be appropriate after delegating a task to the UAP? 1 "Let me tell you how to do this task." 2 "You know what to do and when to report." 3 "Please tell me how you are going to perform this procedure." 4 "It is important that you check the client's temperature every hour."
2 "You know what to do and when to report." According to Hersey's model of situational leadership, the delegator should act according to the situation. When there is an established relationship between the delegator and the delegatee, little guidance needs to be provided to the delegatee. When the relationship is new and a new task is delegated, an explanation is required about how to perform the task. When the delegatee is newly assigned, then the delegator checks the ability of the delegatee by asking how to perform the procedure. When the relationship between the delegatee and delegator is new, and it is for a limited period, then the delegator just informs the delegatee what is to be done.
The registered nurse is assessing the conditions of four different clients. Which client's care should the registered nurse delegate to an unlicensed assistive personnel (UAP)? 1 Client A - brain injury; acute care 2 Client B - diarrhea; sub-acute care 3 Client C - uncontrolled DM; chronic care 4 Client D - HTN; acute care
2 Client B - diarrhea; sub-acute care Client B is delegated to the UAP since they are assigned to perform hygienic tasks and diarrhea is a sub-acute condition. Brain injury is a serious condition and care cannot be performed by the UAP. Uncontrolled diabetes is a chronic condition, so client C is not delegated to UAP. Hypertension is an acute condition, and client D is not delegated to the UAP.
A client is admitted to the emergency department following a motor vehicle accident. The client's wounds are extensive. Which healthcare team member is best suited to care for this client in the emergency ward? 1 Charge nurse 2 Registered nurse 3 Licensed practical nurse 4 Unlicensed nursing personnel
2 Registered nurse A registered nurse should be the healthcare team member to care for the client in the emergency department. The charge nurse's role includes making client assignments, scheduling breaks for staff members, and serving as a staff resource person. The licensed practical nurse is involved in fast-track emergency care. Unlicensed nursing personnel perform all hygienic tasks and are not required in the emergency care unit.
A nurse in the postanesthesia care unit (PACU) is providing care to a client who had an abdominal cholecystectomy and observes serosanguineous drainage on the abdominal dressing. What is the next nursing action? 1 Change the dressing. 2 Reinforce the dressing. 3 Replace the tape with Montgomery ties. 4 Support the incision with an abdominal binder.
2 Reinforce the dressing. The nurse should anticipate drainage and reinforce the surgical dressing as needed. Changing a dressing at this time is unnecessary and increases the risk for infection. Montgomery ties are used when frequent dressing changes are anticipated; they are not appropriate at this time. An abdominal binder rarely is prescribed, and it will interfere with assessment of the dressing at this time.
The nurse finds the respiratory rate is 8 breaths per minute in a client who is on intravenous morphine sulfate. What should the nurse do immediately in this situation? 1 Measure other vital signs. 2 Stop administering the medication. 3 Elevate the head of the client's bed. 4 Report to the primary healthcare provider
2 Stop administering the medication. Morphine sulfate is an opioid analgesic and can depress the central nervous system, which results in respiratory depression. A respiratory rate of 8 breaths per minute indicates respiratory depression, and the nurse should stop the medication immediately. The nurse can measure the other vital signs after discontinuing the medication administration. Elevating the head of the client's bed ensures proper breathing. Therefore the nurse should elevate the client's bed after discontinuing the medication. The nurse should report to the primary healthcare provider for an appropriate antidote after stopping the medication administration.
When does delegation become more challenging? Select all that apply. 1 When the client is stable 2 When the client is pregnant 3 When the geographic area is small 4 When the resources are abundant 5 When school children are receiving care
2 When the client is pregnant, 5 When school children are receiving care The delegation process becomes more challenging when vulnerable populations such as pregnant women and school children are receiving care. Delegation can be safely and successfully carried out in the stable client. Delegation can be accomplished successfully when the geographical area is small and resources are abundant.
The healthcare team is caring for clients in an emergency department. How soon should the clients triaged as an emergency severity index-3 (ESI-3) be seen by the physician according to the five level triage system? 1 Immediately 2 Within 1 hour 3 Could be delayed 4 Within 10 minutes
2 Within 1 hour The clients triaged as an ESI-3 should be seen by the physician within an hour. The clients with life-threatening problems are triaged as ESI-1, and they should be provided with immediate care. The care of the clients in ESI-4 and ESI-5 can be delayed for some time because the condition of the clients in this level is stable. Clients with major injuries are triaged as an ESI-2 and require treatment within 10 minutes.
Which actions of the nurse exhibit transactional leadership? Select all that apply. 1 Motivating or inspiring the employees 2 Meeting the targets within the deadline 3 Working according to organizational rules 4 Correcting the errors in a reactive manner 5 Increasing the employee commitment of an organization
2, 3, 4 The characteristics of transactional leadership include valuing the orders and structures of an organization. The nurse who exhibits transactional leadership will meet the targets within the deadline given by the organization. The nurse will also follow the rules of an organization and will correct the errors of an employee in a reactive manner. Motivating or inspiring the employees and increasing employee commitment are the characteristics of transformational leadership.
The nurse has accepted a position as a navigator. What should the nurse expect to learn during training for this role? Select all that apply. 1 Approaches to reduce the cost of health care 2 Learning ways to work through the health systems 3 Strategies to teach clients about disease, including prevention and treatment 4 Assessing barriers that clients have encountered while attempting to receive care 5 Helping clients cope with delays in receiving treatment until barriers are overcome
2, 3, 4, 5 Navigators are responsible for overcoming health system barriers, providing health education about diseases from prevention to treatment, addressing barriers to care, and providing psychosocial support. These are the areas the nurse should expect to focus on when being trained in the role. Learning approaches to reduce the cost of health care would be appropriate for a case manager to learn.
The charge nurse is identifying tasks for staff caring for clients using functional nursing. Which tasks should be assigned to the licensed practical/licensed vocational nurse (LPN/LVN)? Select all that apply. 1 Showering two clients after breakfast 2 Administering topical and oral medications 3 Providing discharge instructions to three clients 4 Measuring capillary blood glucose level for five clients 5 Identifying nursing diagnoses after analyzing collected data
2, 4 Task assignments are made according to scope of practice. For the LPN/LVN, the scope of practice would include administering topical and oral medications and measuring capillary blood glucose levels. Showering would be a task assigned to unlicensed assistive personnel (UAP). Providing discharge instructions and identifying nursing diagnoses would be assigned to the registered nurse (RN).
The nurse delegates the tasks of caring for a postpartum client. During assessment, the nurse observes an infection in the client caused by lack of hygiene. Which member of the health care team is most likely responsible for the client's condition? Select all that apply. 1 Physician 2 Registered nurse 3 Licensed practical nurse 4 Licensed vocational nurse 5 Unlicensed assistive personnel
2, 5 The registered nurse may delegate the tasks of basic client care to the unlicensed assistive personnel (UAP), but is responsible and accountable for the outcome of the task. UAP are responsible for the client's basic hygiene and comfort. A physician may delegate the task of client care to the registered nurse and other assistive personnel. A licensed practical nurse (LPN) or licensed vocational nurse (LVN) generally carries out tasks such as administering oral medication, but is not typically responsible for client hygiene if UAP are available.
A nurse is assisting another registered nurse in the intensive care unit who is caring for a client with uncontrolled blood pressure. Which action on the part of the nurse indicates "offering" during delegation decisions? 1. "Did you check the client's blood pressure this morning?" 2. "You can use this stethoscope and sphygmomanometer to take the blood pressure." 3. "Would you fetch me the client's laboratory reports? I'll record the blood pressure." 4. "How is the client doing this morning? Let me look at yesterday's blood pressure report."
2. "You can use this stethoscope and sphygmomanometer to take the blood pressure." Offering involves making a suggestion to facilitate the achievement of a desirable client care outcome. The statement, "You can use this stethoscope and sphygmomanometer to take the blood pressure," is an example of offering. Asking begins with questions related to the problem or issue regarding client care. "Did you check the client's blood pressure this morning?" is an example of asking. Doing involves demonstrating the specific task or behavior needed to improve client care. "Would you fetch me the client's laboratory reports? I'll record the blood pressure," is an example of doing. "How is the client doing this morning? Let me look at yesterday's blood pressure report," is an example of supervision.
A nurse is providing anticipatory guidance to a client with early Alzheimer disease and osteoarthritis. Current symptoms include mild forgetfulness and cognition changes. Which is the best example of an educational goal for anticipatory guidance? 1. The client will demonstrate proper organization of medications in a weekly pill box by the end of the teaching session. 2. The client will identify and attend a support group meeting for clients with dementia by the end of the month. 3. The client will verbalize 2 home safety changes that can prevent falls during disease progression by the end of the session. 4. The client will verbalize 3 examples of easy, nutritious meals that can be prepared independently by the end of the clinic visit.
3 Anticipatory guidance prepares clients and caregivers for future health needs and is useful throughout life, from pediatric growth and development to anticipated changes related to disease processes. This type of education promotes health and helps to reduce client/caregiver stress and anxiety, which heighten with unexpected cognitive, physical, and emotional changes. Anticipatory guidance educational goals should be client-oriented, realistic, objective, measurable, and focused on preparing for future needs specific to the client. The client with Alzheimer disease and osteoarthritis is at high risk for falls with disease progression. In the early stage, the client can make changes in the home to promote safety in the future (Option 3). (Option 1) Memory aids (eg, pill organizers, alarms) should be used now, while the client has only mild cognition changes. As the disease progresses, a caregiver should take over medication management. (Option 2) Support groups are an appropriate intervention for current psychosocial needs (eg, depression). (Option 4) Clients with osteoarthritis are at risk for nutritional deficits due to functional decline (eg, inability to open jars), and clients with Alzheimer disease can forget to eat. The nurse should address this current need by teaching simple meal planning. Educational objective: Anticipatory guidance addresses expected changes related to growth and development or disease progression. Educational goals should be client-oriented, realistic, objective, measurable, and focused on preparing for future needs specific to the client.
The health care provider gives the preoperative nurse a signed consent form and walks away rapidly. The client turns to the nurse and states, "I don't know what is going on. Why do I need surgery?" What is the most appropriate action? 1. Call the nursing supervisor 2. Call the operating room scheduler and cancel the surgery 3. Page the health care provider and request clarification on behalf of the client 4. Report the incident to hospital administration
3 Informed consent requires that the health care provider performing the procedure explain everything to the client's satisfaction (within reason). Signed consent may be witnessed by the nurse. If the client does not fully understand informed consent, the nurse must notify the health care provider or refer up the chain of nursing command. The nurse is not responsible for verifying that the client understands the procedure and its respective risks. (Option 1) This would be appropriate if the health care provider refuses to talk to the client. (Option 2) This is not the nurse's responsibility; this request would have to be relayed up the chain of nursing command. (Option 4) This is premature; the incident is isolated and not all facts are known. Educational objective: Clients may not consent to an invasive procedure without being informed of the clinical reasoning, consequences, and possible complications.
The charge nurse must assign a room for a client who was transferred from a long-term care facility and is scheduled for extensive surgical debridement to remove infected tissue from an unstageable pressure injury. Which room assignment is the most appropriate for this client? 1. Room A: Client with multiple myeloma who is being treated with corticosteroids 2. Room B: Client with diabetes mellitus and osteomyelitis receiving IV antibiotics 3. Room C: Client with a gastrointestinal bleed who has a nasogastric tube 4. Room D: Client with influenza with a high fever who is receiving oseltamivir
3 Surgical debridement of an unstageable pressure injury involves using a scalpel to remove necrotic (eschar) or infected tissue from the wound to promote healing. The most appropriate room assignment for this client is Room C, as the client with a gastrointestinal bleed and nasogastric tube is the least susceptible to infection compared with the clients in Rooms A and B (Option 3). (Option 1) Multiple myeloma is a cancer that involves proliferation of malignant plasma cells (monoclonal antibodies), which are ineffective in providing protection against infection and suppress normal bone marrow cell production (eg, erythrocytes, platelets, leukocytes). This client in Room A is especially vulnerable to infection due to immunosuppression related to the disease process and to drug therapy with corticosteroids. (Option 2) The postoperative client should not be assigned to Room B with a client who has osteomyelitis, an infection of bone. (Option 4) The client with influenza requires droplet precautions and would likely require a private room (Room D). Clients with severe disease (ie, requiring hospitalization) should receive antiviral medication (eg, zanamivir, oseltamivir) as they are at high risk for complications. Educational objective: A client undergoing an extensive surgical debridement for an infected pressure injury should not be assigned to a room with a client who is vulnerable to infection (eg, immunocompromised) or who has an active infection.
The nurse manager is looking to include members of the health care team in the decision-making process but finds that many members are reluctant to offer ideas. Which approach by the manager generates a large volume of creative options while encouraging reticent members of the team to participate? 1 Applying the Delphi technique 2 Organizing focus groups 3 Planning brainstorming sessions 4 Applying nominal group techniques
3 Brainstorming helps to get a large volume of creative options from the team by providing a safe environment for the contribution of ideas. The application of the Delphi technique, focus groups strategy, and nominal group techniques are also effective in minimizing these problems, but do not provide a large volume of creative options. The Delphi technique involves collection and summarization of opinions and judgments on a particular issue from expert panels through interviews, surveys, or questionnaires. A focus group involves organizing moderated discussions with small groups of people to identify problems or evaluate processes; it is less likely to provide a nonjudgmental environment for generating ideas. A nominal group technique allows the opportunity to the team members to share ideas, but their ideas are judged and merits are given to each idea.
The registered nurse finds that two nursing students are arguing with each other. Which action by the registered nurse best represents a leadership quality? 1 Complaining to management and asking the students to go outside 2 Letting them continue arguing until they resolve the matter themselves 3 Assessing the condition and strategizing to resolve the matter by reducing the difference 4 Asking the reason for their argument and reprimanding them for having the argument in the hospital
3 Visioning is required by an efficient leader to engage others to assess the current reality. This skill includes determining and specifying a desired end-point state and then strategizing to reduce the differences. Letting them continue arguing and waiting until they resolve the matter may allow the argument to escalate. Complaining to management would pass off responsibility for a resolution and would not indicate leadership. Reprimanding the nurses may stop the argument, but would not be a constructive approach.
During a peer review, the manager finds that a newly appointed nurse leader encourages "bottom up" interaction among the workers. To which statement of the staff does the manager relate this? 1 "He/she accepts responsibility willingly." 2 "He/she is empathetic to the experiences of others." 3 "He/she involves us in shaping policies for client care." 4 "He/she believes in unleashing constructive energy rather than constraining energy."
3 "He/she involves us in shaping policies for client care." "Bottom-up" interaction values every nurse as a human resource with rich perspective. Therefore involving peers in shaping policies is an example of a "bottom-up" interaction. Willingness to accept responsibility is a generally desired attribute. Empathy to others' experiences shows emotional intelligence. A leader who unleashes constructive energy demonstrates the concept of focus on emergence.
Which statement would most likely be made by a client who is receiving care through the functional method? 1 "My nurse's name is Amy." 2 "Susan will be caring for me until 7 pm." 3 "I have to wait until the medication nurse is available for a pain pill." 4 "Barbara coordinated all of my care but I might receive the care from other nurses."
3 "I have to wait until the medication nurse is available for a pain pill." In the functional method, staff are assigned tasks according to scope of practice. In this approach a medication nurse will be identified. Knowing the nurse's name would more likely be a characteristic of team or primary nursing. Knowing which nurse will provide care for a specific period of time would indicate the case approach to care. Knowing which nurse coordinated the care that might be provided by others would more likely indicate primary nursing or case management.
A client's chest tube has accidentally dislodged. What is the nursing action of highest priority? 1 Place the client in a left side-lying position. 2 Apply oxygen via nonrebreather mask. 3 Apply a petroleum gauze dressing over the site. 4 Prepare to reinsert a new chest tube.
3 Apply a petroleum gauze dressing over the site. A petroleum gauze dressing will prevent air from being sucked into the pleural space, causing a pneumothorax. The petroleum gauze dressing should be taped only on three sides to allow for excessive air to escape, preventing a tension pneumothorax. The physician should immediately be notified and the client assessed for signs of respiratory distress. Positioning the client on the left side will not make a difference in outcome. There is no indication that the client is experiencing respiratory distress. Preparing to reinsert a new chest tube is not a priority of the nurse at this moment.
Which nursing action allows for a thorough assessment of a trauma client to prioritize the client's care? 1 Avoiding manipulation of the client's limbs 2 Asking a family member about any client drug allergies 3 Cutting fabric that is stuck to the client's skin with scissors 4 Auscultating heart and lung sounds through the client's clothing
3 Cutting fabric that is stuck to the client's skin with scissors The nurse should remove all clothing to allow for a thorough assessment of the trauma client in order to accurately prioritize care. Cutting fabric that is stuck to the client's skin with scissors is the appropriate action by the nurse. It is necessary to avoid manipulation of the client's limbs during the trauma assessment. While it is important to ask a family member about any client drug allergies, this is done after the initial assessment of the client. Clothing is always removed to allow for an accurate trauma assessment.
A registered nurse (RN) delegates the task of foot care for a client to an unlicensed nursing personnel (UNP). The UNP is skillful and willing to perform the given task, but was recently hired and is unfamiliar with the client's condition. What should the RN do in this situation? 1 Provide guidance to the UNP. 2 Observe and motivate the UNP. 3 Establish mutual expectations and conditions. 4 Explain what to do and how to perform the task.
3 Establish mutual expectations and conditions. If the delegatee is new to the workplace, but has the ability and willingness to perform a task, the RN should establish mutual expectations and conditions of performance to establish a good relationship. If the delegatee has limited knowledge and ability to perform a task, the delegator is expected to guide the UNP. The RN is expected to observe and monitor the task performed by the delegate to ensure the delegatee has the ability and willingness to establish a relationship and accomplish the work. The RN can also explain the task and how to execute it if the situation involves a new task and relationship is ongoing.
The registered nurse (RN) is caring for a client with renal calculi. Which healthcare professional is most suitable to be delegated the task of administering urinary alkalinizer by mouth to the client? 1 Certified technician 2 Patient care associate 3 Licensed practical nurse 4 Unlicensed assistive personnel
3 Licensed practical nurse Administering oral medications such as urinary alkalinizer can be safely delegated to a licensed practical nurse (LPN) or licensed vocational nurse (LVN) as per guidelines. Certified technician is a licensed assistive personnel whose scope of practice is limited for administering medications. The scope of practice of the patient care associate and unlicensed assistive personnel is limited to performing basic care, feeding, and hygiene.
Which element creates an integrative process that fosters effective delegation decisions by the registered nurse? 1 Ability 2 Liability 3 Stability 4 Ethnicity
3 Stability Stability is the element that creates an integrative process that fosters effective delegation decisions. Ability is the factor that needs to be assessed to determine the level the leaders determine. Liability is the person's responsibility and accountability for individual actions. Ethnicity does not play a role in the process of delegation.
Which action of the nurse leader indicates implementing Gardner's task of "explaining"? 1 Assisting clients and families in formulating their vision of future well-being 2 Providing self-care to enhance the ability to care for staff, clients, and their families 3 Teaching and interpreting the information to ensure clients' functioning and well-being 4 Assisting clients in sorting out and articulating personal values in relation to health problems
3 Teaching and interpreting the information to ensure clients' functioning and well-being The nurse leader implements Gardner's task of "explaining" by teaching and interpreting the information that ensures clients' functioning and well-being. The nurse leader implements Gardner's task of "envisioning goals" by assisting clients and their families in formulating their vision of future well-being. The nurse leader implements Gardner's task of "renewing" by providing self-care to enhance the ability to care for staff, clients, and their families. The nurse leader implements Gardner's task of "affirming values" by assisting clients and their families as they sort out and articulate personal values in relation to health problems.
Why does a nurse manager assign a resource person in a healthcare organization? 1 To delegate tasks 2 To supervise actions 3 To serve as a mentor 4 To reassign duties to workers
3 To serve as a mentor The nurse manager assigns a resource person in a healthcare organization to serve as a mentor for the agency nurse to prevent potential problems that could arise if the staff member does not know the institutional routine. The nurse manager also delegates a task, supervises actions, and reassigns duties to workers.
The registered nurse is teaching a novice nurse about the rights of delegation. Which statement by the novice nurse indicates a need for further teaching? 1. "I will refer to the guidelines before delegating the task." 2. "I will check for the competence of the delegatee for the assigned task." 3. "I will instruct the delegatee to monitor and evaluate the client appropriately." 4. "I will check whether the environment is conducive to completing the task safely."
3. "I will instruct the delegatee to monitor and evaluate the client appropriately." Monitoring and evaluating the client's condition is the role of the registered nurse, not a delegatee. Referring to the guidelines before delegating the task is included under the delegation right, "right task." Checking for the competence of the delegatee for the assigned task is included under the delegation right, "right person." Checking whether the environment is conducive to completing the task safely is included under the delegation right, "right circumstance."
The registered nurse is evaluating the statements of the student nurse after teaching about delegation. Which statement made by the student nurse indicates a need for correction? 1. "Delegation is merely sharing a set of functions." 2. "Delegation ensures quality client care outcomes." 3. "Professional aspects of care can also be delegated." 4. "The final accountability of a task remains with the delegator."
3. "Professional aspects of care can also be delegated." Basic activities of daily living and personal hygiene can be delegated but professional aspects of care cannot be delegated and should be performed by the registered nurse only. Delegation is a process of merely sharing a set of functions in which the delegator shares functions with the delegatee. Because delegation involves sharing of functions, it ensures quality client-care outcomes. Though the delegator assigns work, the final accountability of a task remains with the delegator.
Which questions related to decision making for delegation are appropriate according to the delegation right of "right circumstance"? Select all that apply. 1. Is the task legally appropriate to delegate? 2. Is the prospective delegatee a willing and able employee? 3. Are the equipment and resources available to complete the task? 4. Does the delegatee have appropriate supervision to complete the task? 5. Is the task appropriate to delegate based on the institutional policies and procedures?
3. Are the equipment and resources available to complete the task? 4. Does the delegatee have appropriate supervision to complete the task? There are Five Rights of Delegation. Questions related to the equipment and resources available for carrying out the task allotted are appropriate for the delegation right "right circumstance." Asking about the required supervision needed for the delegatee to complete the task is appropriate for the delegation right "right circumstance." Questioning whether the task allotted is legal is appropriate for delegation right "right task." Checking whether the delegatee is an able person to perform the task would come under delegation right "right person." Checking whether the task is based on the policies and procedures of the institution comes under the delegation right "right task."
Which delegation actions may be performed by unlicensed nursing personnel while caring for a client? Select all that apply. 1. Teaching the care plan to the client 2. Infusing intravenous fluids into the client 3. Asking the client to wash the hands before meals 4. Instructing the client to take specific medications 5. Instructing the client to wear footwear while walking
3. Asking the client to wash the hands before meals 5. Instructing the client to wear footwear while walking Unlicensed nursing personnel (UNP) can delegate simple and straightforward client teaching, such as asking the client to wash his or her hands before meals and wear footwear while walking. Complex and multifaceted teaching, such as detailing the care plan to the client, cannot be delegated to a UNP. The UNP has less knowledge and professional skills with which to perform complex procedures such as infusing intravenous fluids into the client and does not have a complete knowledge of medications with which to coach the client about medications.
How can the lines of communication be improved in a healthcare organization during the process of delegation? 1. By considering all aspects of client care 2. By selecting experienced nursing assistants as delegatees 3. By appreciating and valuing each other's cultural perspectives 4. By selecting a delegatee having similar strengths as that of the delegator
3. By appreciating and valuing each other's cultural perspectives The lines of communication in a healthcare organization can be improved by appreciating and valuing each other's cultural perspectives, which balances strengths between the delegator and delegatee and improves client care outcomes. Considering all aspects of client care ensures that all of the client care needs are addressed. Selecting experienced nursing assistants as delegatees increases the chances of the delegatee to adapt to changing situations. Selecting a delegatee having similar strengths as that of the delegator may decrease the lines of communication because the delegatee might do the task of the delegator.
Before assigning a task, the registered nurse makes sure that the delegation process is appropriate to the situation. To which delegation right does this situation refer? 1. Person 2. Supervision 3. Circumstance 4. Communication
3. Circumstance Ensuring that the delegation process is appropriate to the situation refers to right circumstance. Knowing whether the delegatee has the knowledge and experience to perform the specific task safely refers to the right person. Knowing whether the delegator is able to monitor and evaluate the client appropriately refers to the right supervision. Ensuring whether the delegator and delegatee understand a common work-related language refers to the right communication.
If the nurse is considering whether the right equipment and resources are available to complete a task, which delegation right is considered? 1. Task 2. Supervision 3. Circumstance 4. Communication
3. Circumstance If the right equipment and resources are available to complete a task, it is considered the right circumstance. Task is the delegation right that involves asking if the task is appropriate to delegate based on institutional policies and procedures. Supervision is the delegation right involving the provision of clear feedback related to completion of an assigned task. Communication is the right that involves asking the delegator and delegate to understand a common work-related language.
Which condition may lead to delegation failure due to malpractice? 1. Adapting to changing situations by the nursing assistant 2. Educating and monitoring the nursing staff incompetent to perform a task 3. Employing more unlicensed nursing personal (UNP) in the emergency department 4. Assigning the more unlicensed nursing personal (UNP) for long-term care facilities
3. Employing more unlicensed nursing personal (UNP) in the emergency department The greater the stability of a client, the more likely an unlicensed nursing personal (UNP) can provide safe client care. It is not ideal to increase the numbers of UNPs in the emergency department due to client instability. The nursing assistant has to adapt to changing situations to deliver proper client care. The delegator must train and monitor the performance of the nursing staff, who are responsible for completing tasks in a specified time. This helps in improving the performance of any incompetent nursing staff. The intensity and length of the interactions with the client are also significant factors to consider in planning client care. The UNP can provide efficient client care in long-term care facilities because the clients are stable.
