Exam 1 - Unit 3

Time can be maximized to produce the best outcomes by: a. making the first hour of each workday productive. b. completing trivial tasks before performing important tasks. c. eliminating all recreational activities. d. omitting breaks until the entire task has been completed.

ANS: A Correct: Making sure that the first hour of every workday is productive sets the tone for achieving goals. Incorrect: b. Completing trivial tasks first further compromises the important tasks at hand. The bottom line is that you will still have to complete the important task, so avoid procrastination. c. Recreational activities can sometimes help clear the mind and make you more productive; however, the first hour is the most critical one. d. A break can sometimes help clear the mind and make you more productive; however, the first hour is the most critical one.

When using the ABC system of managing time, those items coded A include: a. calling the pharmacy to see whether a drug insert is available for a patient. b. checking to see why a ventilator is alarming. c. organizing the medication cart. d. writing memos to remind everyone to contribute to the boss's birthday gift.

ANS: B Correct: A items should stand out from other items because of their worth and high level of importance. A items are most urgent and may require more energy and time, but they should be completed before any of the B or C items are performed. Incorrect: a. Calling the pharmacy to see whether a drug insert is available for a patient is of lower importance at this time. c. Organizing a medication chart is of lower importance at this time. d. Memo writing is of lower importance at this time.

A nurse gives Dilantin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "Everyone just pushes the medicine slowly. No one checks for compatibility. There isn't even a compatibility chart on the unit." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Appeal to emotion d. Appeal to tradition

ANS: B Correct: An appeal to common practice occurs when the argument is made that something is okay because most people do it. Incorrect: a. Ad hominem abusive is an argument that attacks the person instead of the issue. The speaker hopes to discredit the other person by calling attention to some irrelevant fact about that person. c. An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue. d. An appeal to tradition is the argument that doing things a particular way is best because they've always been done that way.

A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating: a. open communication. b. filtration. c. blocking. d. false assurance.

ANS: C Correct: Blocking occurs when the nurse responds with noncommittal or generalized answers. Incorrect: a. Open communication reflects openness between two parties. b. Filtration is the unconscious exclusion of extraneous stimuli in communication. d. False assurance is showing a lack of concern or a lack of knowledge by responding with meaningless answers such as "don't worry." The patient might even conclude that the nurse is trivializing his concern or is patronizing.

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

ANS: C Correct: The patient must be able to name the day of the week rather than use answer yes or no. Incorrect: a. "Is today Wednesday?" can be answered yes or no, which is not representative of open communication. b. "Do you know what day it is?" can be answered yes or no, which is not representative of open communication. d. "Do you know what the first day of the week is?" can be answered yes or no, which is not representative of open communication.

An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect

ANS: A Correct: An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue. Incorrect: b. An appeal to tradition is the argument that doing things a certain way is best because they've always been done that way. c. Hasty generalization involves coming to a conclusion on the basis of a very small number of examples. A hasty generalization occurs whenever an assumption is made that a small group represents the whole population. d. One confuses cause and effect when he or she assumes that one event must cause another just because the two events often occur together.

After keeping a log of activities designed to improve time management, the nurse divides the distractions into internal and external sources. The nurse would classify which distraction as internal? a. Responding to recurring crises at work or in one's personal life b. Unsuccessful attempts to communicate with the unit manager c. Talking with potential faculty candidates d. Being given unclear job responsibilities

ANS: A Correct: An internal distraction is one that can be controlled only by the person affected; it is important for each of us to recognize and understand the distracters that inhibit our ability to complete tasks and to meet our objectives and goals. Incorrect: b. Unsuccessful attempts to communicate with the unit manager count as an external distractions because they involve other people and may be more difficult to control. c. Talking with potential faculty candidates counts as an external distraction because it involves other people and may be more difficult to control. d. Being given unclear job responsibilities is an external distraction because it involves other people and may be more difficult to control.

The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to: a. the registered nurse (RN). b. the licensed practical/vocational nurse (LPN/LVN). c. unlicensed assistive personnel (UAP). d. all levels of staff, because the information is about the past and cannot change.

ANS: A Correct: Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated. Incorrect: b. The assessment must be completed and signed by the RN; however, some components may be delegated to the LPN/LVN. c. UAPs are not licensed, and only an RN can perform the initial assessment. d. The assessment includes present symptoms and treatments, as well as those reported from the past, and the RN must complete the initial patient assessment.

Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established? a. Administer an enema for an elective surgery patient. b. Administer an antiarrhythmic medication IV while interpreting the patient's rhythm on the cardiac monitor. c. Develop a plan of care for a stable patient admitted for observation after a head injury. d. Teach a patient how to instill eye drops for glaucoma.

ANS: A Correct: The RN who is delegating must consider the following: (1) the delegatee's current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task. Incorrect: b. Administration of an antiarrhythmic drug requires the skill of an RN to evaluate outcomes, especially when it is administered IV because of its fast rate of distribution. c. Only an RN can develop the patient's plan of care, although others may assist in updating information. d. The task of teaching is limited to RNs.

As part of a quality assurance project, a nurse is to round on every patient daily for 1 month to ensure the intravenous tubing is labeled with date hung and nurse's initials. The nurse is hoping to be promoted to a full-time position within the quality department, and her success on this project is very important to her receiving the position. The nurse retains all other assignments, and she is often interrupted to help other staff or answer call lights. The nurse discusses her concerns with the manager, who frees her for 1 hour each day to make rounds. During this 1 hour each day the nurse will organize herself and environment by practicing the: a. art of "no detourism." b. reducing stacked-desk syndrome. c. art of "wastebasketry." d. managing e-mail and memo mania.