The registered nurse (RN) administers intravenous fluids to a client who was in a motorcycle accident. Which assessments made by the nurse would be appropriate based on the principle of right task of delegation? 1. Environmental conditions 2. Resources required for drug administration 3. Institutional policies of drug administration 4. Client's condition prior to drug administration
3. Institutional policies of drug administration Right task of delegation includes information on whether the task performed would be appropriate based on institutional policies. Assessing if the environmental conditions are conducive for completing the task determines right circumstance of delegation. Right circumstance of delegation also includes the assessments of resources and equipment available for performing the task. Assessing the client's condition prior to drug administration may be an appropriate intervention of the nurse under right task of delegation.
The registered nurse is caring for a client admitted with sudden paralysis in the legs and an inability to walk. Which interventions made by the registered nurse (RN) indicates correct active delegation? Select all that apply. 1. The RN assessing the client's diagnostic and laboratory findings 2. The RN administering an intravenous (IV) calcium gluconate injection 3. Instructing the licensed practical nurse (LPN) to report client's vital signs 4. Instructing the licensed practical nurse (LPN) to administer vitamin B12 injection 5. Instructing the unlicensed nursing personnel (UNP) to administer oral vitamin D3
3. Instructing the licensed practical nurse (LPN) to report client's vital signs 4. Instructing the licensed practical nurse (LPN) to administer vitamin B12 injection In active delegation, the RN assesses the situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individual accountable. Instructing the LPN to report the client's vital signs is an active delegation that includes directing the assistive personnel to perform the task. Instructing the unlicensed nursing personnel to administer oral vitamin D3 is beyond their scope of practice. The RN assessing the client's diagnostic and laboratory findings does not involve delegation. The RN administering an intravenous calcium gluconate injection does not involve delegation. Instructing the LPN to administer a vitamin B12 injection is within the scope of practice for the LPN.
Which action in the delegation process represents accountability? 1. Providing open and honest feedback to the delegatee 2. Assisting other registered nurses with delegation decisions 3. Monitoring the client care given and determining outcomes 4. Assessing the ability of the delegatee and educating him or her about the task
3. Monitoring the client care given and determining outcomes Monitoring client care and determining outcomes represents accountability of the task in case of conflicts. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions when there are safety issues, an urgent need to intervene, or potential negative client outcomes. Assessing the ability of the delegatee and educating him or her about the task indicates responsibility.
A healthcare team is caring for a population according to the functional model of nursing. Which healthcare team member is most appropriate for the delegation of hygiene care? 1. Unit secretary 2. Registered nurse 3. Nursing assistant 4. Licensed practical nurse
3. Nursing assistant The nursing assistant is eligible for performing activities such as providing hygiene care and determining vital signs. Unit secretaries are not delegated to provide hygienic care because they do not have formal preparation and legal recognition. The registered nurse performs other activities such as treatment, admissions, and administering intravenous medications. The licensed practical nurse performs activities such as providing oral medications.
Which activity performed by the licensed practical nurse (LPN) would be appropriate while caring for a client based on the principle of right task of delegation? 1. Willing to perform the task 2. Providing feedback to the delegator 3. Performing the task based on institutional policies 4. Following appropriate supervision while performing the task
3. Performing the task based on institutional policies The principle of right task of delegation indicates if the task is appropriate to delegate based on institutional policies and procedures. Assessing whether the delegatee is willing to perform the task indicates the principle of right person. Providing feedback to the delegator and following supervision of the delegator indicates right supervision of delegation.
As a part of the nursing curriculum, the nursing faculty is teaching nursing students about high-quality clinical delegation experiences and has also chosen to engage the students with nursing mentors. Which skill does the nursing faculty expect the nursing students to develop via this approach? 1. Proficiency in delegation 2. Application of theory to delegation 3. Professional self-confidence in delegation 4. Development of clinical judgment in delegation
3. Professional self-confidence in delegation Because of the ever-changing health care system, the faculty in nursing schools should teach and mentor the nursing students regarding advances in the health care system. Teaching and exposing the students to high-quality clinical delegation experiences and engaging the student nurses with nursing mentors is helpful for fostering students' professional self-confidence. These experiences advance the nurse's ability to become a successful delegator. The student's proficiency in delegation is improved with the study and practical application of teaching and learning. The nursing practicum develops the student's ability to apply theoretical knowledge to the process of delegation and also develops the student's clinical judgment skills related to delegation.
When evaluating a task performed by a delegatee, the registered nurse finds that the delegatee fails to provide appropriate feedback. Which right of delegation is compromised in this situation? 1. Right task 2. Right person 3. Right supervision 4. Right communication
3. Right supervision The "right supervision" includes assessing whether the delegatee can provide feedback related to the task when appropriate. "Right task" involves providing tasks to the delegatee in accordance with legal and institutional policies. "Right person" involves delegating tasks to team members who are competent and show willingness towards the task. "Right communication" involves the delegator providing clear, concise instructions and the delegate understanding those instructions.
Which statement is true regarding the framework of delegation related to the Hersey's Situational Leadership Model? Select all that apply. 1. Single factor influences the effectiveness of a leader 2. Ability relates to the individual's attitude and commitment 3. Willingness relates to the individual's attitude towards the task 4. Ability to diagnose performance is a core competency of a situational leader 5. Willingness is the sole factor that must be assessed to determine the readiness of the follower
3. Willingness relates to the individual's attitude towards the task 4. Ability to diagnose performance is a core competency of a situational leader Hersey's Situational Leadership Model serves as a foundation for delegation decision making. Willingness is the individual's attitude and commitment towards the task. The ability to diagnose the performance and commitment of others is a core competency of Hersey's Situational Leadership Model. Multiple factors such as assessment of personality characteristics and readiness level of an individual influence the effectiveness of a leader. Willingness, not ability, relates to attitude and commitment. Willingness and ability are the two factors that are assessed when determining the level of follower's readiness.
The nurse enters a client's room just as the unlicensed assistive personnel (UAP) is completing a bath and placing thigh-high anti-embolism stockings on the client. Which situation would cause the nurse to intervene? 1. UAP applies the anti-embolism stockings while maintaining the client in supine position 2. UAP carefully smoothes out any wrinkles over the length of the stockings 3. UAP checks that the toe opening of the stockings is located on the plantar side of the foot 4. UAP rolls down and folds over the excess material at the top of the stockings
4 Anti-embolism stockings are part of venous thromboembolism (VTE) prophylaxis in hospitalized clients. Anti-embolism stockings improve blood circulation in the leg veins by applying graduated compression. When fitted properly and worn consistently, the stockings decrease VTE risk. The stockings should not be rolled down, folded down, cut, or altered in any way. If stockings are not fitted and worn correctly, venous return can actually be impeded. (Option 1) Anti-embolism stockings should be applied before ambulating while the client is in bed; this maximizes the compression effects of the stockings and promotes venous return. The UAP has performed this correctly. (Option 2) Wrinkles should be smoothed out to avoid impeding venous return. The UAP has performed this correctly. (Option 3) The toe opening should be located on the plantar side of the foot/under the toes. The UAP has performed this correctly. Educational objective: Anti-embolism stockings are worn by clients as part of VTE prophylaxis. It is important that the nurse verifies the stockings are correctly fitted and worn appropriately. Incorrect size and fit or alterations to the stockings can impede venous return.
The charge nurse on the medical surgical unit must assign a room for an immediate post-operative nephrectomy client. Which room assignment is the best option for this client? 1. Room 1 - Client with diabetes mellitus and chronic kidney disease who is on hemodialysis and has a serum glucose level of 265 mg/dL (14.7 mmol/L) 2. Room 2 - Client with chronic HIV infection and overwhelming fatigue who has a CD4+ cell count of 200/mm3 (0.2 x 109/L) 3. Room 3 - Client with cellulitis of the leg due to a spider bite who has a white blood cell count of 13,000/mm3 (13.0 x 109/L) 4. Room 4 - Client with severe epistaxis due to a traumatic nasal fracture who has a platelet count of 85,000/mm3 (85 x 109/L)
4 The best option is room 4 with the client who has severe epistaxis and decreased platelet count (normal 150,000-400,000/mm3 [150-400 x 109/L]) as this does not place the immediate post-operative client at increased risk for infection. (Options 1, 2, and 3) The clients in these rooms place the postoperative client at increased risk for infection: - Room 1: A client with diabetes mellitus and advanced chronic kidney disease may have infectious complications due to increased susceptibility to infection resulting from an altered immune response and decreased leukocyte function due to hyperglycemia. In addition, hemodialysis increases the risk for infection due to invasive lines and catheters. - Room 2: A low CD4+ cell count (<500/mm3 [0.5 x 109/L], normal is 500-1,200/mm3 [0.5-1.2 x 109/L]) in a client with chronic HIV infection indicates disease progression. It can also indicate progression of asymptomatic early infections to more advanced symptomatic infections. - Room 3: The client with cellulitis and an increased white blood cell count (>11,000/mm3 [11.0 x 109/L]) has an infection. Educational objective: An immediate post-operative client should not be assigned a bed in a room with a client who is contagious or potentially infected as this poses an increased risk for infection.
Under a leader, a team of followers has failed to achieve success in conducting research. What does an effective leader do in this situation? 1 Criticizes the team members for failure 2 Provides excuses for the negative outcome 3 Refuses to take the responsibility for failure 4 Accepts failure and gains experience from it
4 Accepts failure and gains experience from it An effective leader should accept the failure and gain experience from it to avoid repetition of the same errors. The effective leader should counsel and motivate the team members for future success and should not criticize them. Making excuses for the negative outcome is not the correct action of the effective leader. The effective leader should take responsibility for the failure and the growth he or she will gain from it.
Which behavior of the nurse indicates management skills according to Gardner's task of achieving workable unity? 1 Assisting the client/family with planning, priority setting, and decision making 2 Assisting multidisciplinary leaders to achieve optimal functioning to benefit client care delivery 3 Assisting clients to achieve optimal functioning to benefit the transition to enhanced health functions 4 Assisting staff to achieve optimal functioning to benefit the transition to enhanced organizational functions
4 Assisting staff to achieve optimal functioning to benefit the transition to enhanced organizational functions According to Gardner's task of achieving workable unity, the nurse in a management position helps the staff achieve optimal functioning to benefit transition to enhanced organizational functions. Assisting the client/family with planning, priority setting, and decision making is the clinical position of Gardner's task of managing. Assisting multidisciplinary leaders to achieve optimal functioning to benefit client care delivery is the executive position of Gardner's task of achieving workable unity. Assisting clients to achieve optimal functioning to benefit the transition to enhanced health functions is the clinical position of Gardner's task of achieving workable unity.
A client with myocardial infarction is admitted in the emergency department, and the primary health care provider recommended the placement of a stent. The client is incompetent to understand the situation. What model does the nurse manager think would be beneficial in this situation? 1 Decision model 2 Autonomy model 3 Social justice model 4 Patient-benefit model
4 Patient-benefit model The patient-benefit model uses substituted judgment such as determining what the client would want for himself or herself if capable of making these issues known, and thereby facilitates decision making for incompetent clients. The decision model is used for nurses; it depends on specific circumstances to know if the situation is routine and predictable or complex and uncertain. The autonomy model facilitates decision making for competent clients. The social justice model considers broad social issues and is accountable to the overall institution.
While delegating a task, the registered nurse says to the delegatee, "Please tell me how you go about performing this procedure, and I will share with you my perspective about how frequently and under what conditions we need to communicate with and report to each other." What does this indicate? 1 The delegatee requires explanation. 2 The delegatee has limited knowledge. 3 The delegatee and delegator relationship is established. 4 The delegatee and delegator are creating mutual expectations.
4 The delegatee and delegator are creating mutual expectations. Asking a delegatee how he or she performs the procedure and sharing each other's perspective and when to communicate indicates that the delegator and delegatee are creating mutual expectations. When the delegatee demonstrates a task, it indicates that the delegatee requires explanation. The delegator will direct the procedures to the delegatee when the delegatee has limited knowledge. The delegator will motivate the delegatee when the relationship between the delegatee and delegator is established.
Which healthcare professionals would the nurse say work under active delegation? Select all that apply. 1 Physician examining clients in the outpatient ward 2 Nurse giving medication to a client as prescribed by the physician 3 Pharmacist dispensing medicines prescribed by the physician to the client 4 Licensed practical nurse (LPN) administering oral medications as delegated by the registered nurse (RN) 5 Unlicensed nursing practitioner (UNP) maintaining oral hygiene of the clients as delegated by the registered nurse
4, 5 If tasks are delegated to a delegatee after a thorough assessment by the delegator who remains accountable for the delegated tasks, it is called active delegation. Delegation to LPNs, UNPs, and other nursing personnel by the registered nurse are examples of active delegation, such as administering oral medications and maintaining oral hygiene. Any task performed normally, or as an essential part of practice by licensed individuals such as physicians, nurses, and pharmacists form a part of passive delegation.
The registered nurse is teaching a newly hired nurse about active delegation. Which statement made by the newly hired nurse indicates the need for further teaching? 1. "I will evaluate the client's pain status." 2. "I will assess the client's laboratory findings." 3. "I will instruct the unlicensed assistive personnel (UAP) to wash the client." 4. "I will instruct the licensed vocational nurse (LVN) to administer intravenous (IV) medications."
4. "I will instruct the licensed vocational nurse (LVN) to administer intravenous (IV) medications." In active delegation, the registered nurse (RN) assesses the client's situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individuals accountable. Instructing the LVN to administer intravenous (IV) medications is beyond the practice scope for an LVN. Evaluating the client's pain status is a part of active delegation. Assessing the client's laboratory findings is active delegation. Instructing the UAP to wash the client is an active delegation as the RN is directing a task that is to be performed by the UAP for the client.
A registered nurse teaches a student nurse about delegation. Which statement made by the student nurse indicates appropriate learning? 1. "Licensed practical nurses are accountable for the tasks they perform." 2. "Complete client care can be delegated to the licensed practical nurse." 3. "Professional aspects of care can be carefully delegated to the licensed practical nurse." 4. "Licensed practical nurses can be expected to perform tasks with which they have experience."
4. "Licensed practical nurses can be expected to perform tasks with which they have experience." The delegator can safely delegate the task to the LPN if the task is within the scope of function or if the LPN is very experienced in performing the task. The LPN, being a delegatee, is not held accountable for the delegated work; the LPN is held responsible for the delegated task. The delegator is held accountable for the LPN's work. The delegator can never delegate complete client care to the LPN, but can only transfer functions and tasks. Basic skills such as activities of daily living and personal hygiene can be delegated by the delegator, but professional aspects of care should not be delegated.
Which among the Five Rights of Delegation is the cornerstone of delegation? 1. "Right person" 2. "Right supervision" 3. "Right circumstance" 4. "Right communication and direction"
4. "Right communication and direction" Among the Five Rights of Delegation, "right communication and direction" is the most important right of delegation. It is the most useful in maintaining the quality and safety outcomes, as it involves communication and direction. "Right person" is useful for understanding which person has the appropriate skills to perform the task. "Right supervision" involves monitoring the tasks that are performed with the goal of improving outcomes. "Right circumstance" seeks to ensure that the appropriate equipment and resources are available for the delegatee.
The registered nurse is evaluating the statements made by a student nurse after teaching about the delegation communication template. Which statement made by the student nurse indicates a need for correction? 1. "The delegation communication template should identify the priorities." 2. "The delegation communication template should specify the deviations." 3. "The delegation communication template should identify the appropriate resources." 4. "The delegation communication template should include only the work that is to be delegated."
4. "The delegation communication template should include only the work that is to be delegated." The delegation communication template should emphasize the work that is not to be delegated. The delegation communication template should identify the priorities such as what is to be done first. The delegation communication template should specify deviations such as when to take an immediate action. The delegation communication template should identify the appropriate resources including the individual consultants
The registered nurse is evaluating the statements made by a student nurse after teaching ways to make appropriate delegation decisions. Which statement made by the student nurse indicates a need for correction? 1. "The delegatee should report the findings back to the delegator." 2. "The delegatee should understand the assigned task completely." 3. "The delegator should trust the delegatee to accomplish the task." 4. "The delegator should recheck and redo the work of the delegatee."
4. "The delegator should recheck and redo the work of the delegatee." Time management is an important part of an appropriate delegation process. If the delegator rechecks and redoes the work of the delegatee, it increases the time to accomplish the task and results in inappropriate delegation. Reporting the findings back to the delegator helps the delegator to understand the progress of the task. The delegatee should understand the task completely to perform as desired by the delegator. Trusting the delegatee reduces time to do the task and build a healthy working environment.
Which activity performed by the registered nurse in a healthcare organization is considered active delegation? 1. A pharmacist giving medications upon prescription 2. A primary healthcare provider assessing and prescribing medication 3. A registered nurse administering medication and fluids upon prescription 4. A registered nurse directing an unlicensed nursing professional to perform certain task
4. A registered nurse directing an unlicensed nursing professional to perform certain task Active delegation by a registered nurse is the process of assessing a situation and determining what is appropriate for client care such as directing an unlicensed nursing professional to perform certain tasks and holding the individual accountable. Passive delegation contains functions that are normally performed or are an essential part of the practice of a licensed individual. A pharmacist giving medications upon prescription is passive delegation since it is a part of practice. A primary healthcare provider assessing and prescribing medication is passive delegation since it is a part of practice for a primary healthcare provider. A registered nurse administering medication and fluids upon prescription is passive delegation since it is a part of practice for a registered nurse.
How does a nurse adopt the element of right circumstances during a task delegation? 1. By giving a clear and concise description of the task 2. By providing appropriate monitoring, evaluation, and intervention as needed 3. By delegating right tasks to the right person to be performed on the right person 4. By considering the appropriate client setting, available resources, and other relevant factors
4. By considering the appropriate client setting, available resources, and other relevant factors The nurse adopts the element of right circumstance by considering the appropriate client setting, available resources, and other relevant factors during task delegation. By giving a clear and concise description of the task, the nurse adopts the element of right direction/communication. By providing appropriate monitoring, evaluation, and intervention as needed, the nurse adopts the element of right supervision/evaluation during task delegation. By giving the right tasks to the right person to be performed on a client, the nurse adopts the element of right person.
The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task? 1. Time 2. Safety 3. Stability 4. Critical thinking
4. Critical thinking Critical thinking is of utmost importance for selecting a suitable nursing assistant for delegation of a task in a situation where a client requires more attention, as the delegatee should be able to perform the task effectively. Time, safety, and stability are also the elements for effective delegation, but these are suitable depending on the situation for assigning a task and delegation.
The nurse manager delegates client-care tasks to members of the health care team in the intensive care unit. Which element of the delegation may extend to direct corporate liability for the institution? 1. Failure of the delegatee to provide client education 2. Accountability of the delegator for the task performed 3. Delegatee not performing the task within acceptable standards 4. Failure of the nurse manager to delegate and supervise the task within acceptable standards
4. Failure of the nurse manager to delegate and supervise the task within acceptable standards Legally, delegation is a complex process. Failure of the nurse manager (delegator) to delegate and supervise the task performed by the delegatee may extend to direct corporate liability for the institution. Failure of the delegatee to provide client education is an element of nursing malpractice. The nurse manager (delegator) is legally accountable and thus liable for his or her actions and those of the delegatee. The delegatee not performing the task within acceptable standards may lead to nursing malpractice.
Which nursing process involves delegation and verbal discussion with the healthcare team? 1. Planning 2. Evaluation 3. Assessment 4. Implementation
4. Implementation The implementation process involves delegation and verbal discussion with the healthcare team. Planning involves interpersonal or small group healthcare team sessions. Evaluation involves the acquisition of verbal and nonverbal feedback. Assessment involves verbal interviewing and a history of talking with the clients.
Which healthcare professionals would the nurse say work under active delegation? Select all that apply. 1. Physician examining clients in the outpatient ward 2. Nurse giving medication to a client as prescribed by the physician 3. Pharmacist dispensing medicines prescribed by the physician to the client 4. Licensed practical nurse (LPN) administering oral medications as delegated by the registered nurse (RN) 5. Unlicensed nursing practitioner (UNP) maintaining oral hygiene of the clients as delegated by the registered nurse
4. Licensed practical nurse (LPN) administering oral medications as delegated by the registered nurse (RN) 5. Unlicensed nursing practitioner (UNP) maintaining oral hygiene of the clients as delegated by the registered nurse If tasks are delegated to a delegatee after a thorough assessment by the delegator who remains accountable for the delegated tasks, it is called active delegation. Delegation to LPNs, UNPs, and other nursing personnel by the registered nurse are examples of active delegation, such as administering oral medications and maintaining oral hygiene. Any task performed normally, or as an essential part of practice by licensed individuals such as physicians, nurses, and pharmacists form a part of passive delegation.
What does the decision strategy of "offering" include in delegation? 1. Allowing the delegator to examine the situation differently 2. Demonstrating the specific task or behavior to improve client care 3. Asking questions related to the problem or issue regarding client care 4. Making a suggestion to facilitate the achievement of a desirable client care outcome
4. Making a suggestion to facilitate the achievement of a desirable client care outcome The decision strategy of offering involves making a suggestion to facilitate the achievement of a desirable client care outcome. The decision strategy of asking allows the delegator to examine the situation differently. The decision strategy of doing includes demonstrating the specific task or behavior to improve client care. The decision strategy of asking includes questioning issues related to the problem regarding client care.
Which definition of delegation given by the nurse is correct? 1. Activities undertaken by a group of people who have common interests 2. Transfer of both accountability and task responsibility from one person to another 3. An organized and innovative plan that helps an organization achieve its objectives 4. Process for the nurse to direct another person to perform nursing tasks and activities
4. Process for the nurse to direct another person to perform nursing tasks and activities The American Nurses Association (ANA) and National Council of State Boards of Nursing (NCSBN) collaboratively defined delegation as the "process for the nurse to direct another person to perform nursing tasks and activities." Collective actions are the "activities that are undertaken by a group of people who have common interests." Transferring both accountability and responsibility from one person to another is referred to as an assignment. Strategy is an "organized and innovative plan that assists an organization to achieve the objectives."
The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction? 1. Asking questions about the client's respiratory rate 2. Asking the client to perform breathing exercises regularly 3. Administering oxygen to the client with shortness of breath 4. Providing constructive feedback about client care management
4. Providing constructive feedback about client care management The nurse may not provide constructive feedback about the client care management during delegation decisions. The nurse may, however, provide constructive feedback to the delegatee to maximize the efficiency of the client care. The nurse may assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Asking involves inquiring about the client care problems and issues such as the respiratory rate. Offering involves suggesting ways to achieve desirable client care outcomes, such as asking the client to perform breathing exercises regularly. Doing involves demonstrating the specific task to improve client care—for instance, administering oxygen to the client.
The registered nurse is delegating tasks for the care of a vulnerable population. Which healthcare team would be appropriate for the delegation of tasks? 1. Charge nurse (CN), chief nursing officer (CNO), and registered nurse (RN) 2. Licensed practical nurse (LPN), unlicensed nursing professional (UNP), and charge nurse (CN) 3. Chief nursing officer (CNO), Registered nurse (RN), and unlicensed nursing professional (UNP) 4. Registered nurse (RN), licensed practical nurse (LPN), and unlicensed nursing professional (UNP)
4. Registered nurse (RN), licensed practical nurse (LPN), and unlicensed nursing professional (UNP) The appropriate healthcare team for delegation of tasks for the care of vulnerable populations consists of the RN, LPN, and UNP. Proper care and assistance can be provided by this team. The CN, CNO, and RN are all licensed health professionals and there are team members to provide assistance on this team. In the team consisting of the LPN, UNP, and CN, there is no person who can take responsibility and accountability of the client care. In the CNO, RN and UNP team, the UNP may not be eligible to carry all the activities and the CNO and RN are responsible for carrying out delegation.
A registered nurse delegates a task to a licensed practical nurse (LPN). The nurse manager asks the registered nurse, "Are the equipment and resources available for the LPN to complete the task?" Which right of delegation is the nurse manager preserving? 1. Right task 2. Right direction 3. Right supervision 4. Right circumstance
4. Right circumstance Questions such as, "Is the environment conducive to completing the task safely?" and, "Are the equipment and resources available to complete the task?" ensure the right circumstance for delegation. Right task is ensured with a question such as, "Is the task appropriate to the delegate, according to institutional policies and procedures?" Delegation is taking the right direction if the answer to a question such as, "Do the delegator and delegatee understand a common work-related language?" is positive. Right supervision is evaluated with a question such as, "Is the delegator able to monitor and evaluate the client appropriately?"
Which right of delegation would the nurse describe as most instrumental in shaping quality and safety outcomes according to Anthony and Vidal? 1. Right task 2. Right person 3. Right supervision 4. Right communication and direction
4. Right communication and direction Right communication and direction is most instrumental in shaping quality and safety outcomes because timely and effective communication enhances the safety and quality of client care. Right task is important to prevent legal issues. Right person is important for ensuring the delegatee has the knowledge and experience to perform the specific task safely. Right supervision is important for monitoring and evaluating appropriately.
The nurse with limited clinical experience is preparing a delegation communication template. Which action by the nurse indicates the need for correction? 1. Identifying the priorities 2. Specifying the performance limitations 3. Emphasizing what may not be delegated 4. Specifying that no extra time is allotted to report data
4. Specifying that no extra time is allotted to report data A delegation communication template is used for the delegation of tasks. It is beneficial to provide greater positive outcomes within specified dates. The template should contain the report time frames and when data is expected. It should specify deadlines, including the allowable deviations and exact timelines. Identifying priorities aids in overcoming challenging and overwhelming situations. Specifying the performance limitations aids in tracking and managing the task updates. It is important to make the delegatee understand what is to be delegated and what is not to be discussed to produce expected data.
Which activity performed by the registered nurse (RN) indicates effective delegation? 1. Following one-way communication with the delegatee 2. Assigning a task to a new licensed practical nurse(LPN) 3. Providing feedback to the delegatee while performing the task 4. Supervising and monitoring the licensed practical nurse (LPN) about the different activities
4. Supervising and monitoring the licensed practical nurse (LPN) about the different activities The delegator should supervise and monitor the delegatee when the work is being assigned to the delegatee. The communication between delegatee and delegator should always be two-way to get the expected outcome. The delegator should evaluate the ability of the delegatee and should supervise the different tasks before assigning the work to the new delegatee. The delegator should always provide feedback at the end of the task.
After delegating the task of administering oral medications to a licensed practical nurse (LPN), the registered nurse (RN) ensures that the LPN is supervised until the task is accomplished. Which right of delegation does the scenario reflect? 1. The right task 2. The right person 3. The right direction 4. The right circumstance
4. The right circumstance The right circumstance is indicated by the appropriate supervision, availability of equipment and resources, and appropriateness of the given situation. If the task is appropriate to the delegate based on institutional policies and is legal then it represents the right task of delegation. If the delegatee has adequate knowledge and experience to perform a task safely and effectively, it represents the right person of delegation. The right direction is indicated by the clear and concise directions provided for the task.
A client on diuretic therapy developed metabolic alkalosis. What does the nurse consider to be the priority nursing care while correcting alkalosis?
A client with *alkalosis* has *hypotension and muscle weakness*, which increases the risk for injury due to falls; therefore, to prevent injury, the *priority nursing care is to prevent falls. * Monitoring electrolytes daily until they return to normal is NOT the priority nursing care. Antiemetics are prescribed for vomiting and are given low priority. Once the client is protected from the risk of injury, diuretic therapy is adjusted.
A nurse manager delegates the task of phlebotomy to the members of a healthcare team who are caring for a client with diabetes. Which individual on the team can be delegated to perform the task of phlebotomy? Incorrect1 Registered nurse Correct2 Cross-trained technician 3 Licensed vocational nurse 4 Unlicensed assistive personnel
A cross-trained technician can safely perform the task of phlebotomy when paired with a registered nurse (RN). The RN delegates tasks to other assistive personnel. A licensed vocational nurse is assigned to administer oral and intramuscular medications to clients. Unlicensed assistive personnel are delegated to perform basic hygiene for clients.
The nurse is managing a client who underwent cardiac bypass surgery. Which healthcare member can be safely delegated the task of monitoring electrocardiography? 1 Nurse aide 2 Certified technician Correct3 Cross-trained technician Incorrect4 Licensed vocational nurse (LVN)
A cross-trained technician is suitable for monitoring electrocardiography in a client who underwent bypass surgery. A nurse aide is an unlicensed individual who can assist the client with basic hygiene; this aide cannot monitor electrocardiography. A certified technician is also an unlicensed member who can only record the vital signs or provide basic hygiene to the client. A licensed vocational nurse (LVN) can administer oral and intramuscular medications and record the vital signs.
Which of these clients is most appropriate for delegation to a cross-trained technician? Correct1 Client A 2 Client B Incorrect3 Client C 4 Client D
A cross-trained technician, when paired with a registered nurse (RN), may perform respiratory therapy, phlebotomy, and electrocardiography. Care of client A can be safely delegated to a cross-trained technician. Though the cross-trained technician can record the ECG, he or she may not monitor the continuous ECG. Monitoring of vital signs is also the role of the RN. Leg exercises may be taught by the RN or by a physician. The other licensed assistive personnel may be delegated the task of reinforcing the teaching, but this is not an appropriate role for the cross-trained technician.
Which delegatee requires little guidance from the delegator? Correct1 Delegatee who is familiar with the task but not the client 2 Delegatee who has experience but is unfamiliar with the task 3 Delegatee who has little experience but has willingness to do the task 4 Delegatee who is very familiar with the client but has a lack of ability to do the task
A delegatee who has experience and is familiar with the task requires less guidance and support from the delegator as he or she has the ability to accomplish the task. A delegatee who has work experience may have ability but requires guidance as he or she is new to the delegated task. A delegatee who shows willingness to do the task but has little experience requires supervision. A delegatee who is familiar with the client but has a lack of ability to do the task requires supervision or guidance.
While caring for a post-operative client, the delegator has assigned a task to a delegatee. Which statements made by the delegator indicates that the delegatee has the experience to perform the task? Select all that apply. Correct1 "I am available to you at any time for report." Correct2 "I am aware of your technical competencies." 3 "I will tell you what is necessary to perform the task." Incorrect4 "I will share my expectations about your performance." Incorrect5 "I will tell you what conditions are important to notify each other."
A delegatee with good experience may need little guidance. He or she knows what to do and when to report. As the delegatee has experience, he or she should just remember that the delegator is available at all times; the delegate can report at any time. The delegator should also make it known that the delegatee's competencies are known. The delegator tells a delegatee who is new to a task what is necessary to perform that task. The delegator will share expectations about the delegatee's performance when that delegatee can do the work and when he or she is new in assisting the registered nurse (RN). When the delegatee can do the work and is new in assisting the RN, the delegator tells the delegatee the appropriate conditions for notifying one another.
A delegator working in a rural setting has to handle a task of managing care for clients in that area. Which crucial step should the delegator take to develop a productive strategy in delegating tasks to a delegatee? 1 Assigning the task to the delegatee 2 Providing feedback to the delegatee 3 Supervising the task at regular intervals Correct4 Understanding the capabilities of the delegatee
A delegator, before handling a task, should understand the specific capabilities and skill set of the delegatee. Selecting a delegatee who has the specific skill set for the particular task is a more productive strategy than just selecting a competent individual. The delegator has to assess the delegatee and then assign the task on the basis of the competitive skills. Providing feedback during and after the task may enhance the working capabilities of the delegatee. Supervising a task is an ultimate essential element for the delegator, because the delegator is responsible for the accountability of completing the task.
Clients are sent to an emergency department for care, and tags are given to the clients based on a priority basis. Which client should be given a red tag?
A red tag is given to indicate the need for immediate treatment due to life-threatening conditions. The client with third degree burns should be given a red tag. A client with burns between 15% and 40% should be tagged red. This condition is critical because untreated burns are prone to fluid and electrolyte problems and life-threatening infections. A client with a closed fracture may not require a red tag as his or her condition is not likely critical or in need of immediate treatment. Closed fractures usually do not cause infection since the fracture may not come in contact with the skin. A client with severe abdominal pain can be given a yellow tag. A client with bruises and superficial lacerations should be given a green tag as the client can wait for some time for suturing the lacerations.
Which factors are associated with transformational leadership? Select all that apply.
A shared vision Increased self worth of followers Coaching and mentoring by the leader
What does "information salience," a characteristic of communication, refer to according to Anthony and Vidal? Incorrect1 Decay of information Correct2 Clarity of information 3 Change in client's health status 4 Change in client's health information
According to Anthony and Vidal, "information salience" is a characteristic of communication that refers to the clarity of information shared between the delegator and the delegate. Decay of information, change in client's health status, and change in client's health information are described by the term "information decay."
The registered nurse is delegating work to four delegatees. Which delegatee has an established relationship with the delegator? 1 Delegatee A Correct2 Delegatee B 3 Delegatee C 4 Delegatee D
According to Hersey's model, if the relationship between the delegator and delegatee is established, the behavior of the delegator is "observing or monitoring." Telling delegate B that his or her method is correct and to continue doing it in the same way indicates that the delegator is monitoring the delegatee's actions, which indicates an established relationship.
The registered nurse is delegating work to four delegatees. Which delegatee has an established relationship with the delegator? 1 Delegatee A Correct2 Delegatee B 3 Delegatee C Incorrect4 Delegatee D
According to Hersey's model, if the relationship between the delegator and delegatee is established, the behavior of the delegator is "observing or monitoring." Telling delegate B that his or her method is correct and to continue doing it in the same way indicates that the delegator is monitoring the delegatee's actions, which indicates an established relationship. Recommending delegatee A do the procedure because it can easily be done indicates a persuading behavior, which is done when the relationship between the delegator and delegate is developing. According to Hersey's model, if the relationship between the delegator and delegate is limited, the behavior of the delegator is "telling." The delegator is simply telling delegatee C to check the client's blood sugar level every morning for 5 days, which indicates a limited relationship between them. Participating in the work of delegatee D by demonstration indicates a new relationship.
The registered nurse is evaluating the statements made by a student nurse after teaching Hersey's situational leadership model regarding core competencies of a situational leader. Which statement made by the student nurse indicates a need for correction? 1 "A situational leader partners for performance." Correct2 "A situational leader is inflexible towards the work." 3 "A situational leader is able to identify the commitment of delegatee." 4 "A situational leader is able to diagnose the performance of a delegatee."
According to Hersey's situational leadership model, a situational leader is flexible towards work and adapts to the given situation. A situational leader collaborates with others to achieve the goals. A situational leader is able to identify the commitment of a delegatee. A situational leader is able to diagnose the performance of a delegate.
What does the nurse understand is the collaborative definition of delegation according to the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)?
According to the ANA and the NCSBN, delegation is the process for the nurse to direct another person to perform nursing tasks and activities. The process of guiding, directing, and influencing the outcome of an individual's performance of an activity is defined as supervision. The transfer of accountability and responsibility indicates assignment. According to the NCSBN, delegation is defined as the act of transferring the authority to perform a selected nursing task in a selected situation to a competent individual.
After assigning a specific work to the unlicensed nursing professional, the registered nurse does a critical analysis of the work to determine if the actions taken were appropriate and provides a detailed explanation of what occurred. Which action related to delegation is the nurse performing?
Accountability
The nurse leader states, "The people in rural America dress and act differently from those in urban centers." What concept describes this statement?
Acculturation
The nurse manager is teaching newly assigned delegators about the limitations of delegation. Which statements made by the delegators indicate effective teaching? Select all that apply. Correct1 "Personal hygiene activities can be delegated to unlicensed assistive personnel (UAP)." Correct2 "Administration of oral medication can be delegated to the licensed practical nurse (LPN)." 3 "Administration of intravenous medication can be delegated to the licensed practical nurse (LPN)." 4 "Tasks related to caring for diabetic clients can be delegated to unlicensed assistive personnel (UAP)." Correct5 "Tasks related to caring for clients in a hospice care setting can be delegated to licensed vocational nurses (LVNs)."
Activities related to client hygiene can be delegated to unlicensed assistive personnel (UAP). Administration of oral medication can be done by the licensed practical nurse (LPN). Licensed vocational nurses (LVNs) can care for the clients in a hospice care setting. Administration of intravenous medication cannot be done by LPNs as they are not eligible. Diabetic clients cannot be cared by UAP as this group does not have sufficient knowledge about how to care for clients with diabetes.
Which work is automatically increased for the delegator when there is a decrease in direct client care? 1 Leadership Correct2 Supervision 3 Delegation 4 Assignment
After delegating tasks to other members of the health care team, the delegator's care towards the client in a direct way decreases, and the supervisory work of the delegator increases. Leadership work does not necessarily increase when there is a decrease in direct client care. Delegation and assignment of work does not increase, because the work has already been delegated to another health care team member.
If there is a problem that requires immediate attention when should you call the doctor?
After you have initiated an ACTIVE INTERVENTION. If it is serious enough to call the Dr. then need something to keep them alive until Dr. gets there.
The nursing student is comparing the causative agents of hyperthermia and hypothermia. Which causative agent is common to both conditions?
Alcohol is the causative agent that is common to both hyperthermia and hypothermia. Barbiturates and phenothiazines can cause hypothermia. Cardiovascular disease can cause hyperthermia.
What is important to know about evaluating a treatment?
All drugs/tx are used to bring a pt back to normal. A successful tx will always reverse the presenting signs and symptoms (ask why treatment initiated).
The nurse observes a dispute between staff members due to differences in perspective concerning nursing practices. Which approaches of the nurse as a leader would be appropriate in building up negotiation "loop-backs" to resolve the conflict? Select all that apply.
Allowing a cooling-off period if the resolution fails Informing of the full consequences of failing to resolve the issues
The registered nurse assists other registered nurses when there are no safety issues. While assisting, the registered nurse uses the strategy of asking. What is the benefit of this strategy? Select all that apply.
Allows the registered nurse to reassess Allows the delegator to examine the situation differently Opens lines of communication between delegator and the delegatee
Who should ambulate an acutely ill, chronic condition patient?
An LPN
Who should do an assessment on a stable acute patient?
An LPN
Who should do an assessment on a stable chronic patient?
An LPN
Who should take care of an SCI patient during their first week (acute)?
An RN
Who should complete sterile procedures?
An RN or LPN
Who should administer medications?
An RN or LPN (no IVs)
The nurse leader and the team received recognition because of a follower on the team. What could be the most important action of the nurse leader?
An effective leader generally is eager to share the rewards, appreciation, and recognition among the team. This increases team spirit and makes the followers follow eagerly. The nurse leader can share the recognition with the family, friends, and other higher professionals, but only after sharing it with the team.
A nurse is a preceptor for an orientee (newly hired nurse). The orientee is providing postoperative care to a client who recently returned from a laryngoscopy. The orientee reminds the client not to eat or drink anything until instructed to do so. How does the preceptor evaluate the suitability of the instructions given to the client by the orientee?
Appropriate; oral intake after the procedure may result in aspiration
Which questions related to decision making for delegation are appropriate according to the delegation right of "right circumstance"? Select all that apply.
Are the equipment and resources available to complete the task? Does the delegatee have appropriate supervision to complete the task?
A nurse manager in a cancer care facility finds that the nursing care team is demotivated due to consecutive deaths of two terminally ill cancer clients. Which action of the nurse manager would help renew the team's energy?
Arranging a notice board in the unit and posting photos or messages reflecting achievements of the team
While caring for a client who was injured in a tornado, the nurse finds that the client is disoriented. Which is the most appropriate nursing intervention to prevent injury in the client?
Asking a family member or significant person who cares for the client to remain with the client will help to reduce confusion in the client. It is the most important intervention to prevent injury in the client. Keeping rails up on the stretcher will help to prevent injury in the client but it is not the most appropriate intervention. Keeping the stretcher in the lowest position will prevent injury but it is not the most appropriate intervention in clients. Maintaining adequate lighting in the room will help to prevent injury from a fall but it is not the most appropriate intervention in case of disoriented or confused clients.
Which behavior of the nurse indicates management skills according to Gardner's task of achieving workable unity?
Assisting staff to achieve optimal functioning to benefit the transition to enhanced organizational functions
The registered nurse (RN) is teaching a novice RN about delegating tasks to licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). Which statement made by the novice RN indicates a need for further teaching? 1 "I will delegate the task of reinforcing client teaching to the LPN." Correct2 "I will delegate the task of assisting the client with bathing to the LPN." 3 "I will delegate the task of recording vital signs of the client to the UAP." Incorrect4 "I will delegate the task of administering intramuscular injections to the LPN."
Assisting the client with bathing is related to providing basic care, comfort, and hygiene and is a task better suited to unlicensed assistive personnel. The scope of practice of an LPN includes reinforcing the client teaching. Recording vital signs is within the scope of practice of UAP. Administering intramuscular injections is within the scope of practice of an LPN, not UAP.
Which component of delegation is suitable to all the members on the healthcare team? Correct1 Authority 2 Supervision 3 Accountability 4 Communication
Authority is the component of delegation that is suitable for all the members on the healthcare team. Supervision is a right of delegation in which the delegator supervises the other assistive personnel to perform the task. Accountability is the component of delegation that is suitable for delegators such as registered nurses (RNs). Communication is the right of delegation in which the delegator gives the directions to perform the task.
The registered nurse is evaluating the statements of the student nurse after teaching about delegation. Which statement made by the student nurse indicates a need for correction? 1 "Delegation is merely sharing a set of functions." 2 "Delegation ensures quality client care outcomes." Correct3 "Professional aspects of care can also be delegated." 4 "The final accountability of a task remains with the delegator."
Basic activities of daily living and personal hygiene can be delegated but professional aspects of care cannot be delegated and should be performed by the registered nurse only. Delegation is a process of merely sharing a set of functions in which the delegator shares functions with the delegatee. Because delegation involves sharing of functions, it ensures quality client-care outcomes. Though the delegator assigns work, the final accountability of a task remains with the delegator.
A healthcare team is delegated the task of assisting a client with bathing. Which member of the healthcare team is responsible and accountable for this aspect of client care? Incorrect1 Nursing aide Correct2 Registered nurse (RN) 3 Patient care associate (PCA) 4 Licensed vocational nurse (LVN)
Bathing is often delegated to a patient care associate (PCA) on the healthcare team. The registered nurse (RN) is accountable for the client care, but is not delegated the task of basic hygiene care such as bathing. Though the nursing aide is responsible for client care, he or she is not accountable for the client care. Similarly, a PCA may be responsible but not accountable for client care. As bathing is not generally delegated to a licensed vocational nurse (LVN), the LVN is neither responsible nor accountable for client care.
The nurse, as a leader, is planning to provide information about personal hygiene to a group of clients. Which communication methods should the nurse use to talk to the clients? Select all that apply.
Being sensitive to nonverbal communication Providing the opportunity for dialogue and feedback Presenting information that addresses the listener's self-interest
Which topics being taught by the nurse belong to Covey's characteristics of leadership? Select all that apply.
Believing in other people Radiating positive energy Engaging in lifelong learning
When a client with cancer reaches an incurable last stage, the nurse explains the situation to the client and calls the client's family members to provide support. Which need of the client does the nurse prioritize here?
Belonging need
The nurse leader is promoted to nurse manager and has a plan of implementing an effective client counseling center in the outpatient department. The nurse gathers data from different healthcare providers and compares methods. Which type of quality improvement does the nurse implement?
Benchmarking
What should be taught regarding home safety?
Bikes & skateboards should not be ridden in the street, guns should not be in homes with children even if they are locked up, <1 year old=sit in back seat facing backward >1 yr & <12 yrs= sit in back seat facing forward, home oxygen should be kept away from flames (stove, fireplace, no wool blankets, and no smoking- the smoke itself won't cause an explosion).
Which client's care can the registered nurse (RN) safely delegate to unlicensed nursing personnel (UNP) based on the given data? Correct1 Client A, with chronic hypertension and stable vitals 2 Client B, with drainage from diabetic foot 3 Client C, with myocardial infarction due to atherosclerosis 4 Client D, with foot ulcers from peripheral vascular disease
Care of client A can be safely delegated because the chronic hypertension with stable vitals is not generally associated with any complications. Client B with drainage from diabetic foot is at a risk of aggravating foot issues, so this client's care cannot be safely delegated. Client C with myocardial infarction due to atherosclerosis is at a risk of cardiovascular instability and care should not be delegated. Client D has a risk of foot ulcers due to peripheral heart disease so this client's care also cannot be safely delegated to the UNP.
A healthcare team is caring for a postsurgical client who underwent knee surgery. Which task is most suitable to be delegated to a licensed practical nurse (LPN) to provide effective client care? Select all that apply.
Changing the dressing Administration of oral analgesics Reinforcing leg exercise instructions
In a health care setting, there are a limited number of unlicensed nursing personnel. Who would take up the responsibility of delegation in place of the registered nurse?
Charge nurse
Which employee should be competent in critical thinking, leadership, communication, and time management skills? Select all that apply.
Charge nurse, registered nurse
In a health care setting, there are a limited number of unlicensed nursing personnel. Who would take up the responsibility of delegation in place of the registered nurse? Correct1 Charge nurse 2 Chief nursing officer 3 Patient care associate 4 Licensed practical nurse
Charge nurses act as delegators as they also have knowledge and expertise in the clinical setting. In cases where there are a limited number of unlicensed nursing personnel, the registered nurse does not delegate tasks. In this instance the charge nurse usually becomes a delegator and delegates the tasks. The chief nursing officer is not the immediate person to delegate the tasks in such instances. Patient care associates and licensed practical nurses act as delegatees.
Who would the registered nurse state is accountable for establishing systems to communicate competency requirements related to delegation?
Chief Nursing officer (CNO)
Which health care professional is accountable for establishing systems to assess and communicate competency requirements related to delegation? Incorrect1 Registered nurses Correct2 Chief nursing officers 3 Licensed practical nurses 4 Unlicensed nursing personnel
Chief nursing officers are expected to establish the systems to assess and communicate the competencies required for delegation. Registered nurses are accountable for client care. The licensed practical nurse and unlicensed nursing personnel act as delegatees for various tasks.
What are the rules to remember when delegating to NAs?
Chronic stable patient only. Assigned tasks defiened in procedures Can take VS on stable patients and 1/2 hour after blood is started. NO delegation of tasks where medical knowledge is necessary or required WATCH KEY WORDS AND STAY AWAY FROM: (show,explain, monitor, teach, check, assess, and demonstrate=NO), Can walk stable patients, reorient/co-conduct . NO TO NA : Sterile procedures Assessments including VS on new admits Feeding choking risk patients Drugs (even OTC topicals), teaching, chest tubes, art lines, trachs, endo tubes, contagious diseases, or vents.
A client with severe burns and injuries from a bomb blast is admitted in the emergency unit. Which triaging priority is preferable for the client?
Class I
Which client care can be safely delegated to the unlicensed nursing personnel (UNP) to provide oral hygiene? Correct1 Client A 2 Client B 3 Client C Incorrect4 Client D
Client A with dental caries is least likely to have any complications during oral hygiene. Oral care in clients with oral cancer has associated risks; therefore, it should be performed by a registered nurse (RN). Since client C with a jaw fracture has limited ability to open the mouth, care cannot be safely delegated to the UNP. In client D with thrombocytopenia, small bruises that could occur during oral care may result in persistent bleeding. This complication prevents delegation of oral hygiene for client D to UNPs.
The registered nurse (RN) delegates a task to a licensed practical nurse (LPN). Which client task can be assigned to the LPN? 1 Client A Correct2 Client B 3 Client C 4 Client D
Client B is delegated to the LPN to perform sterile dressing changes on acute and chronic wounds. Assessments such as evaluating fluid electrolyte needs in client A with dehydration are performed by the RN. In client C, notifying the registered nurse if the client reports pain is done by unlicensed nursing professional (UAP). In client D with presbycusis, helping the client with hearing aid replacement is performed by the UAP.
The nurse manager has delegated tasks to a registered nurse (RN) and unlicensed assistive personnel (UAP) who are paired to provide care for a client with substance abuse. Which hospital care setting uses this model to deliver care to the clients? 1 Hospice care 2 Extended care 3 Long term care Correct4 Rehabilitative care
Clients with substance abuse require rehabilitative care. Rehabilitative care uses the partnership model to deliver care to the clients. In this model, the RN and UAP are paired to deliver the care. Hospice care is indicated for end-of-life care in clients. Extended care is provided for older clients. Long-term care is provided for clients with chronic diseases. Hospice care, extended care, and long-term care setting may not require the partnership model to deliver the care to the clients.
A newly promoted registered nurse (RN) is about to start delegation for the first time in her career. Which experiences foster professional self-confidence in the early career stage for an RN? Select all that apply.
Clinical delegation experiences foster professional self-confidence in the early career of an RN. The nursing practicum experiences of applying theory to practice and developing clinical judgment will also advance the RN's ability to become a successful delegator and foster professional self-confidence. Engagement with a nursing mentor fosters professional self-confidence in the early career of an RN. The RN must have the ability to comprehend the legal authority of delegation decisions.
A student nurse is learning Gardner's Tasks of Leading and Managing. Which position of the health care team has the managing function of priority setting, according to Gardner?
Clinical position
What kinds of patients could be assigned to an OB float nurse?
Closed abdominal surgeries, HTN, DM, Epidurals, and IV drips. If cardiac maybe telemetry bc similar.
A registered nurse is teaching a group of newly hired licensed registered nurses, licensed practical nurses, and unlicensed nursing professionals. Which teaching strategies would be appropriate to develop competencies? Select all that apply. Correct1 Case studies Correct2 Online learning 3 Teaching experience Correct4 Clinical nursing practice Incorrect5 Demographics of learning group
Competencies can be developed through different teaching strategies such as case studies, online learning, and clinical nursing practice. These strategies can help in improving the learning ability of the student nurses, licensed practical nurses, and unlicensed nursing professionals. Teaching experience and demographics may not be required to develop competencies.
The nurse is instructing the student nurse how to administer percutaneous enterostomal gastrostomy (PEG) tube feeding to a client. What should the nurse tell the student? Select all that apply.
Connect tube feeding bag to client and feeding pump. Flush with warm water before beginning feeding. Check prescription for correct client formula. Set correct rate and initiate pump. Check for diarrhea
Which is the priority nursing action to include in a disaster plan for the radioactive dust and smoke that can cause illness from a radiologic dispersal device (RDD)?
Covering the nose
Which assets of the nurse as a licensed health care professional help in planning effective nursing care? Select all that apply.
Critical thinking Diagnostic reasoning Ability to synthesize information
A hospital's emergency power generators were accidentally destroyed. The hospital management has decided to move the clients to another hospital. Which staff interventions are appropriate to ensure client safety? Select all that apply.
Damage to power generators is an example of an internal disaster that can pose danger to clients. Shifting clients to another hospital can help reduce the risk. Hospital staff should carry flashlights to ensure adequate lighting during the move and avoid injuries to clients and themselves. The hospital staff should use staircases to shift clients as the elevators would be non-functional due to power loss. The hospital staff would ideally wear headlamps if they are available as these can provide hands-free lighting. Glow sticks provide lighting and can be used while shifting clients. As previously mentioned, elevators are nonfunctional in the event of power loss and would not be used.
Which skill would most likely be associated with an effective nurse leader?
Delegating work appropriately
Which healthcare professional does the nurse know is authorized to delegate work to other healthcare members? Correct1 Registered nurse (RN) 2 Licensed practical nurse (LPN) 3 Unlicensed nursing personnel (UNP) 4 Unlicensed assistive personnel (UAP)
Delegating work is the most effective professional management strategy that an RN can implement in clinical practice to improve the safety and quality of client care. RNs can delegate work to LPNs, UNP, or UAP.
What would the nurse describe as the challenges of delegation? Select all that apply. Correct1 Limited resources 2 More staff availability Correct3 Larger geographic area Correct4 Care for vulnerable populations 5 Deciding if delegating is time-saving
Delegation can be more challenging when the resources are limited, when the geographic area is greater, and when care is given for vulnerable populations. Availability of more staff is a benefit of delegation. Decisions for delegation should not be solely based on time-saving considerations; they should also be based on the abilities of the nursing staff to complete the tasks effectively and safely.
The registered nurse (RN) is caring for a client who underwent brain surgery. The registered nurse delegated the task of reinforcing ambulation to the licensed practical nurse (LPN). Who is accountable for the client' scare? 1 Charge nurse Correct2 Registered nurse 3 Licensed practical nurse 4 Primary healthcare provider
Delegation involves sharing the responsibility of client care while the delegator retains the accountability. In this scenario, the RN is the delegator who retains the accountability by transferring tasks to the LPN. A charge nurse is accountable in the absence of the RN or if the charge nurse is delegating the task. The LPN is under dependent status and is transferred the responsibility but the accountability is retained by the delegator. The primary healthcare provider may not be accountable for the client's care because the primary healthcare provider is not the delegator.
After assigning a specific task, the registered nurse observes that the delegatee is unable to perform the task accurately. What will be the appropriate statement of the registered nurse in this situation? 1 "It's better if I do the work myself." 2 "We will do the task some other time." 3 "You can't do even this work properly." Correct4 "Just follow my steps and you can do it."
Delegation is a complex process of sharing activities among team members. If a team member is not competent to perform a given task, the registered nurse lowers expectations and helps the delegatee accomplish the task. Therefore the appropriate statement of the registered nurse in this situation is to follow his or her example to do the work, because this provides encouragement. If the registered nurse says that it is better for him or her to do the work, it increases time and affects the process of delegation. If the registered nurse says to accomplish the task some other time, it affects the quality of client care. If the registered nurse says to the delegate that he or she cannot do the work properly, it is a verbal attack, which may undermine their relationship.
What are some challenges faced in the process of delegation? Select all that apply. Correct1 Limited resources Correct2 Large geographic area 3 Time-saving considerations Correct4 Vulnerable populations receiving care 5 Provision of assistance with activities of daily living
Delegation is a complex process. Delegating a task when resources are limited is a great challenge. Delegation is also more challenging the larger the geographic area is where the task should be performed. The process of delegation also becomes more challenging when care is being delivered to vulnerable populations. Time conservation is a benefit of the delegation process even if the decision to delegate may not be based on time-saving considerations. Providing assistance with the client's activities of daily living is a benefit rather than a challenge of delegation.
The unlicensed nursing personnel (UNP) is delegated tasks related to client care. What is the correct order of steps the registered nurse (RN) should follow when deciding to delegate the work to the UNP? Incorrect 1. Determining the knowledge and skills of the UNP Incorrect 2. Assigning the client-specific tasks to the UNP Incorrect 3. Monitoring the assignments allotted to the UNP Incorrect 4. Assessing the client's health status Correct 5. Reporting deviations in the client's response Correct 6. Providing feedback about the UNP performance
Delegation is a process of the RN assigning work to other health care personnel who are capable. First, the RN should assess the client's health needs and the knowledge and skills of the UNP for performing the care. Assignment of tasks to the UNP is based on the client's health needs after assessing the skills of UNP. The RN then monitors the client's responses to the care provided by the UNP, which is also useful to assess the performance of UNP. Any deviated client responses or any other client-specific issues are reported in order to evaluate the client's response to the care. Finally, the RN provides feedback to the UNP to help the UNP improve care.
The registered nurse (RN) is caring for a client who is currently hospitalized for a stroke. What is the most effective professional management strategy for the RN to improve the safety and quality of client care? Correct1 Delegation 2 Leadership 3 Supervision 4 Assignment
Delegation is the most effective professional management strategy to implement in clinical practice to improve the safety and quality of client care by the registered nurse. Leadership is the action of leading a group, which is not suitable in this situation. Supervision is the active process of directing, guiding, and influencing the outcomes. Assignment is the transfer of both accountability and the responsibility from one person to another.
The registered nurse assigns a task to a licensed practical nurse (LPN) to check the blood pressure and temperature of a client. Which factor is transferred to the LPN for the performance of the task? 1 Liability 2 Authority Correct3 Responsibility 4 Accountability
Delegation is the transfer of responsibility for the performance of the task. So, the LPN is responsible until the task is completed. Liability is the person's responsibility and accountability for individual actions. Authority is the ability to perform duties in a specific role. Accountability is transferred when the work of one individual is performed by the other.
The registered nurse is teaching the student nurse about the concepts of delegation. Which response given by the student nurse indicates the need for further teaching? 1 Delegation always involves two individuals. Correct2 Delegation is the transfer of accountability while retaining responsibility. 3 Delegation is an important strategy for client safety and quality of client care. 4 Delegation has five rights that should be followed in the process of delegation.
Delegation is the transfer of the responsibility for the task, while the final accountability is always retained with the delegator. Delegation involves the delegator and the delegatee. Delegation is an important strategy for ensuring client safety and quality of client care. Delegation has five rights that are to be followed throughout the delegation process: right task, right person, right circumstance, right direction/communication, and right supervision.
How can registered nurses develop delegation and supervisory strategies to adapt to their changing roles? Select all that apply. Correct1 Engage a nurse mentor for guidance. 2 Practice the nursing care process in various clinical settings. Correct3 Reinforce delegation knowledge through continuing education. 4 Become familiar with the hierarchy of authority in the health care organization. Correct5 Seek high-quality clinical delegation experience early in their career.
Engaging a nurse mentor helps provide guidance and facilitate problem-solving related to delegation and supervision. Reinforcing delegation knowledge through continuing education helps nurses become familiar with the changing trends in health care delivery in context of delegation. Seeking high-quality clinical delegation experience early in a nurse's career helps nurses gain confidence in delegation skills. Practicing the nursing care process in various clinical settings helps the nurses to improve patient outcomes, but would not specifically help develop delegation and supervisory strategies. Becoming familiar with the hierarchy of authority in the health care organization may help nurses understand management-related issues. However, this knowledge would not directly help nurses develop delegation and supervisory strategies.
Before assigning a task, the registered nurse makes sure that the prospective delegatee is willing to complete the task. Which delegation right does this situation reference? Correct1 Person 2 Supervision 3 Circumstance Incorrect4 Communication
Ensuring that the prospective delegatee is willing to complete the task refers to the delegation right person. Knowing whether the delegator is able to monitor and evaluate the client appropriately refers to the delegation right supervision. Ensuring whether the equipment and resources are available to complete the delegation process refers to circumstance. Ensuring whether the delegator and delegatee understand a common work-related language refers to the delegation right communication.
The intensive care unit at a hospital has recently experienced a turnover of several long-tenured nurses who assumed important leadership roles. As a result the unit has become less effective and productive despite the consistent performance of the remaining nurse leaders. What should the management team do to ensure that effectiveness and productivity remains consistent in the event of future leadership turnover?
Establish a leadership succession plan
A registered nurse (RN) delegates the task of foot care for a client to an unlicensed nursing personnel (UNP). The UNP is skillful and willing to perform the given task, but was recently hired and is unfamiliar with the client's condition. What should the RN do in this situation?
Establish mutual expectations and conditions.
During the process of delegation, the delegator's behavior is noted to be observing and monitoring. How is the relationship between the delegator and delagatee in this situation?
Established
In an organization, the leader is providing specific feedback regarding positive performance to his or her subordinate. Which leadership theory behavior is being displayed by the leader?
Expectancy theory
Which statement is true regarding leadership theories?
Expectancy theory states that leaders should provide specific feedback about positive performance.
A nurse leader of a state nurse's association (SNA) is advising legislators regarding health policy improvements. Which key idea is involved in this type of leadership power?
Expert power
Which care settings are more suitable for unlicensed nursing personnel (UNP)? Select all that apply. 1 Acute care 2 Surgical care Correct3 Extended care Correct4 Long-term care 5 Emergency care
Extended care and long-term care settings are more suitable for unlicensed nursing personnel (UNP). Acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals. Acute care, surgical care, and emergency care are not suitable for UNPs because the clients are less stable compared to those in extended care and long-term care. Since acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals, the UNP's role is very limited.
A registered nurse delegated a task to the unlicensed nursing personnel (UNP) and is supervising the UNP. Which statements made by the nurse after the UNP completes the task can yield a positive outcome from the UNP? Select all that apply. Correct1 "Nice job." 2 "What is wrong with you?" Correct3 "You performed that task safely and professionally." 4 "Did the client respond positively to the nursing care?" Correct5 "The task was well done, but there is room for improvement."
Feedback, when given clearly and honestly, will yield a positive outcome from the UNP. When the nurse says, "You performed that task safely and professionally," or "The task was well done, but there is room for improvement," it shows that the UNP's work is recognized. Statements such as, "Nice job," are vague and ineffective. Statements such as, "What is wrong with you?" will be perceived as a verbal attack and will not have any positive effect. Questions should be open-ended, in order to encourage the UNP to share experiences with the RN. "Did the client respond positively to the nursing care?" is a closed-ended question that cannot be described further.
A registered nurse is providing feedback to a delegatee after monitoring the work. Which feedback is the best for shaping the future behavior of the delegatee? 1 "Nice job." Incorrect2 "You could have done it better." 3 "That was better than what I expected." Correct4 "You performed that procedure safely and professionally."
Giving feedback that the performance was safe and professional clearly describes the work performance and helps in shaping the future behavior of the delegatee. Giving feedback that the work was nice is vague and not specific to a behavior. Giving feedback that the work was better than expected is insulting and is not constructive feedback. Giving feedback that the work done was better than expected is vague and does not clearly explain the work performance.
What patients are immunocompromised?
HIV, cancer, chemo, steroids, organ transplants, cushings, addisons, and radiation.
What interventions are needed to prevent aspiration?
HOB elevated to eat, bed in low position, place on right side after eating, call bell in reach, suction available, and side rails elevated.
What are the rules to remember when delegating to an LPN?
HOSPITAL: An LPN works under direct supervision of an RN. IN a nursing home they might be charge nurses and handle all aspects of care. EX: plan, assess, evaluate, intervene and notify Dr. GET IN HOSPITAL Assign: stable chronic conditions with predictable outcomes .(Pts 24 hours after surgery). NO: discharge planning, admission assessments (including VS). NO IVs, and NO teaching. CAN: give narcotics. HAVE patient 72 hours after MI, CVA, SCI (spinal cord injury), Vents, or low coma scale (after 1 week), and may reinforce teaching.
The behavior of four nurses in different situations is given below. Which nurse exhibits a behavior that can be characterized as delegation according to Hersey's model? 1 Nurse A Correct2 Nurse B 3 Nurse C 4 Nurse D
Hersey's model describes "delegation" as the leader's behavior of observing or monitoring if the delegatee has the ability, willingness, and expertise to accomplish the work and there is an established relationship, as with nurse B. Nurse A exhibits guiding or directing, described as "telling," in which the delegator simply tells the individual what is the task to be done and how to perform the task. This happens if the relationship is limited. "Selling" is exhibited by nurse C and is the process of explaining and persuading, which happens if a situation involves a new task and the relationship is ongoing. "Participating" is exhibited by nurse D and is the ability of encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task.
A delegator, working in collaboration with a delegatee, allots responsibilities and explains the various procedures and techniques needed to accomplish the task. Which action is the delegator performing, according to the Hersey model? 1 Guiding and directing 2 Observing or monitoring Correct3 Explaining and persuading 4 Encouraging or problem solving
Hersey's model describes the leader's behavior as explaining or persuading, which is characterized as "selling." In this situation, the delegator is assigning the work to the delegatee and explaining the various procedures and techniques to accomplish the specified task. A leader's behavior described as guiding or directing is characterized as "telling," in which the delegate simply assigns the task to the delegatee. The leader's behavior of observing or monitoring is characterized as "delegating," in which the delegator is responsible and accountable for the entire task. A leader's behavior that is encouraging or problem solving is characterized as "participating," in which the delegator establishes a working environment in which to complete the task in the specified time.
While performing a secondary emergency assessment survey, the nurse uses the mnemonic AMPLE to determine the client's condition after a natural disaster. Which type of assessment is performed in this scenario?
History and head-to-toe assessment involves use of the mnemonic AMPLE that includes Allergies, Medication history, Past health history, Last meal, and Events preceding illness/injury to determine the history of the client. Giving comfort measures is an emergency assessment that is used to assess, treat, and reassess for pain and anxiety. Posterior surfaces are inspected to determine bleeding, bruises, and lacerations. Facilitating family presence includes determining the caregiver's desire to be present during invasive procedures.
The nurse leader is giving a speech on leadership skills to followers. Which questions enable the nurse leader to evaluate the understanding level of the followers? Select all that apply.
How can you solve a conflict at the workplace?" "What did you 'hear' in the process of this communication?
Which question related to quality of decisions would the nurse leader consider while assessing the degree of conflict resolution?
How creative are the resulting plans?
What should be done for effective infection control?
ID type of precautions required (airborne, droplet, contact, or standard), put infected patients in private rooms or with patient c same organism, airborne in private room with negative pressure (TB), Droplet (mask within 3 feet), contact (gown & gloves), and infected patients can leave room as long as wear same PPE out of room as ppl wear going into the room.
A patient care associate (PCA) is delegated a task that can be completed in 2 hours. The PCA has limited knowledge and willingness regarding that particular task. Which leadership style should be implemented by the delegator in this situation?
If the ability and willingness of the delegatee is low and the work assigned to the delegatee can be completed in 2 hours, it means the nature of relationship between delegator and delegatee is limited. In such situation, the leadership style of the delegator should be telling, because it provides a fair amount of guidance and also limits the time spent on the interactions. The selling style of leadership should be used when the relationship is ongoing; that is, individuals who usually work together continue to work together. The monitoring style should be used when the delegatee has the ability and willingness, and has an established relationship with the delegator. The participating style can be implemented when the delegatee is willing to perform the task. Tip: Hershey's Model of leadership provides solid foundation for delegation
The registered nurse (RN) delegates a task to the licensed practical nurse (LPN). If the LPN fails to perform the task within acceptable standards, what would happen? Select all that apply.
If the delegated task is not performed within acceptable standards, a potential for nursing malpractice emerges. Failure to delegate and supervise within acceptable standards may extend to direct corporate liability for the institution. Whenever care is provided by staff other than a registered nurse (RN), the accountability for care remains with the delegator who is an RN. The licensure of the licensed practical nurse (LPN) would not be cancelled because the LPN is not held accountable for the situation. When the work is assigned to the LPN, only responsibility of the task is transferred.
The registered nurse (RN) delegates a task to the licensed practical nurse (LPN). If the LPN fails to perform the task within acceptable standards, what would happen? Select all that apply. Correct1 A potential for nursing malpractice emerges. Correct2 The institution remains legally responsible for the situation. Correct3 The accountability for care remains with the registered nurse (RN). 4 The licensure of the licensed practical nurse (LPN) would be revoked. Incorrect5 The accountability for care remains with the licensed practical nurse (LPN).
If the delegated task is not performed within acceptable standards, a potential for nursing malpractice emerges. Failure to delegate and supervise within acceptable standards may extend to direct corporate liability for the institution. Whenever care is provided by staff other than a registered nurse (RN), the accountability for care remains with the delegator who is an RN. The licensure of the licensed practical nurse (LPN) would not be cancelled because the LPN is not held accountable for the situation. When the work is assigned to the LPN, only responsibility of the task is transferred.
The registered nurse is caring for a client admitted with sudden paralysis in the legs and an inability to walk. Which interventions made by the registered nurse (RN) indicates correct active delegation? Select all that apply. 1 The RN assessing the client's diagnostic and laboratory findings 2 The RN administering an intravenous (IV) calcium gluconate injection Correct3 Instructing the licensed practical nurse (LPN) to report client's vital signs Correct4 Instructing the licensed practical nurse (LPN) to administer vitamin B12 injection 5 Instructing the unlicensed nursing personnel (UNP) to administer oral vitamin D3
In active delegation, the RN assesses the situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individual accountable. Instructing the LPN to report the client's vital signs is an active delegation that includes directing the assistive personnel to perform the task. Instructing the unlicensed nursing personnel to administer oral vitamin D3 is beyond their scope of practice. The RN assessing the client's diagnostic and laboratory findings does not involve delegation. The RN administering an intravenous calcium gluconate injection does not involve delegation. Instructing the LPN to administer a vitamin B12 injection is within the scope of practice for the LPN.
The registered nurse is teaching a newly hired nurse about active delegation. Which statement made by the newly hired nurse indicates the need for further teaching? 1 "I will evaluate the client's pain status." 2 "I will assess the client's laboratory findings." 3 "I will instruct the unlicensed assistive personnel (UAP) to wash the client." Correct4 "I will instruct the licensed vocational nurse (LVN) to administer intravenous (IV) medications."
In active delegation, the registered nurse (RN) assesses the client's situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individuals accountable. Instructing the LVN to administer intravenous (IV) medications is beyond the practice scope for an LVN. Evaluating the client's pain status is a part of active delegation. Assessing the client's laboratory findings is active delegation. Instructing the UAP to wash the client is an active delegation as the RN is directing a task that is to be performed by the UAP for the client.
Which nursing model includes a registered nurse (RN) paired with technical assistance? 1 Team nursing model Correct2 Co-primary nursing model 3 Patient-focused care model 4 Functional model of nursing
In the co-primary nursing model or practice partnership model, the registered nurse (RN) is paired with technical assistance. The team nursing model is a modification of the functional nursing model. The focused care model is the care delivered in patient-focused care. The functional model of nursing is a method of providing care by each licensed and unlicensed staff member who performs specific tasks for a large group of clients.
When assigning a task, the delegator should understand the delegatee's personal values and align them with the organizational values. Which task can be achieved from this delegation? Correct1 Affirming 2 Managing Incorrect3 Renewing 4 Motivating
In the task of affirming values, sharing the personal values of the delegatee and aligning them with organizational values enables the delegatee to achieve an outcome. In managing, the delegator assists the delegatee with planning. In renewing, the outcome is achieved by enhancing the ability to care for the delegatee. In motivating, the delegatee is inspired to achieve the outcome.
The registered nurse (RN) has delegated a task to an unlicensed nursing personnel (UNP). After performing the task, the UNP reports to the RN for appraisal. Which statement by the UNP is related to individual accountability? Select all that apply. Correct1 "I take full responsibility for the action performed." Correct2 "I have ensured that the action has achieved the desired outcome." 3 "I have ensured that there is a ventilator placed in every intensive care unit." 4 "I have established systems for assessing and monitoring the tasks assigned." Incorrect5 "I have evaluated whether the work environment is conducive to work or not."
Individual accountability is a component of delegation. It refers to the individual's ability to take responsibility for the actions performed and outcomes related to the task, which are obtained after the action. Ensuring that there is a ventilator placed in the intensive care unit, establishing systems for assessing and monitoring the competencies, and evaluation of the work environment are all related to organizational accountability, not individual accountability.
The registered nurse (RN) delegates the collection of respiratory rate data to a licensed practical nurse (LPN) for a client who is experiencing severe dehydration and whose condition is unstable. The LPN reports the data to the RN. The RN rechecks the data and finds that the report no longer reflects the patient's current condition. Which characteristic of communication has interfered with the delegation process? Correct1 Information decay 2 Information salience 3 Confidence in abilities 4 Synergy between team members
Information decay can occur in a rapidly changing situation when reported information is no longer relevant to a patient's condition. Information salience describes the different ways individuals from different backgrounds might assess the quality, meaning, and clarity of certain information. Trust is developed when there is confidence in the abilities and capabilities of the team members. Healthy relationships among members of the health care team promote synergy between the team members.
The registered nurse finds information decay during the process of delegation. What possible causes may have contributed to this? Select all that apply. Correct1 Frequent changes in the heart rate of the client Correct2 Rapid change in the blood pressure of the client Correct3 Frequent changes in the client's perception of pain Incorrect4 Diverse cultural background of the delegator and delegatee Incorrect5 Different educational background of the delegator and delegatee
Information decay is a characteristic of communication that occurs when the client's health status changes rapidly and specific information loses its value or becomes irrelevant to the client's condition. Rapid change in the blood pressure, frequent changes in the heart rate, and frequent changes in the client's perception to pain can all cause rapid changes in information and lead to information decay. Diverse cultural backgrounds of the delegator and delegatee refer to another characteristic of communication, "information salience." Different educational backgrounds of the delegator and delegatee refer to another characteristic of communication, "information salience."
The direct care nurse is delegated the task of reviewing the informed consent form after being completed by the client. Who should the direct care nurse consult regarding queries related to client rights? Incorrect1 Charge nurse Correct2 Nurse manager 3 Licensed practical nurse 4 Primary healthcare provider
Informed consent is the authorization by the client or client's representative to perform some therapeutic intervention. Informed consent is an important concept for nurse managers, and the nurse manager is the person who can clarify queries regarding informed consent. The charge nurse is the registered nurse who has the responsibility of coordinating and assigning client care and supervises the delegatees. A licensed practical nurse is a licensed nursing professional whose scope of practice is limited. It is not the responsibility of the primary healthcare provider to explain the concepts of informed consent of the client to the direct care nurses.
While caring for a client, the registered nurse (RN) needs the assistance of a licensed practical nurse (LPN). The RN feels that the LPN requires supervision as the LPN has previously only worked in a physician's office. Which action by the RN would help diminish any negative feelings the LPN might have about being supervised?
Initiating a conversation about the new role and functions of the LPN
While caring for a client, the registered nurse (RN) needs the assistance of a licensed practical nurse (LPN). The RN feels that the LPN requires supervision as the LPN has previously only worked in a physician's office. Which action by the RN would help diminish any negative feelings the LPN might have about being supervised? 1 Initiating a conversation about the limited skills of the LPN Incorrect2 Appreciating the performance of the LPN when providing feedback 3 Explaining the policies and procedures of the organization Correct4 Initiating a conversation about the new role and functions of the LPN
Initiating a conversation related to new role and functions of the LPN opens up the lines of communication and provides an opportunity to explain why the supervision is necessary. It also helps eliminate or diminish the negative feelings of the LPN regarding the supervision. The RN can open up the line of communication by briefing the drawbacks of the LPN, but this may not help in diminishing the negative feelings about supervision. Appreciating the LPN's work may be welcome and appropriate, but would not necessarily address the LPN's negative feelings about being supervised. Likewise, an explanation of the organization's policies and procedures is important for a LPN who is new to the organization, but this would not necessarily diminish the LPN's negative feelings about supervision.
How should a student nurse be trained for implementing delegation in practice? 1 By reinforcing delegation to the student nurse only during academics Correct2 By interacting with highly qualified, clinically experienced nursing mentors 3 By improving didactic content by theoretically educating the student nurse Incorrect4 By considering the student nurse's opinions for the master delegation decisions
Interaction with highly qualified, clinically experienced nursing mentors fosters professional self-confidence in the student nurse. These experiences allow student nurses to build up their ability to be successful delegators. Delegation knowledge should also be reinforced in nursing continuing education programs. Didactic content about delegacy can be improved by pairing the education and the clinical experience from the healthcare practice site. The student nurse does not have enough knowledge to make master delegation decisions without adequate training.
The registered nurse is caring for a client suffering from skin infections. The nurse delegates the client care tasks to the health care team. Which task delegated is correct as per guidelines? 1 Daily changing of wet dressings by the unlicensed assistive personnel (UAP) Correct2 Topical administration of medication by the licensed practical nurse (LPN) 3 Administering intravenous antibiotics by the licensed practical nurse (LPN) 4 Teaching the client to minimize sun exposure by the unlicensed assistive personnel (UAP)
LPN scope of practice is limited to administering oral, topical, and parenteral medications except intravenous. The LPN can be delegated the task of administering topical medication to the client. The scope of practice for an unlicensed assistive personnel involves maintaining the client's hygiene and daily changing of wet dressings is delegated to a certified technician. Administering intravenous antibiotics to a client with infection is an inappropriate task to be delegated to an LPN. Teaching the client to minimize sun exposure cannot be delegated to the UAP. UAP can only reinforce the teaching provided by the registered nurse.
The registered nurse is caring for an older client who is admitted with gastric ulcer and joint pains and is unable to perform activities of daily life (ADL). The legal authority has stated, "Provide the treatment according to the client's care sheet." Which delegatee should take up the task?
Licensed practical nurse
The primary healthcare provider prescribes a rectal suppository for a client with severe constipation. Which healthcare professional would be delegated the task of administering the suppository? 1 Patient care associate Correct2 Licensed practical nurse 3 Unlicensed assistive personnel 4 Unlicensed nursing personnel
Licensed practical nurses may be delegated the task of administering rectal suppositories to the client. Patient care associates, unlicensed assistive personnel, and unlicensed nursing personnel may do all hygiene tasks and basic care for clients. However, administering suppositories is not in their scope of practice.
What should be done if staff turns of alarms on equipment?
MORE EDUCATION
What should be done if staff breaches confidentiality (taking in public areas, giving D/C instructions with others in room, teaching with family in room, calling support groups w/o pt permission?
MORE EDUCATION. NURSE MANAGER OFFICE IS NOT OPEN TO THE GENERAL PUBLIC (=safe place to discuss).
While caring for clients who survived an earthquake, the nurse finds the need to free up inpatient beds for disaster victims. Which clients does the nurse plan to discharge? Select all that apply.
Medical-surgical unit nurses, in collaboration with healthcare providers, decide to recommend clients for discharge to free inpatient beds for disaster victims. Clients who can be treated in long-term care and who can be cared for in rehabilitation should be discharged. Clients who have had no critical change in condition for the past 3 days should also be discharged to free up inpatient beds for disaster victims. Clients who are admitted for observation and are not bedridden can be discharged. Clients who have diagnostic evaluations and are not bedridden can be discharged.
The legal authority has delegated the tasks according to the model of analysis type of care. Which statements are true regarding the model analysis? Select all that apply. Correct1 Model analysis improves client satisfaction. Correct2 Model analysis is a cost-effective idea for client care. 3 Quality control is better in the model analysis type of care. Correct4 Model analysis promotes organizational decision-making at lower levels. 5 Model analysis promotes adequate communication among the staff members.
Model analysis is a type of care that benefits clients in terms of satisfaction of care being provided. In model analysis, the team nursing method is followed. It is a cost-effective system because it works with an expected ratio of unlicensed to licensed personnel. Organizational decision making occurs at lower levels in model analysis. Control of quality is lower in model analysis. There may be inadequate communication among staff members due to the higher potential for fragmentation of care.
The legal authority has delegated the tasks according to the model of analysis type of care. Which statements are true regarding the model analysis? Select all that apply.
Model analysis is a type of care that benefits clients in terms of satisfaction of care being provided. In model analysis, the team nursing method is followed. It is a cost-effective system because it works with an expected ratio of unlicensed to licensed personnel. Organizational decision making occurs at lower levels in model analysis. Control of quality is lower in model analysis. There may be inadequate communication among staff members due to the higher potential for fragmentation of care. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.
Which action in the delegation process represents accountability? 1 Providing open and honest feedback to the delegatee 2 Assisting other registered nurses with delegation decisions Correct3 Monitoring the client care given and determining outcomes 4 Assessing the ability of the delegatee and educating him or her about the task
Monitoring client care and determining outcomes represents accountability of the task in case of conflicts. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions when there are safety issues, an urgent need to intervene, or potential negative client outcomes. Assessing the ability of the delegatee and educating him or her about the task indicates responsibility.
The nurse manager is delegating tasks to the healthcare team to care for a client who underwent brain surgery. Which individuals on the team share accountability during delegation? Select all that apply.
Nurse manager Healthcare provider
A nursing assistant is working with a delegator. Which action of the nursing assistant may negatively affect client care management? 1 Addressing challenges together Correct2 Performing the same tasks as the delegator 3 Initiating conversation about the new roles and functions Incorrect4 Communicating the cultural perspectives with the delegator
Nursing assistants who have similar strengths as the delegator should adapt to changing situations. A nursing assistant performing the same tasks as the delegator may create a gap in the delivery of client care. Building on the strengths and minimizing the challenges of the team proves to be an effective strategy. Initiating a conversation about the new roles and functions in the organization can open lines of communication to explain why supervision is necessary. It also helps to eliminate or diminish any negative feelings about being supervised. The lines of communication between the delegator and the nursing client can be improved by appreciating and valuing cultural perspectives.
During the process of delegation, the delegator's behavior is noted to be observing and monitoring. How is the relationship between the delegator and delagatee in this situation?
Observing and monitoring behavior of the delegator indicates delegating, which is done when the relationship between the delegator and delegatee is established. The delegator's behavior is guiding or directing when the relationship between the delegator and delegatee is limited. The delegator's behavior is encouraging or problem solving when the relationship between the delegator and delegatee is new or developing. The delegator's behavior is explaining or persuading when the relationship between the delegator and delegatee is developing or ongoing.
During the process of delegation, the delegator's behavior is noted to be observing and monitoring. How is the relationship between the delegator and delagatee in this situation? 1 Limited Correct2 Established 3 New or developing Incorrect4 Developing or ongoing
Observing and monitoring behavior of the delegator indicates delegating, which is done when the relationship between the delegator and delegatee is established. The delegator's behavior is guiding or directing when the relationship between the delegator and delegatee is limited. The delegator's behavior is encouraging or problem solving when the relationship between the delegator and delegatee is new or developing. The delegator's behavior is explaining or persuading when the relationship between the delegator and delegatee is developing or ongoing.
Which statement is true regarding delegation? Select all that apply.
Open lines of communication between delegator and delegatee helps to eliminate any misunderstanding regarding delegated tasks. Delegation occurs only when at least two people are involved in a mutual work situation; one who has the authority to perform specific tasks and other who holds accountability for the task being performed. Delegation involves sharing activities with other appropriate authority to accomplish the work. When delegating a task to delegatee, the delegator retains accountability for effective client care by ensuring that the task is completed by the right person and that the person is supervised appropriately. The delegation potentials are significantly higher when caregivers such as UNPs are partnered.
The registered nurse instructs a student nurse to perform an action as a community volunteer. Which action should the student nurse perform as a community volunteer?
Organizing individuals in the community to develop healthcare delivery
A nurse delegator assigns work to a delegatee who has the ability and willingness to do the work but the relationship between the delegator and delegatee is relatively new. How is the delegator's behavior described according to Hersey's Model?
Participating
The registered nurse (RN) is caring for a client with epilepsy. Which tasks delegated by the registered nurse (RN) to the assistive personnel indicates active delegation? Select all that apply. 1 Instructing the licensed practical nurse (LPN) to administer diazepam Correct2 Instructing the licensed practical nurse (LPN) to monitor the vital signs 3 Instructing the licensed vocational nurse (LVN) to administer sedatives Correct4 Instructing the unlicensed assistive personnel (UAP) to reposition the client Correct5 Instructing the unlicensed assistive personnel (UAP) to place the oxygen mask
Passive delegation includes performing the tasks based on the position description such as physician or pharmacist. The individual functioning in this role performs these tasks through passive delegation. Instructing the LPN to administer diazepam, medication that was already prescribed by the primary healthcare provider, is passive delegation. Instructing the LVN to administer sedatives that were already prescribed by the primary healthcare provider is passive delegation. Instructing the LPN to monitor vital signs is active delegation as the RN directs assistive personnel to perform certain tasks and holds the individual accountable. Instructing the UAP to reposition the client is also an active delegation as the UAP is carrying out certain tasks that are directed by the RN. Instructing the UAP to place the oxygen mask is an active delegation as the RN directs assistive personnel to perform certain tasks.
A client with foot ulcers is admitted to the hospital. The nurse manager should delegate the task of maintaining hygiene to which staff members to maximize efficient use of human resources? Select all that apply.
Patient care associate (PCA) Unlicensed nursing practitioner (UNP)
A registered nurse (RN) in charge of a mental health unit has two additional staff members: a licensed practical nurse (LPN) and a nursing assistant (NA). The unit has 20 clients, with one client on constant observation for acute suicidality. What should the nurse in charge do when making the daily assignments?
Provide client care and administrative duties and assign the LPN to administer medications and the NA to maintain constant observation of the suicidal client.
What tasks should the nurse perform as a leader to increase productivity? Select all that apply.
Provide coaching and mentoring to the staff. Provide information and direction related to meeting unit productivity goals. Prepare a staffing plan that balances the organizational directives with unit needs.
What are the various challenges related to delegation? Select all that apply.
Providing clear direction to the delegatee aids accomplishment of the specified task in the given time. Understanding the specific skill set and capabilities of the delegatee is a crucial element in the delegation process. Selecting a delegatee with the specific skill set for the particular task is more productive than just selecting a competent individual. Maintaining an open line of communication with the delegatee, without any derogatory or offensive comments, yields a collaborative and productive work environment. Providing verbal attack feedback may not produce effective change and could undermine any long-term working relationship. Creating a working environment is an essential and easy delegation task that is essential to promoting positive work output.
The registered nurse (RN) is planning to provide feedback to the licensed practical nurse(LPN). Which questions asked by the RN help in eliciting the LPN's work quality? Select all that apply. 1 "Are you feeling well today?" Correct2 "How did the patient respond?" 3 "Has the task been completed?" 4 "Are you willing to perform the task?" Correct5 "What changes were observed in the client?"
Providing feedback is the best strategy for shaping the future behavior of the individual. To elicit feedback, a series of open-ended questions should be asked by the registered nurse (RN). This will help collect pertinent information from the individuals delegated a portion of client care, such as client's response and the task to be completed. Asking personal questions about the delegatee does not help in eliciting the work quality of the delegatee. Asking whether the task has been completed is not an open-ended question. Willingness to perform the task directly implies the work interest of the delegate, but not the quality of the delegatee's work.
A delegator is providing feedback to four delegatees. Which feedback is constructive feedback that can help the delegatee to improve quality of care? 1 A 2 B 3 C Correct 4 D
Providing feedback to delegatee D that the procedure properly performed followed by demonstrating a more effective way to perform the task improves quality of client care. Therefore, the feedback given to delegatee D is constructive feedback. Saying to delegatee A that the work was nice is vague feedback, which does not specify the behavior of the delegatee and is not constructive feedback. Providing feedback to delegatee B asking what had gone wrong with him or her today is a verbal attack that does not produce effective change and potentially may undermine a long-term working relationship. Asking delegatee C how the client responded after the task was done is an open-ended question that allows the delegator to gain pertinent information from the delegatee.
A nurse manager asks for extra help from other nurses in the unit. In exchange, the nurse manager ensures special care for the parent of a staff nurse who is currently a client in the hospital. Which behavior does the nurse manager exhibit?
Quid pro quo
What is important to remember with room assignments?
RISK= Radiation (isolation), Infection/Immunocompromised/Isolation, Safety/Sex, and Know growth and development. If older than 6= must have a same sex roommate and must be both children have the same disease( example: one child has a fractured femur and another child with a fracture or a post-procedure with no infection = best room placement. HOWEVER, there is another 6 years old child but the child has an infection, this would not be an appropriate roomate for the child due to the risk of transmitting the infection.
What patients are prioritizing-----life threatening
RLQ (appendix) pain, LLQ (diverticulosis) pain, mid epigastric pain (preg-seizure), spinal cord injury above T6, child drooling (epiglotitis), central line with SOB, compartment syndrome (pain not relieved by drugs/cast or crushing injury c swelling), muffled heart sounds (cardiac tamponade), taking nitro within 1 week of MI (may be another MI), Femur/Pelvis fx c S&S of fat emboli, enlarged veins on Abd (portal HTN), DVT/PE, Immunocompromised pt with nonproductive cough (PCP) or temp, restlessness, abnormal electrolytes, progressive neurological diseases, burns c smoke inhalation, withdrawal symptoms of drugs/alcohol, angina c indigestion=MI, neuroleptic malignant syndrome, toxic levels of medication, and Spinal cord injury (SCI) c autonomic dysreflexia (crazy high BP).
Which hospital care setting is most appropriate for a case manager to perform tasks as a delegatee? 1 Hospice care 2 Extended care Incorrect3 Long-term care Correct4 Rehabilitative care
Rehabilitative care settings are the most suitable for a case manager to perform tasks as a delegatee. Hospice care settings are generally delegated to the registered nurse (RN). In extended care and long-term care settings, tasks are delegated to unlicensed assistive personnel (UAP).
Which constructive aspects of conflict does the nurse leader identify? Select all that apply.
Releases pent-up emotions Helps individuals grow personally Builds cohesiveness among people
Which task is achieved by the delegator when he or she engages in self-care to enhance his or her ability to care for the healthcare team?
Renewing
What should be done if there is no drainage from an NG tube?
Reposition patient or tube
Which component of delegation is considered a "two way process"?
Responsibility is a two way process. Authority is the ability to perform duties in a specific role. Supervision is defined as the "provision of guidance and oversight of a delegated nursing task." Accountability may not be a two-way process. It determines if the actions were appropriate and provides a detailed explanation of what occurred.
Which component of delegation is considered a "two way process"? 1 Authority 2 Supervision Correct3 Responsibility 4 Accountability
Responsibility is a two way process. Authority is the ability to perform duties in a specific role. Supervision is defined as the "provision of guidance and oversight of a delegated nursing task." Accountability may not be a two-way process. It determines if the actions were appropriate and provides a detailed explanation of what occurred.
The licensed practical nurse (LPN) has been asked to monitor the blood pressure of a client with hypertension. The LPN reports to the registered nurse (RN) that the blood pressure monitor is malfunctioning. Which component of the duty is the LPN practicing? 1 Authority 2 Supervision Correct3 Responsibility 4 Accountability
Responsibility refers to the reliability, dependability, and obligation to accomplish a task; it is allocated by the delegator and accepted by the delegatee. Authority is the ability of an individual to perform duties in a specific role, it also involves the responsibility of the delagatee to inform the delegator about limitations that may impede completion of a task, such as malfunctioning equipment. Supervision involves the delegator providing guidance and oversight. Accountability involves the delegator determining whether the appropriate actions are being performed and the delegatee providing a detailed explanation of what is happening in the ongoing process.
The care delivery committee is determining whether primary nursing would be appropriate to implement in a 500-bed acute care hospital. Which information would support the selection of another care delivery approach? Select all that apply.
Short lengths of stay do not provide enough time for the primary nurse to plan, coordinate, and implement all aspects of a primary client's needs. Nurses with limited experience may not be prepared educationally for primary nursing. Primary nursing is costly since the entire staff is made up of registered nurses. Since the organization was 120% over budget for salaries during the last quarter, the organization may not be financially able to implement primary nursing. Primary nursing does not use unlicensed assistive personnel (UAP) so only having 20 UAP for a 500-bed organization would support the implementation of primary nursing. Clients requesting one nurse to provide care would also support the implementation of primary nursing.
A nurse manager receives a complaint from a client that a particular staff member had been rude when providing care. The nurse, rather than punishing the staff member, listens to his or her side of the story and then talks to the client to clarify the misunderstanding. Which leadership theory is reflected in this scenario?
Situational-contingency theory
The registered nurse oversees five unlicensed nursing personnel (UNP), and each UNP cares for five clients, so the registered nurse in effect has responsibility for five UNPs and 25 clients. What do these numbers of subordinate and clients indicate? Incorrect1 Supervision Correct2 Span of control 3 Passive delegation 4 Appropriate authority
Span of control is the number of individuals the supervisor or delegator is responsible for. In this instance, the RN is responsible for the delegatees as well as the clients they are caring for. Supervision involves ensuring that the appropriate oversight and guidance is provided for a delegated task. Passive delegation occurs when licensed members of an organization perform tasks that are essential to their normal practice. Appropriate authority is the specific ability to perform the work or task.
The nurse is triaging a group of clients injured in a tornado using the three-tier system. Which conditions are triaged as life-threatening conditions? Select all that apply.
Stroke, active hemorrhage, chest pain with diaphoresis, and respiratory distress are life-threatening conditions and should be triaged as emergent. Clients with skin rash are categorized as nonurgent as care can be delayed without fear of deterioration. Displaced or multiple fractures are triaged as urgent, meaning they require quick treatment but are not life threatening.
Which leadership theory focuses on the role of leaders in relational and contextual terms?
Style theories focus on what leaders do in relational and contextual terms. The two-factor leadership theory refers to using motivator factors to inspire work performance. The expectancy theory of leadership refers to providing specific feedback about positive performance. The transformational theory of leadership refers to a process in which the leader attends to the needs and motives of followers.
A nursing supervisor sends an unlicensed healthcare worker to help relieve the burden of care on a short-staffed medical-surgical unit. Which tasks can be delegated to the health care worker? Select all that apply. Correct1 Taking routine vital signs 2 Applying a sterile dressing Correct3 Answering clients' call lights 4 Administering saline infusions Correct5 Changing linens on an occupied bed 6 Assessing client responses to ambulation
Taking routine vital signs is a universal activity that all healthcare workers are taught to perform regardless of the setting; it is within the job description for unlicensed health care workers. Answering call lights is a universal activity that all unlicensed healthcare workers are taught to perform regardless of the setting; it is within the job description for unlicensed healthcare workers. Making an occupied bed is a universal activity that all unlicensed healthcare workers are taught to perform regardless of the setting; it is within the job description for unlicensed healthcare workers. Unlicensed health care workers do not have the expertise or credentials to apply sterile dressings. Unlicensed healthcare workers do not have the expertise or credentials to administer intravenous solutions. Registered nurses are not permitted to delegate assessment.
When evaluating a task performed by a delegatee, the registered nurse finds that the delegatee fails to provide appropriate feedback. Which right of delegation is compromised in this situation? 1 Right task 2 Right person Correct3 Right supervision Incorrect4 Right communication
The "right supervision" includes assessing whether the delegatee can provide feedback related to the task when appropriate. "Right task" involves providing tasks to the delegatee in accordance with legal and institutional policies. "Right person" involves delegating tasks to team members who are competent and show willingness towards the task. "Right communication" involves the delegator providing clear, concise instructions and the delegate understanding those instructions.
A client presents to the physician with a rash. The physician orders the application of a topical medication. Which healthcare team member will most likely carry out this order? 1 Nurse manager (NM) 2 Registered nurse (RN) Correct3 Licensed practical nurse (LPN) 4 Unlicensed assistive personnel (UAP)
The LPN administers oral and topical medications and monitors all vital signs. The NM is the designated individual to whom all nursing professionals are answerable regarding a given task. The RN is responsible for performing the administration of intravenous medications and the delegation of tasks to LPNs and UAPs. The UAP assistive personnel performs all hygiene tasks.
A healthcare team is caring for a 68-year-old client with diabetes insipidus. Which task is most suitable to be delegated to licensed practical nurse (LPN) to provide effective client care? Select all that apply. Incorrect1 Emptying the urinary drainage bag Correct2 Monitoring urine output 3 Feeding the client with food 4 Administration of intravenous fluids Correct5 Administering oral rehydration medication
The LPN scope of practice includes monitoring urine output. Administration of any type of oral medication can also be performed by the LPN. Activities related to a client's hygiene such as emptying the drainage is usually performed by unlicensed assistive personnel (UAP). Feeding the client is usually performed by a UAP. Administration of intravenous fluids is the responsibility of the registered nurse.
The registered nurse (RN) assigned the task of providing client care to four clients to a licensed practical nurse (LPN). In which order of priority should the LPN provide care to the clients? Correct 1. Client C Correct 2. Client A Incorrect 3. Client B Incorrect 4. Client D
The LPN should prioritize care to client C who underwent surgery for a heart attack and was hospitalized for 2 days to monitor the conditions post-surgery. Client A should be the next priority, so the LPN should assign a UNP to monitor the client for any changes. Third, the LPN should provide care for client D who has severe diarrhea and who has been hospitalized for 2 days. Finally, the LPN should monitor client B.
The newly hired nurse is delegated the task of preparing the client care plan for a diabetic client who underwent amputation. Which task in the care plan is inappropriate according to guidelines?
The LPN's scope of practice includes monitoring vital signs in clients with a stable condition. Instructing the LPN to monitor the vital signs of a client in an acute condition is inappropriate according to the guidelines. Administering antidiabetic medications to a diabetic client who underwent amputation should be done by the RN because the condition of the client is acute. The RN is responsible for assessing the blood glucose levels of the client who underwent amputation. The LPN is instructed to change the dressing at the amputation site.
The newly hired nurse is delegated the task of preparing the client care plan for a diabetic client who underwent amputation. Which task in the care plan is inappropriate according to guidelines? 1 The registered nurse (RN) administering antidiabetic medications Correct2 Instructing the licensed practical nurse (LPN) to monitor vital signs 3 The RN assessing the client's blood glucose levels at regular intervals Incorrect4 Instructing the licensed practical nurse (LPN) to change the dressing at the amputation site
The LPN's scope of practice includes monitoring vital signs in clients with a stable condition. Instructing the LPN to monitor the vital signs of a client in an acute condition is inappropriate according to the guidelines. Administering antidiabetic medications to a diabetic client who underwent amputation should be done by the RN because the condition of the client is acute. The RN is responsible for assessing the blood glucose levels of the client who underwent amputation. The LPN is instructed to change the dressing at the amputation site.
The registered nurse (RN) delegates the task of caring for a client with a leg fracture to a licensed practical nurse (LPN) and asks the LPN to alert her if any issues arise. What approach is the RN taking as delegator in this instance?
The RN as delegator asks the LPN as delegatee to contact her if any issues arise while caring for the client; this approach involves the RN providing little guidance to the LPN. Supervision involves more than simply requesting that the delegatee alert the delegator if any issues arise. The delegator provides explanation when a new task is being delegated to a delegatee who has an established relationship with the delegator. The delegator and delegatee must establish mutual expectations when the delegatee has willingness and ability but the relationship is new.
The registered nurse (RN) delegates the task of caring for a client with a leg fracture to a licensed practical nurse (LPN) and asks the LPN to alert her if any issues arise. What approach is the RN taking as delegator in this instance? 1 Providing supervision Incorrect2 Providing explanation Correct3 Providing little guidance 4 Establishing mutual expectations
The RN as delegator asks the LPN as delegatee to contact her if any issues arise while caring for the client; this approach involves the RN providing little guidance to the LPN. Supervision involves more than simply requesting that the delegatee alert the delegator if any issues arise. The delegator provides explanation when a new task is being delegated to a delegatee who has an established relationship with the delegator. The delegator and delegatee must establish mutual expectations when the delegatee has willingness and ability but the relationship is new.
A client is diagnosed with cancer and is physically weak. The delegator has delegated the healthcare team members to care for the client. Which aspects of the care are most appropriate for the registered nurse (RN)? Select all that apply.
The RN is capable of providing physical and emotional aspects of care when the client is diagnosed with life-threatening conditions. The RN should take the responsibility of helping the client be hopeful about the treatment and providing emotional support to the client's family. Vitamin supplements are administered by the licensed practical nurse. The unlicensed nursing professional can collect the medical history. Collecting urine samples is delegated to nursing assistive personnel.
A healthcare team is caring for a client who is hospitalized with severe diarrhea. According to the principle of right of supervision of delegation, what does the RN do in this situation? 1 Feed the client every 2 hours. Correct2 Monitor the hemodynamic status. 3 Assess the resources required in the client's care. 4 Follow the institutional procedures for administering fluids.
The RN should monitor the hemodynamic status of the client according to the right of supervision of delegation. It is the responsibility of the RN to supervise the delegated task. Feeding the client is usually performed by a licensed practical nurse, unlicensed nursing professional, or any member of the healthcare team. Assessment of resources is monitored before assigning tasks to the healthcare team. Following institutional procedures for administration of fluids is actually done by the RN, so it is not supervised by the RN.
A registered nurse (RN) diagnosed with chemical impairment issues is transferred to work at a rehabilitation center as a part of treatment. Which actions performed by the nurse manager at the new work place result in effective outcome of treatment for chemical impairment? Select all that apply. Correct1 Restricting the RN from working near the abused chemical 2 Delegating other staff to assist the RN in providing client care Correct3 Restricting the RN from administering any controlled substances 4 Requiring the RN to share what he or she is doing to control the problem Incorrect5 Permitting the RN to share the problem with other members of the healthcare team
The RN's job has been moved to a rehabilitation center because of chemical impairment issues and the RN is restricted from working at a facility where the drug is used, which helps the RN in his or her recovery. Controlled substances may be abused, so restricting the RN from administering such substances may result in effective outcome of therapy. Delegating the other staff the task of assisting the RN in providing client care may be a positive experience for the staff, but this intervention may not result in positive outcome of the treatment. Requiring the RN to share what he or she is doing to control the problem or allowing the RN to share his or her problem with other staff of the healthcare team may not result in positive outcome of the treatment.
The registered nurse is assisting a client who is hospitalized with high fever. Which task delegated to the unlicensed assistive personnel (UAP) would be appropriate? Select all that apply. 1 Assessing the vital signs Correct2 Performing all hygiene tasks 3 Administering oral medications Correct4 Helping the client in changing clothes 5 Administering intravenous medications
The UAP does all the hygiene tasks and also helps in changing the clothes. Assessing the vital signs may not be performed by the UAP. Administering the intravenous medications is performed by the registered nurse. Oral administrating of medication is performed by the licensed practical nurse.
The nurse is caring for a client who underwent a hysterectomy and who is admitted to a general medical-surgical unit. Which tasks can be delegated to the unlicensed assistive personnel (UAP)? Select all that apply. Correct1 Oral hygiene Correct2 Assistance with bathing 3 Oral medication administration 4 Intravenous fluid administration 5 Providing treatments with supervision
The UAP is eligible to carry out hygiene tasks such as providing oral hygiene and assisting with bathing. The licensed practical nurse and licensed vocational nurse may provide oral medications and treatments under the supervision of an RN. While treating clients, tasks such as intravenous administration of fluids should be carried out by the RN, as they are associated with potential risk if improperly infused.
A client is hospitalized with pressure ulcers. Which task could be delegated to an unlicensed nursing professional (UNP)? Select all that apply. Correct1 Empty wound drainage containers. Correct2 Report changes in wound appearance. 3 Apply prescribed dressings and medications. 4 Assess and record data about wound appearance. 5 Choose dressings and therapies for wound treatment.
The UAP is eligible to empty wound drainage and report changes in wound appearance. The licensed practical nurse is eligible to apply prescribed dressings and medications to the client. A licensed practical nurse can collect and record data about the appearance of a wound. The registered nurse is eligible to choose dressings and therapies for wound treatment.
The registered nurse is delegating tasks for the care of a vulnerable population. Which healthcare team would be appropriate for the delegation of tasks? 1 Charge nurse (CN), chief nursing officer (CNO), and registered nurse (RN) 2 Licensed practical nurse (LPN), unlicensed nursing professional (UNP), and charge nurse (CN) 3 Chief nursing officer (CNO), Registered nurse (RN), and unlicensed nursing professional (UNP) Correct4 Registered nurse (RN), licensed practical nurse (LPN), and unlicensed nursing professional (UNP)
The appropriate healthcare team for delegation of tasks for the care of vulnerable populations consists of the RN, LPN, and UNP. Proper care and assistance can be provided by this team. The CN, CNO, and RN are all licensed health professionals and there are team members to provide assistance on this team. In the team consisting of the LPN, UNP, and CN, there is no person who can take responsibility and accountability of the client care. In the CNO, RN and UNP team, the UNP may not be eligible to carry all the activities and the CNO and RN are responsible for carrying out delegation.
Which statements are true regarding the primary nursing care developed by Marie Manthey as a method for organizing client care? Select all that apply. Correct1 The associate nurse provides input into the client's plan of care. 2 The charge nurse will be accountable for the care from admission to discharge. Correct3 If the client develops complications, the associate nurse should notify the primary nurse. 4 According to the associate nurse's care specifications, the primary nurse should provide care. Correct5 The registered nurse functions autonomously as the primary nurse throughout the client's hospital stay.
The associate nurse cares for the client according to the care specifications provided by the primary nurse in the care plan. The associate nurse provides input to the client's plan care if the associate nurse notices any complications and also notifies the primary nurse for alterations in the care plan. The registered nurse functions autonomously as the client's primary nurse by taking the responsibility and accountability of the client care from admission through discharge. It is the primary nurse, rather than the charge nurse, who will be accountable for the care of the client from the admission through discharge. According to the primary nurse's care specifications, the associate nurse should provide care.
Which action by the nurse constitutes constructive feedback for the delegatee? 1 Providing verbal attacks on feedback Incorrect2 Providing feedback to individual delegatee 3 Providing nonspecific feedback about the behavior Correct4 Providing open feedback about specific strategies for change
The best strategy is to provide open, honest, and constructive feedback. The feedback should be about work-related performance and specific strategies for change in the quality of performance. A verbal attack on a delegatee does not produce effective change and could undermine any long-term working relationship. Providing feedback to an individual delegatee as satisfactory may diminish the credibility of the nurse. Creating a work environment in which specific feedback about performance is provided is the best strategy for shaping the future behavior of the delegatee.
Who functions as a liaison between team leaders and other healthcare providers? Correct1 Charge nurse 2 Registered nurse 3 Nursing manager 4 Chief nursing officer
The charge nurse functions as a liaison between team leaders and other healthcare providers. Registered nurses function as accountable and responsible people for delegated tasks. Nursing managers are responsible for more than one unit and have other managerial responsibilities. Chief nursing officers are accountable for establishing systems to assess, monitor, verify, and communicate competency requirements related to delegation.
During the delegation process, which healthcare professional acts as a liaison between the team leader and healthcare provider? Correct1 Charge nurse 2 Nurse manager 3 Nursing supervisor 4 Chief nursing officer
The charge nurse is responsible for acting as a liaison between the team leaders and healthcare providers. Nurse managers cannot act as a liaison between the team leader and other healthcare providers because they are often responsible for more than one unit and have other managerial responsibilities. The nursing supervisor will be delegated to supervise and ensure effective outcomes for the tasks delegated to the delegatees. The chief nursing officer is responsible for establishing the systems for assessment.
Which intervention should the charge nurse perform to manage a task when the unlicensed nursing personal (UNP) is lacking competence? 1 Provide constructive feedback and assign another task. 2 Provide open vocal feedback and withdraw the UNP from task. Correct3 Provide additional support and temporarily lower expectations. Incorrect4 Provide accountability to the organization and undergo training again.
The charge nurse should manage a task by temporarily lowering expectations and providing additional support to an unlicensed nursing personal (UNP) who is lacking competence. This strategy allows the UNP to build on strengths, minimize weaknesses, and gain confidence. Providing constructive feedback and assigning another task may not improve the strategy of the UNP and may affect the productivity of the new task. Withdrawing the UNP from the task and providing open vocal feedback may weaken the working relationship and the UNP may lose confidence or become frustrated. The charge nurse should be aware of accountability to the organization in case of a failure of the delegation, but assigning the UNP for further training may lead to high risk for legal liability.
The registered nurse is caring for a client with dysrhythmias. Which action should the nurse perform immediately according to priority?
The client with any life-threatening complication such as dysrhythmias should be assessed for ABCs immediately because the client may suffer with airway obstruction. Oxygen saturation should be monitored during ongoing assessments and after providing the client with initial treatment. Intravenous access should be established after performing initial assessments such as vital signs. After assessing ABCs in a client with dysrhythmias, the client should be provided with oxygen via nasal cannula or nonrebreather mask to maintain oxygen levels.
What does the decision strategy of "offering" include in delegation? Incorrect1 Allowing the delegator to examine the situation differently 2 Demonstrating the specific task or behavior to improve client care 3 Asking questions related to the problem or issue regarding client care Correct4 Making a suggestion to facilitate the achievement of a desirable client care outcome
The decision strategy of offering involves making a suggestion to facilitate the achievement of a desirable client care outcome. The decision strategy of asking allows the delegator to examine the situation differently. The decision strategy of doing includes demonstrating the specific task or behavior to improve client care. The decision strategy of asking includes questioning issues related to the problem regarding client care.
After assessing the delegatee's inability to perform an assigned task, the delegator explains the procedure and demonstrates the task to the delegatee. What can be inferred about the delegatee?
The delegatee may have an ongoing relationship with the delegator, but a new task is assigned.
The delegatee is performing a task and in the process loses confidence in what he or she is doing. Which delegator's action may have contributed to the delegatee's loss of confidence? Correct1 Intervening when the delegatee is performing the task 2 Providing feedback about the work performed Incorrect3 Communicating with the delegatee about the work being performed 4 Stating that the task should be completed by a specified time
The delegatee may lose confidence and get frustrated if the delegator intervenes. Therefore intervening in tasks is not encouraged. The delegator can instead provide feedback about the task being performed to help improve the effectiveness of the delegation. Communication generally opens lines between the delegator and delegatee and will be helpful in effective delegation. The delegator should brief the delegatee about the specified time the task should be completed; this would not make the delegatee lose confidence.
A registered nurse teaches a student nurse about delegation. Which statement made by the student nurse indicates appropriate learning? 1 "Licensed practical nurses are accountable for the tasks they perform." 2 "Complete client care can be delegated to the licensed practical nurse." Incorrect3 "Professional aspects of care can be carefully delegated to the licensed practical nurse." Correct4 "Licensed practical nurses can be expected to perform tasks with which they have experience."
The delegator can safely delegate the task to the LPN if the task is within the scope of function or if the LPN is very experienced in performing the task. The LPN, being a delegatee, is not held accountable for the delegated work; the LPN is held responsible for the delegated task. The delegator is held accountable for the LPN's work. The delegator can never delegate complete client care to the LPN, but can only transfer functions and tasks. Basic skills such as activities of daily living and personal hygiene can be delegated by the delegator, but professional aspects of care should not be delegated.
The registered nurse is teaching a newly hired nurse about communicating with delegatees during delegation. Which statement made by the newly hired nurse indicates the need for further learning? 1 "I should identify priorities." Incorrect2 "I should specify deviations." Correct3 "I should provide examples of each delegation." 4 "I should specify any performance limitations to the delegatee."
The delegator should ask the delegatee to provide examples of each delegation in order to understand his or her knowledge level. The delegator should identify priorities before delegating the task to the delegatee. The delegator should specify deviations, such as when the delegatee must take an immediate action while performing the task. The delegator should specify the performance limitations to the delegatee, which can help in performing the task effectively.
What should the delegator do when he or she finds that a delegatee is unable to perform the given task? 1 Assign another task to the delegatee 2 Remove the delegatee form the task Incorrect3 Make an effort to complete the task on his or her own Correct4 Make sure to educate and provide feedback to the delegatee
The delegator should educate and guide the delegatee on finding that the delegatee is not competent to perform the task. The delegator should also provide feedback to the delegatee during and after the task to enhance working performance. Assigning the delegatee to another task may lead to poor performance and low quality of output. Removing the delegatee from the task may weaken the working relationship. The delegator has to make an effort to have the task completed by assigning, guiding, and monitoring the delegatee at regular basis.
A registered nurse (RN) delegates a task to a licensed practical nurse (LPN). What should the RN do when the LPN executes the task improperly? Correct1 Provide constructive feedback. 2 Engage in a verbal attack on the delegate. 3 Express satisfaction with the LPN's execution of the task. 4 Ignore the task for now but stop considering the LPN for further delegation.
The delegator should provide constructive and positive, yet honest, feedback about the work of the delegatee. A verbal attack will destroy the relationship between the delegatee and delegator. The RN would lose credibility by conveying satisfaction with the delegatee's work, which is not satisfactory. Ignoring the task and not giving feedback will not promote a healthy relationship.
Which behavior of the delegator with respect to the work delegated to a delegatee is characterized as "selling" according to the Hershey's Model? 1 Guiding or directing Correct2 Explaining or persuading 3 Observing or monitoring 4 Encouraging or problem solving
The delegator's behavior when explaining or persuading the delegatee is characterized as "selling" according to Hershey's Model. The delegator's behavior when guiding or directing the delegatee is characterized as "telling." The delegator's behavior when observing or monitoring the delegatee is characterized as "delegating." The delegator's behavior when encouraging or problem solving is characterized as "participating."
Which condition may lead to delegation failure due to malpractice? 1 Adapting to changing situations by the nursing assistant 2 Educating and monitoring the nursing staff incompetent to perform a task Correct3 Employing more unlicensed nursing personal (UNP) in the emergency department Incorrect4 Assigning the more unlicensed nursing personal (UNP) for long-term care facilities
The greater the stability of a client, the more likely an unlicensed nursing personal (UNP) can provide safe client care. It is not ideal to increase the numbers of UNPs in the emergency department due to client instability. The nursing assistant has to adapt to changing situations to deliver proper client care. The delegator must train and monitor the performance of the nursing staff, who are responsible for completing tasks in a specified time. This helps in improving the performance of any incompetent nursing staff. The intensity and length of the interactions with the client are also significant factors to consider in planning client care. The UNP can provide efficient client care in long-term care facilities because the clients are stable.
Which of these clients can be provided care safely by unlicensed nursing personnel? Select all that apply. 1 A client with pain 2 A client who is upset Correct3 A client who is stable Correct4 A client who is recovering 5 A client with suicidal intention
The greater the stability of a client, the more likely it is that unlicensed nursing personnel (UNP) can provide safe client care. It is also easy for a UNP to care for a client who is recovering. A client with pain is anxious and agitated, and it will take the UNP time to calm the client. Client care may be affected when the client is psychologically upset and has suicidal intentions.
The registered nurse considers the qualification of the unlicensed nursing personnel (UNP) before delegating a task. Which right of delegation is followed by the nurse? 1 Task Correct2 Person 3 Direction 4 Supervision
The knowledge and experience to perform the specific task safely by the delegatee is assessed by the qualification of the delegatee, which determines whether he or she is the right person. The right task involves assessing whether the task is legally appropriate to delegate or whether it is appropriate under institutional policies. The right direction involves the delegator providing clear and concise directions to perform the task. The right supervision is determined by whether the delegator is able to monitor and evaluate the client appropriately.
A healthcare team is caring for a client with food poisoning. Which task is most suitable to be delegated to licensed practical nurse (LPN)? 1 Collecting vital signs 2 Performing a stomach wash Correct3 Administering oral antiemetic medication 4 Administering intravenous replacement fluids
The licensed practical nurse (LPN) can perform activities such as administering oral medication for the client. Monitoring vital signs can also be performed by the LPN but since the condition of the client is acute, it will be performed by the registered nurse. Performing a stomach wash and administering intravenous replacement fluids are performed by the registered nurse.
The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction? 1 Asking questions about the client's respiratory rate 2 Asking the client to perform breathing exercises regularly 3 Administering oxygen to the client with shortness of breath Correct4 Providing constructive feedback about client care management
The nurse may not provide constructive feedback about the client care management during delegation decisions. The nurse may, however, provide constructive feedback to the delegatee to maximize the efficiency of the client care.
The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction?
The nurse may not provide constructive feedback about the client care management during delegation decisions. The nurse may, however, provide constructive feedback to the delegatee to maximize the efficiency of the client care. The nurse may assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Asking involves inquiring about the client care problems and issues such as the respiratory rate. Offering involves suggesting ways to achieve desirable client care outcomes, such as asking the client to perform breathing exercises regularly. Doing involves demonstrating the specific task to improve client care—for instance, administering oxygen to the client.
Which assets of the nurse as a licensed health care professional help in planning effective nursing care? Select all that apply. Correct1 Critical thinking Correct2 Diagnostic reasoning Correct3 Ability to synthesize information Incorrect4 Establishment of assessment system for the organization Incorrect5 Communication of competency requirements
The nurse uses critical-thinking skills to analyze the process of delegation. Diagnostic reasoning and the ability to synthesize information from various sources are also skills that allow the nurse to deliver an effective nursing care plan that is beneficial for the client. Establishing systems for assessment and the communication of competency requirements are the responsibilities of a chief nursing officer.
A healthcare team is caring for a population according to the functional model of nursing. Which healthcare team member is most appropriate for the delegation of hygiene care? 1 Unit secretary 2 Registered nurse Correct3 Nursing assistant 4 Licensed practical nurse
The nursing assistant is eligible for performing activities such as providing hygiene care and determining vital signs. Unit secretaries are not delegated to provide hygienic care because they do not have formal preparation and legal recognition. The registered nurse performs other activities such as treatment, admissions, and administering intravenous medications. The licensed practical nurse performs activities such as providing oral medications.
The registered nurse (RN) delegates the tasks of caring for a client with pressure ulcers. The client suffers further tissue necrosis during treatment. What could be the reason for this condition?
The patient care associate (PCA) is not authorized to irrigate the wound as improper technique can lead to tissue damage. The RN is qualified to perform wound care; therefore, cleaning the wound is not likely to lead to tissue necrosis. Pressure ulcers are associated with pain. The LPN administering oral analgesics may relieve the pain, but it will not cause tissue necrosis. Having the licensed practical nurse (LPN) reposition the client every 1 or 2 hours will minimize the risk of tissue necrosis due to pressure ulcers.
The nurse leader is giving a speech on leadership skills to followers. Which questions enable the nurse leader to evaluate the understanding level of the followers? Select all that apply.
The question such as "what did you 'hear' in the process of this communication?" cannot be answered by a "yes" or "no" and requires a detailed explanation of the things that are taught. The questions starting with "how" are usually open-ended and require the person to answer in detail. Therefore these questions can help the nurse leader evaluate the understanding level of the followers. The questions such as "are you getting my points?", "would you all like a break?", and "can I change the topic in a little while?" can be answered by a "yes" and "no." Therefore these questions do not help the nurse leader to evaluate the understanding level of the followers.
Which question does the registered nurse recognize as related to the right of circumstance when delegating? Correct1 "Is the delegation appropriate to the situation?" 2 "Is the task within the delegatee's scope of practice?" 3 "Is the prospective delegate a willing and able employee?" Incorrect4 "Is the delegator able to monitor and evaluate the client appropriately?"
The question, "Is the delegation appropriate to the situation?" is related to right circumstance. The question, "Is the task within the delegatee's scope of practice?" is related to right task. The question, "Is the prospective delegate a willing and able employee?" is related to right person. The question, "Is the delegator able to monitor and evaluate the client appropriately?" is related to right supervision.
The client is admitted to the medical unit with a diagnosis of pulmonary edema. The client care is assigned to the registered nurse (RN) by the charge nurse. The RN admits and provides a written plan and assigns the client to a licensed practical nurse. Which healthcare personnel is accountable and responsible for the client if there is development of any complications in the client? 1 Charge nurse 2 Associate nurse Correct3 Registered nurse 4 Licensed practical nurse
The registered nurse is responsible and accountable for the client if complications develop. The registered nurse is responsible for the client because he or she delegated client care and wrote the care plan. The charge nurse may be accountable but may not be responsible since the charge nurse gets the task in the absence of the RN. The associate nurse is responsible for the client's condition if the primary nurse's written plan is implemented by the associate nurse. The licensed practical nurse (LPN) is not responsible because the LPN follows the written plan given by the RN.
An elderly client with periods of confusion underwent surgery and requires assistance for feeding. To which healthcare professional should the registered nurse delegate the task? 1 Charge nurse 2 Nurse manager Correct3 Licensed practical nurse Incorrect4 Unlicensed assistive personnel (UAP)
The registered nurse should delegate the task of feeding to the licensed practical nurse. The charge nurse may delegate the task in the absence of a registered nurse, but he/she is not likely to feed the client. The nurse manager is the designated individual to whom all nursing professionals should be answerable regarding a given task. The UAP performs all hygienic tasks. Feeding the client can be performed by the UAP but only for uncomplicated, low-risk clients.
The registered nurse is caring for an older client who is admitted with gastric ulcer and joint pains and is unable to perform activities of daily life (ADL). The legal authority has stated, "Provide the treatment according to the client's care sheet." Which delegatee should take up the task?
The registered nurse will delegate the task of providing medication to the client to the licensed practical nurse (LPN). The LPN's scope of practice is to administer oral medications and to provide the treatment that is prescribed in the client's case sheet. Orderlies are unlicensed assistive personnel who are delegated with tasks such as providing basic care, hygiene care, and assisting the clients in ADLs. Certified nursing aides are also unlicensed assistive personnel whose scope of practice does not allow them to perform tasks such as administering medications. A patient care associate is an unlicensed assistive personnel who can care for the client with basic needs such as ADLs
The registered nurse finds that the delegatee is only working for half a day in the healthcare unit. Which is the most appropriate leadership style in this situation? 1 Selling Correct2 Telling 3 Delegating 4 Participating
The relationship between the delegator and the delegatee is limited if the delegatee is only working for a half day in the healthcare unit. Therefore, the most appropriate leadership style in this situation is telling because it provides a fair amount of guidance but limits the time spent on the interactions. The leadership style of selling requires more time because the delegator needs to understand the delegatee's motivation related to the situation. Delegating is the leadership style when the relationship between the delegator and delegatee is well established and the delegatee spends more time in the healthcare organization. Participating is the leadership style of sharing and exchanging views, which requires more time and an ongoing relationship between the delegator and the delegatee.
The registered nurse delegates the task of feeding a 90-year-old client suffering from dysphagia to the unlicensed assistive personnel (UAP) who has previously performed this task. The client died of choking and aspiration after being fed by the UAP. Which right of delegation was violated for this client? 1 Task 2 Person Correct3 Circumstance 4 Communication
The right circumstance includes whether the delegation process is appropriate to the situation or not. For this client, the nurse is responsible for supervising during feeding or providing feeding as the client is suffering from dysphagia. In accordance with right task, the UAP can be delegated the task of feeding. As the UAP is caring for this client and has performed this task previously, he or she has experience of performing this task. Therefore he or she is the right person to delegate the task of feeding as per the UAP ability and willingness. The right of direction and communication includes the delegator providing clear instructions to the delegatee; there is no indication that this right was violated.
The nursing team is involved in effective pain management. Which task would be performed by a registered nurse (RN) in this case? 1 Performing hygiene tasks 2 Taking and reporting vital signs 3 Administering oral pain medications Correct4 Developing a treatment plan for client's pain
The role of the RN is to develop a treatment plan for the client's pain. All hygienic tasks are performed by unlicensed nursing personnel. Administering oral pain medications is done by the licensed practical nurse. Taking and reporting vital signs is done by the licensed practical nurse.
Which client is most appropriate to be delegated to unlicensed assistive personnel (UAP) based on the given data? 1 Client A 2 Client B 3 Client C Correct4 Client D
The unlicensed assistive personnel (UAP) is delegated to work in long-term care settings and extended-care settings as the clients are more stable. The UAP may not be delegated to work in acute care, emergency care, and intensive care settings. In dementia, the client experiences confusion, so long-term care is essential for this client. Since UAPs generally work in long-term care, client D is most appropriate to be delegated to a UAP. As severe diarrhea needs acute care, client A may not be delegated to a UAP. Though a hand fracture may require extended care, the client can do work on his or her own when compared to the client with dementia. Therefore, client B may not be delegated to a UAP. Clients with bronchitis need acute care as they may experience breathing difficulties. Therefore, client C is not delegated to a UAP.
What should the mental health nurse keep in mind when preparing to meet with a group of staff nurses who cared for victims of a disaster that occurred in the community? Select all that apply.
The usual arrangement for the most effective group interaction is a circular configuration of chairs. Staff involved in the incident need protected time to undergo stress debriefing, which generally lasts from 1 to 3 hours per session. Food should be available so that hunger is not a distraction. Typical "ground rules" for stress debriefing include strict confidentiality of information shared during the session and unconditional acceptance of the thoughts and feelings expressed by people within the group. This means that the session should not be audiotaped. The setting should be private. An auditorium would not be private.
Which questions related to decision making for delegation are appropriate according to the delegation right of "right circumstance"? Select all that apply. 1 Is the task legally appropriate to delegate? 2 Is the prospective delegatee a willing and able employee? Correct3 Are the equipment and resources available to complete the task? Correct4 Does the delegatee have appropriate supervision to complete the task? Incorrect5 Is the task appropriate to delegate based on the institutional policies and procedures?
There are Five Rights of Delegation. Questions related to the equipment and resources available for carrying out the task allotted are appropriate for the delegation right "right circumstance." Asking about the required supervision needed for the delegatee to complete the task is appropriate for the delegation right "right circumstance." Questioning whether the task allotted is legal is appropriate for delegation right "right task." Checking whether the delegatee is an able person to perform the task would come under delegation right "right person." Checking whether the task is based on the policies and procedures of the institution comes under the delegation right "right task."
After assessing the behavior of team members, the nurse leader concludes that the team is ineffective. Which activities by the team members might have led to this conclusion? Select all that apply.
They are unclear about their assignments. They are uncomfortable with disagreement. They frequently use formal voting to make decisions
Which principle of systems thinking theory involves the nurse focusing on the needs of all residents in a long-term care facility?
Thinking of the big picture
The nurse leader has implemented a change in documentation of nursing care. The nurse leader finds that the licensed practitioner nurse (LPN) is resistant to change and is not participating in the change process. Which approach made by the nurse leader would be appropriate in dealing with the LPN?
To confront the LPN and encourage verbalization of feelings regarding the change
Which factors does the registered nurse consider in the decision to delegate process? Select all that apply. 1 Evaluation Incorrect2 Nursing judgment Correct3 Predictability of outcomes Incorrect4 Pervasive functions of assessment Correct5 Complexity of the task to be performed
Two factors responsible for the decision to delegate process are predictability of outcomes and complexity of the task to be performed. Evaluation, nursing judgment, and pervasive functions are not factors in the decision to delegate process.
Which client's care is least likely to be delegated to unlicensed nursing personnel (UNP)? 1 Client A 2 Client B 3 Client C Correct4 Client D
UNP can safely care for clients in stable condition because these cases will not require critical nursing assessment and decision-making. In an emergency setting, the client with accidental poisoning should be kept under constant monitoring and any small detail of fluctuation should be noted. Therefore, client D cannot be safely delegated to UNP. Clients undergoing home care, extended care, or long-term care do not require exhaustive monitoring and do not have life-threatening conditions, so they can be safely delegated to UNP.
The charge nurse is assigning client care to oncoming staff. The new nurse on the unit expresses an inability to care for the assigned client and is requesting to be reassigned. What should the delegator do in this situation?
Understand the delegatee's motivation in the situation.
A client is brought to the emergency department following ingestion of pesticides. The primary health care provider orders gastric suction. Which task can be delegated to the unlicensed assistive personnel (UAP) in this situation? 1 Monitoring the vital signs 2 Evaluating the client response 3 Gastric suctioning through vented tube Correct4 Emptying and measuring the gastric drainage
Unlicensed assistive personnel (UAP) scope of practice is limited to providing basic care, comfort, and hygiene. The UAP can measure the drainage and report the finding before emptying it. Unlicensed assistive personnel (UAP) can monitor vital signs only for clients in a stable condition. This client has an acute condition, so monitoring the vital signs is the role of registered nurse. Evaluating the client response is the role of registered nurse. UAP may perform all hygiene tasks; however, gastric suctioning through a vented tube is not within the scope of practice of the UAP.
The registered nurse is caring for a client undergoing chemotherapy. Which statement made by the client shows a need for the registered nurse (RN) to delegate unlicensed assistive personnel (UAP) to help the client with activities of daily living (ADL)? Select all that apply. 1 "I have severe nausea." 2 "I developed rashes after therapy." 3 "I am unable to bear the pain of chemotherapy." Correct4 "I am unable to eat by myself due to the intravenous (IV) catheter." Correct5 "I am unable to get out of bed because I am so weak from the therapy."
Unlicensed assistive personnel are members of the healthcare team whose scope of practice is limited to feeding, providing basic care, hygiene, and comfort. The client reporting an inability to eat due to the intravenous catheter and an inability to get out of bed due to weakness indicates that he or she can be assisted by the UAP. The RN will be required to report the client's severe nausea to the primary healthcare provider. The RN will be required to report the pain experienced by the client undergoing chemotherapy. The client who developed rashes after therapy will require the RN to report the side effects of the medication to the primary healthcare provider.
Which delegation actions may be performed by unlicensed nursing personnel while caring for a client? Select all that apply. 1 Teaching the care plan to the client 2 Infusing intravenous fluids into the client Correct3 Asking the client to wash the hands before meals 4 Instructing the client to take specific medications Correct5 Instructing the client to wear footwear while walking
Unlicensed nursing personnel (UNP) can delegate simple and straightforward client teaching, such as asking the client to wash his or her hands before meals and wear footwear while walking. Complex and multifaceted teaching, such as detailing the care plan to the client, cannot be delegated to a UNP. The UNP has less knowledge and professional skills with which to perform complex procedures such as infusing intravenous fluids into the client and does not have a complete knowledge of medications with which to coach the client about medications.
Which members of the healthcare team are under dependent status when a task is delegated by the registered nurse (RN)? Select all that apply.
Unlicensed nursing personnel (UNP), the licensed practical nurse (LPN), or the licensed vocational nurse (LVN) whose function is under the direction of a registered nurse are given dependent status. The client attendant and the LVN are on dependent status when a task is delegated by the RN. The unit secretary is a member of the healthcare team but is devoid of formal preparation or legal recognition. The RN is the leader of the team and has responsibility for other members of the group. The primary healthcare provider is a member of the healthcare team but may delegate tasks to those with dependent status.
A client with tongue occlusion has loss of gag reflex and alterations in level of consciousness. The blood gas test shows oxygen saturation as 40mm Hg and carbon dioxide saturation as 75 mm Hg. Which type of support provides immediate relief to the client?
Upper airway obstruction may occur with tongue occlusion, which is associated with loss of gag reflex and alterations in the level of consciousness. The client suffering from severe hypoxia (O 2 saturation of 40mm Hg) and who is hypercapnic (CO 2 saturation of 75 mm Hg) requires an emergency tracheotomy for relief within 2 minutes. Laryngeal repair is performed to prevent laryngealstenosis and to cover exposed cartilage. The abdominal thrust maneuver clears upper airway obstruction caused by a foreign body. Autotitrating positive airway pressure resets the pressure throughout the breathing cycle in a client with severe sleep apnea.
The registered nurse (RN) who delegates work to a newly hired licensed practical nurse (LPN) says, "Please tell me how you will go about performing this procedure, and I will share my expectations with you." Which behavior strategy of Hersey's model is being applied?
When the LPN has the willingness and ability to perform a task, but the relationship is new, the RN will share his or her expectations and conditions with the LPN. This is a clinical example of participating. Participating is encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task. If the LPN has limited knowledge and ability to perform a task, the RN will provide more guidance, which is an example of telling what is the task to be done and how it is to be performed. If the LPN is delegated a new task, it requires explanation from the RN. This is termed as selling in Hersey's model, which is the process of explaining and persuading; this happens if a situation involves a new task and the relationship is ongoing. If the LPN has an established relationship and experience, he or she requires a little guidance and this is called delegation.
The registered nurse (RN) who delegates work to a newly hired licensed practical nurse (LPN) says, "Please tell me how you will go about performing this procedure, and I will share my expectations with you." Which behavior strategy of Hersey's model is being applied? 1 Telling 2 Selling Incorrect3 Delegating Correct4 Participating
When the LPN has the willingness and ability to perform a task, but the relationship is new, the RN will share his or her expectations and conditions with the LPN. This is a clinical example of participating. Participating is encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task. If the LPN has limited knowledge and ability to perform a task, the RN will provide more guidance, which is an example of telling what is the task to be done and how it is to be performed. If the LPN is delegated a new task, it requires explanation from the RN. This is termed as selling in Hersey's model, which is the process of explaining and persuading; this happens if a situation involves a new task and the relationship is ongoing. If the LPN has an established relationship and experience, he or she requires a little guidance and this is called delegation.
A client is admitted to the hospital with severe backache and chest discomfort. After reviewing the client's condition, there is a need for 24-hour client care by the registered nurse (RN). Which healthcare professional is responsible for assigning the task to a registered nurse when 24-hour client care is needed? Correct1 Nurse manager 2 Nursing supervisor 3 Chief nursing officer 4 Primary healthcare provider
When the client requires 24-hour care, the nurse manager is responsible for deciding oversight of RN supervised care to the client. The nursing supervisor is responsible for supervising tasks being performed by team members. The chief nursing officer is responsible for establishing systems to provide competent and effective care. The primary healthcare provider cares for the client by diagnosing and prescribing; assigning work to the registered nurse is the responsibility of the nurse manager.
When delegating a task, the delegator says, "Please tell me how you are going to perform this procedure, and I will share my expectations regarding how we need to communicate with each other." What can be inferred about the delegatee? 1 The delegatee has expertise and an established relationship with the delegator. 2 The delegatee has limited knowledge and ability to perform the task. Correct3 The delegatee has willingness and ability, but the relationship is new. 4 The delegatee has an established relationship with the delegator, but a new task has been delegated.
When the delegatee has the willingness and ability to perform the task but the relationship is new, the delegator tries to establish mutual expectations and conditions for performing the task. The delegator must open the lines of communication with the delegatee. When the delegatee has expertise and an established relationship with the delegator, the delegator asks the delegatee to communicate if any issue or concern arises. When the delegatee has limited knowledge and ability to perform the task, the delegator would provide more guidance to the delegatee by giving detailed instructions. If the delegatee has an established relationship with the delegator but a new task has been delegated, the delegator will need to provide explanation of what is needed to accomplish the task.
The registered nurse (RN) who was caring for a postsurgical client went out for a break. The RN assigns the work to a healthcare professional who is also an RN. Which is the correct statement regarding this situation? 1 The situation describes delegation. Correct2 The situation describes assignment. 3 The second nurse holds accountability rather than responsibility for the client. Incorrect4 The second nurse holds responsibility rather than accountability for the client.
When the work is assigned to another registered nurse (RN), it indicates assignment. The RN holds responsibility and also accountability of the assigned task. When the work is assigned to other practitioners, it indicates only responsibility is transferred.
While caring for a client with severe fever, the registered nurse (RN) delegated the task to a new delegatee to assist the RN in recording the temperature. Which instruction given by the RN indicates that the delegatee is new to working with that RN?
When the work relationship is new, the registered nurse (RN) should ask the delegate to explain how he or she would perform a particular task. So, learning how the delegatee will record the temperature will help to create mutual expectations and conditions for performance. Recording the temperature every hour is the instruction given to the delegatee who has limited knowledge and limited ability to perform the task. Telling the delegatee what is necessary while recording the temperature is important to a delegatee who is new to the assigned task. A delegatee with good knowledge needs minimal guidance, but he or she should remember to report any client issues to the available RN at any time.
The registered nurse (RN) is teaching a newly hired nurse how to communicate with a delegatee while delegating a task. Which statements made by the newly hired nurse indicate effective learning? Select all that apply. Correct1 "I will keep the information simple." 2 "I will share more information than required." Correct3 "I will share the information using electronic media." Correct4 "I will provide an opportunity to clarify the information." Incorrect5 "I will repeat the information in the same way until the new nurse understands it."
While communicating with the delegatee, the information should be simple to enable better understanding. Electronic media is used as a primary communication mechanism to share information. Providing an opportunity to clarify the information helps evaluate the ability of the delegatee. Giving more information than required may lead to confusion. The information should be repeated in different ways if necessary, to ensure better understanding.
Which statement is true regarding the framework of delegation related to the Hersey's Situational Leadership Model? Select all that apply.
Willingness relates to the individual's attitude towards the task Ability to diagnose performance is a core competency of a situational leader
A nurse is conducting a health campaign in a school. During the health campaign, the nurse finds that the school management has replaced the registered nurse (RN) with a trained clerk. What should the nurse, as a community opinion leader, do?
Write a letter to a local newspaper editor opposing the decision of the school board
Which aspects are considered when determining the willingness of a nursing assistant before delegating a task? Select all that apply.
attitude confidence commitment
A nurse is preparing to administer an intravenous piggyback medication to a client who is receiving a continuous infusion of intravenous (IV) fluids. What is the priority nursing intervention?
check the compatibility of the medication and the continuous IV solution.
While interviewing a nurse for the position of leader, the chief executive officer of a healthcare facility asks "How will you develop political skills in your team?" Which answers provided by the nurse most likely will result in an offer for the position? Select all that apply.
i will encourage their participation in Nurse Lobby day I will encourage their active membership in the state nurses' association
The registered nurse, as a transformational leader, is assigning a task to a practitioner nurse. Which effects on the follower does the nurse expect from transformational leadership? Select all that apply.
increasing self worth coaching and mentoring performing challenging and meaningful work
The senior leader instructs the direct care nurses about asking the right question in PICOT (patient population, intervention, comparison, outcome, and time frame) format. During the discussion, the leader discussed factors such as complication rate, satisfaction, nursing diagnosis, and nursing quality indicator. What do these factors indicate in the PICOT format?
outcome
Influenza epidemic take orders from
state officials
During a status meeting for a research project, the project leader asks the team members for feedback. What leadership theory is represented by the action of the leader?
style theory
The nurse leader is executing quality improvement (QI) processes in a team. Why are QI processes important?
they review the nursing activities
The registered nurse (RN) is caring for a client with epilepsy. Which tasks delegated by the registered nurse (RN) to the assistive personnel indicates active delegation? Select all that apply. 1. Instructing the licensed practical nurse (LPN) to administer diazepam 2. Instructing the licensed practical nurse (LPN) to monitor the vital signs 3. Instructing the licensed vocational nurse (LVN) to administer sedatives 4. Instructing the unlicensed assistive personnel (UAP) to reposition the client 5. Instructing the unlicensed assistive personnel (UAP) to place the oxygen mask
2. Instructing the licensed practical nurse (LPN) to monitor the vital signs 4. Instructing the unlicensed assistive personnel (UAP) to reposition the client 5. Instructing the unlicensed assistive personnel (UAP) to place the oxygen mask Passive delegation includes performing the tasks based on the position description such as physician or pharmacist. The individual functioning in this role performs these tasks through passive delegation. Instructing the LPN to administer diazepam, medication that was already prescribed by the primary healthcare provider, is passive delegation. Instructing the LVN to administer sedatives that were already prescribed by the primary healthcare provider is passive delegation. Instructing the LPN to monitor vital signs is active delegation as the RN directs assistive personnel to perform certain tasks and holds the individual accountable. Instructing the UAP to reposition the client is also an active delegation as the UAP is carrying out certain tasks that are directed by the RN. Instructing the UAP to place the oxygen mask is an active delegation as the RN directs assistive personnel to perform certain tasks.
A healthcare team is caring for a client who is hospitalized with severe diarrhea. According to the principle of right of supervision of delegation, what does the RN do in this situation? 1. Feed the client every 2 hours. 2. Monitor the hemodynamic status. 3. Assess the resources required in the client's care. 4. Follow the institutional procedures for administering fluids.
2. Monitor the hemodynamic status The RN should monitor the hemodynamic status of the client according to the right of supervision of delegation. It is the responsibility of the RN to supervise the delegated task. Feeding the client is usually performed by a licensed practical nurse, unlicensed nursing professional, or any member of the healthcare team. Assessment of resources is monitored before assigning tasks to the healthcare team. Following institutional procedures for administration of fluids is actually done by the RN, so it is not supervised by the RN.
Which statement is true regarding delegation? Select all that apply. 1. The delegatees are accountable for effective client care. 2. Open lines of communication must occur between delegator and delegatee. 3. Delegation occurs only when at least two people are involved in a mutual work situation. 4. The delegation potentials are significantly lower when caregivers such as UNPs are partnered. 5. Delegation involves sharing activities with other appropriate authority to accomplish the work.
2. Open lines of communication must occur between delegator and delegatee. 3. Delegation occurs only when at least two people are involved in a mutual work situation. 5. Delegation involves sharing activities with other appropriate authority to accomplish the work. Open lines of communication between delegator and delegatee helps to eliminate any misunderstanding regarding delegated tasks. Delegation occurs only when at least two people are involved in a mutual work situation; one who has the authority to perform specific tasks and other who holds accountability for the task being performed. Delegation involves sharing activities with other appropriate authority to accomplish the work. When delegating a task to delegatee, the delegator retains accountability for effective client care by ensuring that the task is completed by the right person and that the person is supervised appropriately. The delegation potentials are significantly higher when caregivers such as UNPs are partnered.
The registered nurse assesses if an unlicensed assistive personnel (UAP) new to the unit is capable of carrying out a task. Which principle of delegation does this illustrate? 1. Right task 2. Right person 3. Right circumstance 4. Right communication
2. Right person The right person is to select a person with appropriate expertise to complete the task. The right task is the right based on institutional polices. The right communication is to know whether the delegator and delegatee can understand a common work-related language. The right circumstance is to know which delegation process is appropriate to the situation.
The registered nurse suggested that a newly hired registered nurse delegate tasks to nursing assistants. Which is an element that fosters effective delegation decisions by the newly hired registered nurse? 1. Skills 2. Stability 3. Practice 4. Environment
2. Stability Stability along with safety, critical thinking, and time for decision-making creates an integrative process, which fosters effective delegation decisions. Skills are important for making decisions based on critical thinking. Practice accomplishes safety in delegation. Environment with feedback about performance is the best strategy for shaping the future behavior of individuals.
The registered nurse delegates a task to the unlicensed assistive personnel (UAP). After the UAP starts the task, the registered nurse (RN) asks for feedback related to the task. Which right of delegation is the RN following? 1. Task 2. Supervision 3. Circumstance 4. Communication
2. Supervision The delegation right of supervision refers to obtaining feedback, monitoring, and evaluating the delegatee appropriately. Right task refers to the delegation of an appropriate task based on institutional policies and procedures. Right circumstance refers to evaluation of the working environment and ensuring adequate supervision of delegatees. To ensure right communication, the RN should communicate properly and accurately to the delegatee and provide clear and concise directions for the task.
The delegator explains the procedure of the task to the delegatee and asks to provide regular feedback on the events. Which delegation right is the delegator referring to in this situation? 1. The right person 2. The right supervision 3. The right circumstances 4. The right communication
2. The right supervision The delegator is supervising the task by asking the delegatee to provide regular feedback on the events of the specific assigned task. The delegator has to understand and assess the abilities and skills of the delegatee to determine that the right person is selected to perform the specified task. The right circumstance may be assessed by checking the environment, equipment, and resources to perform the task. The delegator has to develop and maintain open lines of communication to promote a positive work environment.
What is the ultimate goal of delegation? 1. To deliver client care as a team 2. To maximize client care outcomes 3. To improve the working ability of the nurse 4. To maintain open lines of communication between delegator and the delegatee
2. To maximize client care outcomes The ultimate goal of the delegation is to maximize client care outcomes. Delegation helps to deliver client care as a team and improves the working ability of the nurse but these are not the ultimate goals of delegation. Maintaining open lines of communication between delegator and the delegatee creates a productive work environment in delivering client care.
When does delegation become more challenging? Select all that apply. 1. When the client is stable 2. When the client is pregnant 3. When the geographic area is small 4. When the resources are abundant 5. When school children are receiving care
2. When the client is pregnant 5. When school children are receiving care The delegation process becomes more challenging when vulnerable populations such as pregnant women and school children are receiving care. Delegation can be safely and successfully carried out in the stable client. Delegation can be accomplished successfully when the geographical area is small and resources are abundant.
The registered nurse is evaluating a group of student nurses after teaching how leaders should maintain balance. Which statement by a student nurse indicates effective learning?
"A good strategy for retaining control is to get control over communication."
The registered nurse is teaching a group of nursing students about leadership principles. Which statement made by a nursing student indicates the need for further teaching?
"A leader has a formal position."
Who should transcribe orders?
An RN
What things should an RN never delegate?
TIA= Teaching, Interventions, and Assessments
Which group discussion technique involves a large number of respondents who may be participating in the discussion remotely?
delphi techniques
What is the role of the nurse executive as a leader?
empowerment
Which skills would be essential for an effective nurse manager to develop and improve collaboration with others? Select all that apply.
flexibility ability to listen to others ability to share info and ideas
What are the desirable actions of the nurse as a transformational leader? Select all that apply.
fostering a shared vision providing coaching and mentoring
Which type of leadership theory explains the effectiveness of leadership and depends on the match between a leader's style and the demands of a situation?
Contingency Model
The nurse, as a leader, takes care of himself or herself to promote the nurse's ability to care for the staff. Which of Gardner's tasks of leadership is the nurse applying in practice?
renewing
A nurse leader is promoting dialogue within the team successfully. Which actions of the nurse leader are responsible for this success? Select all that apply.
serving as a facilitator Encouraging the sharing of ideas Reacting to changed proposals honestly
Which conditions make a delegation more challenging for the registered nurses, delegatees, and clients? Select all that apply. 1. Limited resources 2. More staff availability 3. More client care time 4. Greater geographical area 5. Vulnerable populations receiving care
1. Limited resources 4. Greater geographical area 5. Vulnerable populations receiving care Delegation is a multifaceted decision-making process which involves a nurse directing another person to perform nursing tasks and activities. Delegation is more challenging when other resources are limited because it is difficult to care for all clients when resources are limited. Delegation is more challenging when the geographic area is greater because of more population. Delegation is more challenging when vulnerable populations are receiving care because they are economically uninsured. Delegation is better when more staff is available and when more time is allotted to care for clients.
Which organization advocates nurses taking a prominent role in the healthcare arena?
Institute of Medicine
WHAT IS THE MEANING OF PHYSIOLOGICAL SIGN IN PSYCH PATIENT
.Anxiety (also called angst or worry) is a psychological and physiological sign and also including vital signs of the patient...
A nurse leader is teaching about the functional model of nursing to a student nurse. Which statements made by the student nurse indicate effective learning? Select all that apply.
"I will focus on tasks and activities allotted to me." "I will coordinate the unlicensed personnel to provide care to a large group of clients."
The registered nurse (RN) is teaching a newly hired nurse how to communicate with a delegatee while delegating a task. Which statements made by the newly hired nurse indicate effective learning? Select all that apply.
"I will keep the information simple." "I will share the information using electronic media." "I will provide an opportunity to clarify the information."
A registered nurse is teaching a nursing student about disaster management during an accidental fire in an industry. Which statement by the student indicates the need for further teaching?
"I will risk my life to move clients to a safe location if needed." The nurse should never risk injury to self or staff members while moving clients or attempting to extinguish a fire. The nurse can ask the help of ambulatory clients to rescue and move other clients who are at risk. Clients who sustain mild injuries can be asked to walk so that stretchers can be used for people in greater need. If a client has breathing difficulty, respiration should be manually maintained until the client iis rescued from the fire.
The head nurse of the emergency department is teaching a group of student nurses about Critical Incident Stress Debriefing (CISD) in emergency nursing. Which statement of the student nurse indicates a need for *further teaching?*
*"The coleader is responsible for keeping unauthorized people out."* A CISD team is a component of a CISM program. It is called to deal with the emotional needs of healthcare team members after a devastating event. A doorkeeper is a third member of CISD team who is responsible for keeping inappropriate people, such as media and spectators, out. The coleader is a peer of the group being debriefed. The doorkeeper talks to the person who leaves the session early and makes an effort to obtain follow-up from the person. The team leader has a background in a mental health/behavioral health-related field.
Which description by the nurse is a correct explanation of delegation?
***not accountability*** The transfer of responsibility for the performance of an activity
Which responsibility of the nurse manager differs from the responsibilities of a nurse leader? 1 Planning the budget 2 Motivating the team 3 Resolving the conflicts 4 Penalizing for poor performance
1 Planning the budget Budgeting is the responsibility of a nurse manager. The role of nurse leader is to motivate the nursing subordinates. Resolving conflicts is the responsibility of both the nurse leader and the nurse manager. Penalizing for poor performance is a behavior of transactional leadership.
The registered nurse is teaching a newly hired nurse about communicating with delegatees during delegation. Which statement made by the newly hired nurse indicates the need for further learning? 1 "I should identify priorities." 2 "I should specify deviations." 3 "I should provide examples of each delegation." 4 "I should specify any performance limitations to the delegatee."
3 "I should provide examples of each delegation." The delegator should ask the delegatee to provide examples of each delegation in order to understand his or her knowledge level. The delegator should identify priorities before delegating the task to the delegatee. The delegator should specify deviations, such as when the delegatee must take an immediate action while performing the task. The delegator should specify the performance limitations to the delegatee, which can help in performing the task effectively.
While teaching a nursing student about delegation, the registered nurse instructs the student to determine whether the delegation process is appropriate to the situation before delegating a task. Which right of delegation is the registered nurse referring to? 1. Task 2. Person 3. Supervision 4. Circumstance
4. Circumstance There are five rights in delegation. Before delegating a task, the delegator should know whether the process is appropriate to the situation, thus assessing that it is the right circumstance. The delegator should know whether the task is appropriate to delegate based on institutional policies and procedures to determine if it is the right task. Selecting a knowledgeable and experienced delegatee to perform the task ensures that the right person is chosen. Supervision is the last right of delegation which is performed by the delegator in which the delegator monitors and evaluates the delegatee and elicits feedback whenever appropriate.
What should pregnant nurses avoid?
5th disease (slapface/Parovirus), measles, varicella, internal radiation, isotopes, and chemo drug handing.
The nurse as a leader explains ethical principles to the student nurse. Which example does the leader give for autonomy?
Accepting the client's wish to donate his/her organs after death
Which task can be delegated to the licensed vocational nurse (LVN)? Select all that apply.
Administering oral hypoglycemic agents Administering intramuscular medications
The chief operating officer (COO) discusses the performance of a newly appointed leader with the nursing staff. The team communicates that the practical approach of the leader fulfills the quantum theory. What type of work environment does the COO understand that the leader creates at the workplace?
An environment that is rapidly changing and dynamic
The leader is devising a strategy to connect individuals, groups, and organizations to attune them toward a common goal. Which political strategy is the leader pursuing?
Building coalitions
The nurse leader performs his or her own honest appraisals on a regular basis and feels good about the job. Which rule is the nurse leader implementing by this action?
Building self-confidence
While supervising the LPN's technique with medication administration, the nurse manager sees the LPN beginning to dispense an incorrect dose. How should the nurse manager respond initially?
By questioning the dosage in the hope that the LPN will identify the error
Which of these clients is most appropriate for delegation to a cross-trained technician? 1 Client A - lung cancer; lobectomy treatment; postop care is providing respiratory therapy 2 Client B - CAD; cardiac bypass treatment; postop care is continuous ECG monitoring 3 Client C - dysmenorrhea; hysterectomy treatment; postop care is monitoring of vitals 4 Client D - fractured pelvis; observation as treatment; postop care is teaching leg exercises
1 Client A A cross-trained technician, when paired with a registered nurse (RN), may perform respiratory therapy, phlebotomy, and electrocardiography. Care of client A can be safely delegated to a cross-trained technician. Though the cross-trained technician can record the ECG, he or she may not monitor the continuous ECG. Monitoring of vital signs is also the role of the RN. Leg exercises may be taught by the RN or by a physician. The other licensed assistive personnel may be delegated the task of reinforcing the teaching, but this is not an appropriate role for the cross-trained technician.
The nurse leader is calculating the productive hours of the staff nurse for that year. The nurse took a vacation for 19 days. What are the productive hours of the staff nurse? Round your answer using a whole number. _____ hours
1928
The nurse leader is teaching about the role of followers to the nursing staff. Which statement made by the nursing staff is true regarding the followers' traits? Select all that apply.
A follower demonstrates collaborative behavior in daily practice. A follower cooperates with the leader and peers to reach the team goal.
A manager is planning to implement Gardner's Managing task of leadership. Which leadership and management behaviors would the leader display? Select all that apply.
Ensuring that organizational systems work on the client's behalf Assisting the client and client's family with planning, priority setting, and decision making
The registered nurse delegates the care of a client in the immediate postoperative period to the patient care associate (PCA). Which tasks performed are in the scope of practice of the PCA? Select all that apply.
Feeding the client Assisting the client with bathing
The charge nurse is delegating tasks for the nursing assistants regarding the postpartum care of a client. Which task is appropriate to be delegated to an unlicensed assistive personnel (UAP) to provide effective client care? Select all that apply.
Feeding the client Providing basic hygiene Encouraging breastfeeding
The behavior of four nurses in different situations is given below. Which nurse exhibits a behavior that can be characterized as delegation according to Hersey's model?
Hersey's model describes "delegation" as the leader's behavior of observing or monitoring if the delegatee has the ability, willingness, and expertise to accomplish the work and there is an established relationship, as with nurse B. Nurse A exhibits guiding or directing, described as "telling," in which the delegator simply tells the individual what is the task to be done and how to perform the task. This happens if the relationship is limited. "Selling" is exhibited by nurse C and is the process of explaining and persuading, which happens if a situation involves a new task and the relationship is ongoing. "Participating" is exhibited by nurse D and is the ability of encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task.
A client underwent extraction of a tooth due to an underlying tumor one day ago. Which healthcare professional is appropriately involved in caring for the postoperative oral hygiene needs of this client? Correct1 Registered nurse (RN) 2 Licensed practical nurse (LPN) 3 Licensed vocational nurse (LVN) Incorrect4 Unlicensed nursing practitioner (UNP)
If there is any anticipated risk in client care, the task should not be delegated but should be carried out by the RN. Because there is a risk of infection and oral bleeding, the RN should not delegate the task of postoperative oral hygiene to the LPN, LVN, or UNP.
Which characteristics should a nurse focus on to become an effective transformational leader? Select all that apply.
Inspiring a shared vision Improving interpersonal skills Being able to motivate the nursing staff
OB Modification Theory
OB Mod theory of leadership uses positive reinforcement to motivate followers to repeat constructive behaviors in the workplace. According to this theory, the leader uses punishment sparingly as the results are unpredictable in supporting the desired outcome.
During a therapy group session, a female client begins to cry and tells the other group members that her husband has told her that he wants a divorce. What is the most appropriate initial response by the nurse?
Observing how the group responds to her statement
Which statement is true regarding delegation? Select all that apply.
Open lines of communication must occur between delegator and delegatee. Delegation occurs only when at least two people are involved in a mutual work situation. Delegation involves sharing activities with other appropriate authority to accomplish the work.
The nurse is attending a city commission meeting being held to discuss using a community park to build a museum. How should the nurse advocate as a community opinion leader to help maintain a health conscious society?
Oppose building the museum
The nurse manager uses operant conditioning when managing the staff by providing positive reinforcement to motivate them to repeat constructive behavior. Which leadership theory is reflected in this practice?
Organizational behavior (OB) modification
What is the memonic to remember how to use the fire extinguisher?
PASS= Pull Pin, Aim, Squeeze, and Sweep
A client requires emergency cardiac surgery. The leader nurse wants to make the client aware of the situation and wants the client to decide what should be done. Which ethical model does the leader nurse follow here?
Patient-benefit model
Which member of the healthcare team would the nurse claim performs functions through passive delegation?
Pharmacist
A nurse preceptor is evaluating a nurse who is preparing to administer digoxin intravenously (IV) to a client. The preceptor should stop the nurse from continuing with the procedure when the preceptor observes the nurse doing what?
Piggybacking the digoxin in an existing infusion
The nurse is caring for four different clients with different health conditions. Which client care task delegated to the licensed vocational nurse (LVN) would be appropriate to develop a suitable care outcome? 1 Client 1 2 Client 2 3 Client 3 Correct4 Client 4
Providing oral medication to the client who has undergone hysterectomy can be done by the licensed vocational nurse (LVN). The LVN is not eligible to write a nursing care plan for the client with hysterectomy; this must be performed only by the registered nurse (RN). An LVN cannot provide intravenous fluids. Continuous peritoneal dialysis is not performed by an LVN; this procedure requires a more experienced practitioner such as an RN.
The registered nurse tells a nursing student, "In the nursing model, the registered nurse is responsible for all aspects of care for one or more clients during a shift of care and the care can be delegated." Which disadvantage would be most likely related to this nursing model?
The continuity of care is a problem.
Which of these clients can be provided care safely by unlicensed nursing personnel? Select all that apply.
The greater the stability of a client, the more likely it is that unlicensed nursing personnel (UNP) can provide safe client care. It is also easy for a UNP to care for a client who is recovering. A client with pain is anxious and agitated, and it will take the UNP time to calm the client. Client care may be affected when the client is psychologically upset and has suicidal intentions.
The nurse leader wants to avoid a conflict and postpone its resolution. What could be the reason for this avoidance?
The leader wants to gather more information.
The client with methicillin-resistant staphylococcus aureus (MRSA) is admitted to the medical unit. Which of the following tasks should be performed by the registered nurse? 1 Feeding 2 Administrating oral medication Correct3 Initiating intravenous (IV) antibiotic therapy 4 Changing the dressing of a postoperative wound
The registered nurse performs the task of administering the IV medication. Feeding the hospitalized client is done by the unlicensed nursing professional. Oral administration of medicine is done by the licensed practical nurse. Changing the dressing of a postoperative wound is done by the unlicensed nursing professional.
The registered nurse delegates the care of a client in the immediate postoperative period to the patient care associate (PCA). Which tasks performed are in the scope of practice of the PCA? Select all that apply.
The tasks that may be delegated to the patient care associate (PCA) for postoperative client care include providing basic comfort and hygiene. Feeding the client is basic care provided by the PCA. Assisting the client with bathing is the basic hygiene provided by the PCA. Primary ambulation of a postoperative client should be done by the registered nurse or another licensed practitioner. The PCA can monitor vital signs for stable clients but would not be delegated the task of monitoring vital signs for a postoperative client. Primary teaching of leg exercises to the client should be done by the registered nurse. Test-Taking Tip: The PCA has a limited scope of practice when delivering care to the postoperative client. When answering questions related to postoperative care, be specific about the role of PCA.
What should be done if someone presents with dilated pupils and decreased LOC?
They probably have increased ICP so sit them up to help decrease the pressure.
Which example would the nurse consider to be a part of systems thinking theory?
To focus on the needs of all residents in a long-term care facility
While caring for a client with severe fever, the registered nurse (RN) delegated the task to a new delegatee to assist the RN in recording the temperature. Which instruction given by the RN indicates that the delegatee is new to working with that RN? 1 "Note the temperature every hour." Correct2 "Tell me how you record the temperature." 3 "You can approach me at any time to report any of the client's issues." 4 "Let me show you what is necessary while recording the temperature."
When the work relationship is new, the registered nurse (RN) should ask the delegate to explain how he or she would perform a particular task. So, learning how the delegatee will record the temperature will help to create mutual expectations and conditions for performance. Recording the temperature every hour is the instruction given to the delegatee who has limited knowledge and limited ability to perform the task. Telling the delegatee what is necessary while recording the temperature is important to a delegatee who is new to the assigned task. A delegatee with good knowledge needs minimal guidance, but he or she should remember to report any client issues to the available RN at any time.
The registered nurse assists other registered nurses when there are no safety issues. While assisting, the registered nurse uses the strategy of asking. What is the benefit of this strategy? Select all that apply.
When there are no safety issues, the registered nurse can assist other nurses by using different strategies. The strategy of asking begins with questions related to the problem or issue regarding client care and it allows the nurse to reassess and examine the situation differently. Asking provides an opportunity to open lines of communication between the delegator and delegatee. The strategy of doing helps in demonstrating a specific task or behavior to improve client care. The strategy of offering helps in making a suggestion to facilitate the achievement of a desirable client care outcome.
The direct care nurse, as a leader, finds that there is no formalized mechanism for providing input for organizational decision making. Which strategies does the nurse use in this situation? Select all that apply.
When there is no formalized mechanism for input into organizational decision making in a hospital, the direct care nurse uses some strategies for influence. These strategies include filing official complaints, creating unit campaigns, and holding informal discussions. Mobilizing volunteers for health fairs is the role of nurse as community leader. Inspiring staff in changing the workplace is the role of the nursing manager.
While serving as a leader, the nurse assists the client with planning, priority setting, and decision making. Which of Gardner's leadership tasks is the nurse putting into practice?
managing
Which internal factors affect the decision-making process of a leader? Select all that apply.
values interest knowledge
What is the key element of success for a nurse manager as a leader?
Including the direct care nurses in decision making
Which behavior of the nurse as a leader would be considered a smart trust action according to Covey?
Focusing first on developing character
The registered nurse, as a leader, asks student nurses to think "outside the box." Which complexity principle is the nurse applying in this condition?
Focusing on emergence
Which nursing actions indicate effective implementation of systems thinking theory principle with respect to "thinking of the Big Picture"? Select all that apply.
Focusing on the needs of all the residents in a long-term care facility Knowing about the complications of emergency department overcrowding in an urban setting
The Case Management Society of America has identified the standards of practice for nursing case managers. What are the standards that provide effective care? Select all that apply.
Focusing on transitions of care Improving medication reconciliation Expanding the interdisciplinary team
A nurse leader has resolved a conflict within the team. Which further action of the nurse leader prevents the same conflict in the future?
Working with the team members after the conflict
Which questions should the delegator assess to determine the right task? Select all that apply. "Is the task legally appropriate to delegate?" "Is the environment conducive to completing the task safely?" "Does the delegator provide clear and concise directions for the task?" "Is the task appropriate to delegate based on institutional policies and procedures?" "Does the delegatee have the knowledge and experience to perform the specific task safely?"
"Is the task legally appropriate to delegate?" "Is the task appropriate to delegate based on institutional policies and procedures?" Rationale The delegator has to determine right task by assessing whether the task is legally appropriate to delegate. The delegator must also check that the task is appropriate to delegate based on institutional policies and procedures. The right circumstance can be assessed by asking, "Is the environment conducive to completing the task safely?" The right direction and communication is assessed by asking, "Does the delegator provide clear and concise directions for the task?" The right person eligible to accomplish the task is assessed by asking, "Does the delegatee have the knowledge and experience to perform the specific task safely?"
The nurse leader is teaching a student nurse about the modifications in the patient-focused care model. Which statement made by student nurse indicates ineffective learning?
"It requires a technician to provide client care."
The nurse manager shares experiences faced during the journey to leadership with other staff members. Which statement made by the nurse appropriately describes the barriers faced during the leadership journey? Select all that apply.
"It requires time commitment." "The title doesn't guarantee good leadership
Which statement of the nurse leader reflects the actions suggested by the Joint Commission for disruptive behavior by a direct care nurse?
"You are terminated, effective now."
The registered nurse (RN) and unlicensed assistive personnel (UAP) have been working together for two years. Which statement made by the RN would be appropriate after delegating a task to the UAP?
"You know what to do and when to report"
A registered nurse delegated a task to the unlicensed nursing personnel (UNP) and is supervising the UNP. Which statements made by the nurse after the UNP completes the task can yield a positive outcome from the UNP? Select all that apply.
"You performed that task safely and professionally." "The task was well done, but there is room for improvement."
A nurse leader is planning to improve the quality of the team members. What should the nursing leader refrain from suggesting when building an effective team?
"You should establish a formal and regimented work environment."
Which component of delegation is suitable to all the members on the healthcare team?
*Authority* is the component of delegation that is suitable for all the members on the healthcare team. Supervision is a right of delegation in which the delegator supervises the other assistive personnel to perform the task. Accountability is the component of delegation that is suitable for delegators such as registered nurses (RNs). Communication is the right of delegation in which the delegator gives the directions to perform the task.
A nurse manager is informed that a community disaster drill will take place. The disaster scenario will include a bombing in a shopping mall with hundreds of casualties. What location should the nurse consider for triage of casualties when planning for this exercise?
At the scene of the disaster
What is the ideal situation that is present on the NCLEX?
1 nurse, 1 patient, and all the time in the world. Assume all orders are written.
How are patients on the psych ward prioritized?
1st: Physiological, 2nd: Change in psych behavior, 3rd: Safety
Which situations require that the registered nurse (RN) report to an appropriate authority? Select all that apply. 1. Client has a row of 3-inch circles down the back from "cupping" 2. Client is diagnosed with gonorrhea and requests not to report under the Health Insurance Portability and Accountability Act (HIPAA) 3. RN thinks a teenage client's signs are from abuse, but the health care provider does not 4. RN thinks an elderly client's signs are from abuse but the client denies this 5. Syphilis is diagnosed in an 11-year-old who denies sexual activity
2, 3, 4, 5 The RN is required to report suspected abuse of vulnerable clients (eg, underage, elderly, mentally ill) to appropriate authorities, regardless of what other practitioners think. A proper investigation, rather than conflicting opinions, will determine whether abuse has occurred (Option 3). The RN should report suspected abuse of vulnerable clients even if the client denies it because other factors (eg, dependence on the abuser, dementia) could be the reason for denial (Option 4). Sexually transmitted infection (STI) in a child is sexual abuse and must be reported and investigated (Option 5). The greater good of society outweighs an individual's right to confidentiality. Gonorrhea is an STI; the client should be informed that public health will be notified and partners will be contacted to receive treatment (Option 2). (Option 1) Cupping is a recognized alternative medicine practice in which a circular object is typically used to create suction underneath a cup. The tension pulls the skin upward and promotes release of muscle tension and scar tissue. After the process, the circular marks remain for a certain period. The location, organized rows, and history help validate the cause of the marks. Educational objective: An RN is required to report suspected abuse of vulnerable clients even if other practitioners do not agree or the clients deny it. An STI in a child is considered sexual abuse and requires reporting. Reportable conditions by law are not protected from reporting under the confidentiality of personal health care information in HIPAA.
Which critical factors would the nurse say are associated with situational-contingency theory? Select all that apply. 1 Environmental demands 2 The personal characteristics of followers 3 The ability of the leader to reward followers 4 The degree of trust and respect between leaders and followers 5 The task structure about goals and the complexity of the problems being faced
3 The ability of the leader to reward followers 4 The degree of trust and respect between leaders and followers 5 The task structure about goals and the complexity of the problems being faced Situational-contingency theory considers three factors to be critical. It includes the ability of the leader to reward followers in terms of power and position. It is also comprised of the degree of trust and respect between leaders and followers. The task structure about goals and the complexity of problems faced is a critical factor. Environmental demands and the personal characteristics of followers are contingent variables.
What entity outlined the principles of delegation for registered nurses? 1. Nurse Practice Act 2. Multilevel nursing model 3. American Nurses Association (ANA) 4. National Council of State Boards of Nursing (NCSBN)
3. American Nurses Association (ANA) The ANA outlined the principles of delegation for registered nurses. The Nurse Practice Act of each state examines the value of unlicensed personnel in client care delivery and declares that the importance of delegation decisions is the safety and welfare of the public. The multilevel nursing model consists of registered nurses, licensed practical nurses, and unlicensed nursing professionals. The National Council of State Boards of Nursing (NCSBN) stated that the state boards of nursing should regulate nursing assistive personnel across multiple settings.
The registered nurse (RN) is teaching a newly hired nurse about delegating tasks to the healthcare team. When asked what the rights of delegation are, which right listed by the hired nurse indicates the need for further teaching? 1. Right task 2. Right direction 3. Right drug name 4. Right person
3. Right drug name The 5 rights of delegation are right task, right circumstance, right person, right directions and communication, right supervision and evaluation.
The nurse leader working in a 50-bed surgical unit accrued 765 client days in November and 189 of the clients were discharged during the month. What is the average length of stay for November? Record your answer using a whole number. _____ days
4
Which statement is true related to the role of the registered nurse in active delegation? 1. To provide direct care to a client 2. To perform the task on behalf of a delegatee 3. To perform certain functions as the healthcare provider 4. To direct an unlicensed practical nurse (UNP) to perform certain tasks
4. To direct an unlicensed practical nurse (UNP) to perform certain tasks In active delegation, the registered nurse assesses the situation to direct a UNP to perform certain tasks. The registered nurse assigns and supervises work to the LPN and the LPN directly provides care to a client. The delegate performs the task on behalf of the registered nurse, rather than the registered nurse providing direct care to the client. The registered nurse does not perform the task on behalf of delegatee; rather the delegatee performs the tasks on behalf of delegator. The registered nurse has the appropriate authority to perform certain functions as the healthcare provider.
Which member of the healthcare team would the nurse claim performs functions through passive delegation?
A pharmacist performs functions through passive delegation. Unit secretaries may not be eligible to perform any activity because they do not have formal preparation and legal recognition. The licensed practical nurse does not delegate, but rather acts as a delegatee. The unlicensed assistive personnel are also delegatees.
What should you be concerned about first with someone who experienced burns?
Airway and breathing bc if they were close enough to get burned they were close enough to inhale smoke.
The nurse is assessing the level of readiness before delegating tasks to unlicensed assistive personnel (UAP). According to Hersey's model of situational leadership, what specific factors reflect the level of readiness? Select all that apply. Correct1 Ability 2 Honesty Incorrect3 Reliability Correct4 Willingness Incorrect5 Conscientiousness
Ability and willingness are two factors that determine the level of readiness according to the Hersey's model. Honesty and reliability may not determine the readiness of the UAP to perform a delegated task. Conscientiousness is the desire to complete a task, which may not determine readiness if the UAP does not have sufficient knowledge to perform the task.
The nurse leader, while teaching a group of nurse leaders, references an approach of evidence-driven consciousness to be applied in the nursing practice. What is the main concern of the nurse leader?
About the safety of the clients
The nurse manager is observing the performance of a nursing assistant. Which behavior by the nursing assistant toward a client reflects a boundary violation?
Accepting a gift from the client
The registered nurse is assigning work to four delegatees. Which delegatee most likely has a limited relationship with the delegator? Incorrect1 Delegatee A Correct2 Delegatee B 3 Delegatee C 4 Delegatee D
According to Hersey's model, if the relationship between the delegator and delegatee is limited, the behavior of the delegator is "telling." The delegator is telling Delegatee B to check the client's blood pressure every morning, which indicates a limited relationship between them. Participating in the delegatee's work by helping to complete the task early indicates a new relationship, which may be ongoing. Monitoring the delegatee by saying he or she is right indicates an established relationship between the delegator and delegatee. Recommending that the delegatee use a digital sphygmomanometer for ease and accuracy indicates selling behavior; this is done when the relationship between the delegator and delegatee is ongoing.
Which component of delegation is retained while the delegator is delegating the client's care task to the nursing aide?
Accountability
What three things should the Dr. be called for?
Acute epiglottitis, back pain (Abdominal Aortic Aneurysm (triple A)), and Eye Pain (glaucoma or cataract surgery). Only call MD for abnormal situations not what is expected.
A client with hypoglycemia is admitted to the hospital. Which duties can the registered nurse (RN) safely delegate to the licensed practical nurse (LPN)? Select all that apply.
Administering oral medications Administering intramuscular medication
Situational-contingency theory
Assessing each situation and determining the action based on the people involved indicates the application of situational-contingency theories of leadership. The leader should present a task structure that has clarity of goals The leader should develop trust and respect between leaders and followers The leader should reward followers for their excellent work.
The registered nurse (RN) is caring for a client who has severe abdominal pain. The RN plans to work with the assistance of an unlicensed nursing personnel (UNP). The RN starts the client care. What should the RN consider during the process of active delegation? Select all that apply.
Assessing the level of the client's abdominal pain Directing the UNP to assist the client while toileting Ensuring that the UNP is accountable for successful completion of the task
FLOATERS (NRSES WHO FLOAT FROM THE OTHER UNITS)
Assign the float nurse a condition they would see their own ward. Give them the most stable patients. Float nurses NEVER get Cardiac pts, Borderline/ Antisocial
A nurse manager transfers the task of caring for a client who has undergone appendectomy to a registered nurse (RN). Which element of the healthcare system is the RN practicing?
Assignment
According to the Model for Differentiated Nursing Practice, which entry-level nurse is most prepared for prioritization of client care?
Bachelor's degree registered nurse
Which system thinking theory principle is involved when the nurse considers the decision of a client to terminate clinical treatment?
Balancing short-term and long-term objectives
What points should the nurse consider when delegating a task? Select all that apply.
Before selecting a delegatee for any particular task, it is important to understand the skill set and capabilities of the delegatee because selection of delegatees is based on specific skill sets. Selecting a delegatee based on his or her competency is an important aspect of delegation. Being certain about the capabilities is a crucial element of delegation. Willingness is not a crucial element for selecting a delegatee. In a rural setting the generally longer tenures of employees may make the delegation process easier.
A PATIENT WITH GLAUCOMA IS TREATED WITH MANNITOL?
DIAMOX is used for glaucoma patient to decrease aqueous humor. But here mannitol used for PAIN (eye).
What kinds of patients could be assigned to a medical surgical float nurse?
DM, DVT, HTN, SURGERIES, CHRONIC CONDITIONS, AND SEIZURES.
Which description of accountability is correct?
Determination of appropriate actions and provide detailed explanations of the actions
A nurse leader wants to communicate and explain changes to hospital rules to team members. Which approaches should the nurse leader follow for effective communication? Select all that apply.
Explaining the reason behind the change Providing the opportunity for dialogue and feedback Giving information that addresses the listener's self-interest
A team member has asked the nurse leader about changes in the work schedule. What is the accurate action to be taken by the nurse leader in this situation?
Explaining the reason for the change to the team member clearly
What is discussed in Hersey's 2006 model related to delegation?
Hersey's model describes situational leadership, which include the core competencies of a situational leader. Anthony and Vidal described the five rights of delegation. Hersey's model does not include the legal authorities for delegation. Anthony and Vidal described characteristics of communication, such as information decay and information salience.
A nurse leader changes the work schedule after a team member asks for more flexibility in the schedule. Which theory outlines this nurse leader's approach?
Herzberg's theory
RNs should delegate to what level of a person's confidence? Based on?
Highest level of confidence and based on experience, training, and licensure.
A nurse manager is assessing the qualities of a team that is led by the nurse leader. Which qualities indicate an effective team? Select all that apply.
Informal in the work environment Ability to handle conflicts by open discussions
A direct care nurse has great skill in teaching clients different self-care activities and is sought out by colleagues to teach their clients. Which power does the nurse possess?
Information power
What is contraindicated with an allergy to bananas, kiwi, chesnuts, an avocado?
Latex/rubber
The nurse is teaching breathing exercises to a client who underwent surgery. Which member of the healthcare team is most suitable for reinforcement of teaching in the client?
Licensed vocational nurse (LVN)
Which actions in the delegation process represent accountability? Select all that apply.
Monitoring client care and seeking the outcome report represents accountability of the task in case of conflicts. Assessing the ability of the delegatee and educating about the task indicates responsibility. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions regarding safety issues, urgency to intervene, or potential negative client outcomes.
What are examples of progressive neurological diseases? What kind of death do they suffer from?
Multiple Sclerosis, Amynotrophic lateral Sclerosis (ALS), Parkinsons, Huntingtons Chorea, Gullian Barre Syndrome, Myasthenia Gravis, and Scleroderma (hardening). THEY DIET A RESPIRATORY DEATH.
STRESS RELATED CONDITION PATIENT
Multiple sclerosis (MS), Lupus, psoriasis Addison, Rheumatoid arthritis, Rayanuds Crohn's and asthma These patient need relaxation technoques: Meditation, quite environment, imagery, music, breathing exercise and regular exercise.
What does it mean if the patient with an NG tube complains of N&V?
NG may be occluded so irrigate.
A nurse is assisting another registered nurse in the intensive care unit who is caring for a client with uncontrolled blood pressure. Which action on the part of the nurse indicates "offering" during delegation decisions? 1 "Did you check the client's blood pressure this morning?" Correct2 "You can use this stethoscope and sphygmomanometer to take the blood pressure." 3 "Would you fetch me the client's laboratory reports? I'll record the blood pressure." 4 "How is the client doing this morning? Let me look at yesterday's blood pressure report."
Offering involves making a suggestion to facilitate the achievement of a desirable client care outcome. The statement, "You can use this stethoscope and sphygmomanometer to take the blood pressure," is an example of offering. Asking begins with questions related to the problem or issue regarding client care. "Did you check the client's blood pressure this morning?" is an example of asking. Doing involves demonstrating the specific task or behavior needed to improve client care. "Would you fetch me the client's laboratory reports? I'll record the blood pressure," is an example of doing. "How is the client doing this morning? Let me look at yesterday's blood pressure report," is an example of supervision.
What does it mean if the doppler isn't reading?
Patient may not have pulses
It is determined that a staff nurse has a drug abuse problem. What approach to the staff nurse's addiction should be taken as an initial intervention?
Referred to the employee assistance program
Which action on the part of the nurse constitutes transactional leadership?
Rewarding the licensed practitioner nurse for high performance
The nursing staff of a unit is frustrated and uncomfortable with the newly appointed nurse leader. Which role transition process is involved?
Role discrepancy
What type of patient should be discharged during an emergency?
Select patient with stable chronic condition. DO NOT discharge acute surgical patients. Pressure ulcers are considered chronic.
Which delivery system was developed to provide care through others as an adaptation to functional nursing?
Team
What should be your response to Non-patient/non-medical issues that arise?
Tell direct supervisor (Ex: staff eating off of patient's trays).
Who should do the steps of the nursing process (assess, plan, interventions, outcomes)?
The RN
The registered nurse (RN) is delegating tasks to licensed practical nurses (LPNs) regarding client care. Which factors should be considered when delegating a task to the LPN? Select all that apply.
The decisions for delegation should be based on multiple factors such as the client's condition, complexity of the task, and predictability of outcomes. The number of LPNs may not be important information while assigning the tasks. Relationship status between the delegatee and the delegator are not important considerations for delegating a task to the LPN effectively.
Which healthcare professional would the nurse know is held accountable for the tasks performed by the patient care associate (PCA)?
The delegator is held accountable for tasks performed by the delegatee. In this situation, the delegator is the RN; therefore, the RN is held accountable for the tasks performed by the PCAs. The RN is also accountable for delegation to LVNs, UAPs, and UNPs as delegatees.
Which healthcare team member would the nurse expect can be delegated with the task of administering oral medication to a client per the functional model? Incorrect1 Registered nurse 2 Patient care associate Correct3 Licensed practical nurse 4 Unlicensed assistive personnel
The licensed practical nurse can give oral medication to a client. The registered nurse gives IV medication to a client. Patient care associates assist and monitor vital signs. Unlicensed assistive personnel perform all hygienic tasks.
A nurse leader implements the nominal group technique while making decisions about a critical issue but is unable to find a proper solution. What could be the reason for the failure of technique?
The members are talking and discussing with one another while writing down their ideas.
A nurse manager agrees to mentor a newly recruited nurse who wishes to develop leadership qualities. Which statements hold true about this mentor relationship? Select all that apply.
The mentor should serve as a role model. The mentor should provide advice whenever necessary. The mentor should give appropriate feedback to promote improvement.
What are the three strategies that the nurse can perform while assisting other nurses in making delegation decisions? Select all that apply. Correct1 Doing 2 Telling Correct3 Asking Correct4 Offering 5 Participating
The nurse can assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Telling and participating are the strategies used by the nurse to communicate with the delegatee.
Which right does the question, "Do staffing ratios demand the use of high-level delegation strategies?" indicate?
The right circumstance
The postpartum nurse is delegating tasks to an unlicensed health care worker. Which task should the nurse delegate?
Vital signs on a client 4 hours after delivery
What motivation factors would the nurse describe as forming a part of two-factor theory of leadership? Select all that apply.
The two-factor theory is comprised of motivation factors and hygiene factors. The motivation factor promotes job enrichment by creating job satisfaction. It includes recognition and achievement. The hygiene factor includes salary, status, and security, which help avoid job dissatisfaction and motivate workers by meeting their safety and security needs.
The registered nurse is evaluating the statements of the student nurse after teaching about the span of control in a group of individuals working in a healthcare organization. Which statement made by the student nurse indicates a need for correction? Correct1 "The unit secretary in a healthcare organization has legal recognition." 2 "The nurse manager in a healthcare organization is a designated delegator." 3 "The licensed practical nurse working under a physician has a dependent status." 4 "The registered nurse is designated as being answerable to a designated delegator."
The unit secretary in healthcare organizations has no formal preparation and legal recognition. Therefore, the statement of the student nurse that the unit secretary in healthcare organization has legal recognition is incorrect. The nurse manager in a healthcare organization is a designated delegator. The licensed practical nurse has a dependent status and works under a physician. The registered nurse is designated as being answerable to a designated delegator.
According to style theory of leadership, which is an action of a nurse leader?
Using feedback from superiors to measure own performance