ANS: A Correct: The art of "no detourism" focuses on one task until completed. Incorrect: b. Reducing stacked-desk syndrome is removing all papers and personal items except the ones that are currently being used for the project. c. The goal for the art of "wastebasketry" is to handle a paper (or e-mail) only once, then either act on it (do it), send it along to another appropriate person (delegate it), or throw it away (dump it). d. The goals of managing e-mail and memo mania are to efficiently keep current with e-mails and other forms of written communication but does not allow nurse to focus on the task of rounding uninterrupted.

A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of the delegatee? a. Actually observe the delegatee perform the assigned task. b. Ask the delegatee how many times he/she has performed the task. c. Ask the patient if the care provided was satisfactory. d. Ask other nurses if they feel the delegatee is competent.

ANS: A Correct: The best way for the nurse to determine the competency of LPNs or UAPs is to observe them perform the task and check on them regularly throughout the shift. Incorrect: b. Asking the delegatee may inform the RN of how many times the task has been performed but will not provide evidence of competency. c. Patients may be able to rate their satisfaction with care but cannot judge the competency of the LPN or UAP. d. The opinion of other nurses can be used to validate the RNs findings, but only firsthand observation can provide evidence of competency.

The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of: a. direction and communication. b. task. c. person. d. circumstances.

ANS: A Correct: The directions were not clear. The RN did not specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back. Incorrect: b. The task was within the scope of practice for an LPN. c. LPNs are qualified to perform the task—more so than a UAP, who may with training perform the task. d. This task does not require independent nursing judgment.

In deciding whether to say no to a request that involves a time commitment, the professional nurse must consider: a. the cost-benefit ratio. b. the time commitment of co-workers. c. ways to buffer saying no. d. personal preference.

ANS: A Correct: The first step in learning the art of saying no is determining when to say it. The cost/benefit ratio of each opportunity must be evaluated in relation to the overall goal. If the activity will provide an overall benefit, obviously it must be given careful consideration. If it will not result in significant benefit, decline gracefully but emphatically. Incorrect: b. Considering only the time commitment of peers does not address the overall goals of the request. c. Figuring out how to say no to protect yourself or the feelings of others focuses on one's personal preference but does not consider the overall goals of the request. d. Considering one's own personal preference does not consider the overall implications of the request.

A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Unlicensed assistive personnel (UAP) d. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.

ANS: A Correct: The patient's condition is not stable; therefore, the skills of an RN are required. Incorrect: b. The assessment expertise of an RN is needed because of the unstable nature of the patient's condition. c. Obtaining a baseline set of vital signs for an unstable patient would be considered high-risk delegation for a UAP. d. The patient's condition is very dynamic; assessments will have to be completed by the RN on admission and then as indicated by the stability of the patient.

Which statement made by an RN regarding delegation indicates the need for additional teaching? (Select all that apply.) a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely. b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion. d. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. e. Responsibility can be delegated to the UAP, but the delegator retains accountability.

ANS: A, B, C Correct: a. The statement "UAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely" indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus the assessment skills of an RN are required. b. The statement "an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD" indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. c. Dopamine is a vasoactive drug that can have a profound effect on a patient's blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN. Incorrect: d. The RN can delegate this responsibility if the patient is stable and the competence of the UAP has been established. e. Accountability remains with the person who is delegating, but when the UAP accepts the assignment, responsibility rests with the UAP.

3. Which functions can be delegated only to another RN with appropriate experience and training? (Select all that apply.) a. Assessment of skin integrity on third day of hospitalization b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises c. Nursing judgment related to withholding medication based on vital signs d. RNs do not delegate to other RNs, they delegate only to Licensed Practical Nurses or Unlicensed Assistive Personnel e. Formulation of nursing diagnosis "potential for fall"

ANS: A, B, C, E Correct: a. Activities like assessing skin integrity—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. b. Activities like evaluating patient teaching—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. c. Activities like deciding to withhold medication based on vital signs—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. e. Activities like formulating a nursing diagnosis—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Incorrect: d. RNs delegate to other RNs in certain situations, such as when a charge nurse delegates to an RN or a team leader delegates to an RN.

A nurse is hoping for a promotion and seeks the help of a coach to improve time management skills. The first task assigned by the coach is for the nurse to list all external distractors that prevent organization and completion of tasks. The nurse would include: Select all that apply: a. waiting for oncoming shift to start walking rounds. b. failure to delegate tasks to the Licensed Practical Nurse and Unlicensed Assistive Personnel and instead, completing task herself. c. talking with a patient's family member who is also a personal friend. d. spending time thinking about the vacation to the beach. e. using the Internet to read about a new drug that will be administered; then taking time to look for news about the profession, new legislation about the Patient Protection and Affordable Care Act, and new uniforms for the season.

ANS: A, C Correct: a. Waiting, such as for meetings or oncoming shift, is an external distraction. c. Socializing with visitors is an external distraction. Incorrect: b. ineffective delegation is an internal distraction. d. Daydreaming about an upcoming vacation is an internal distraction. e. Surfing the Internet after using it wisely to ensure patient safety is an internal distractor.

A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is known as: a. straw man. b. red herring. c. slippery slope. d. confusing cause and effect.

ANS: B Correct: A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue. Incorrect: a. A straw man occurs when a person's position on a topic is misrepresented. c. A slippery slope is the belief that one event will inevitably follow another without any real support for that belief. d. Cause and effect are confused when one assumes that one event must cause another just because the two events often occur together.

An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for: a. delegating the task to another UAP if he or she does not have the time or skill to complete the task. b. keeping the RN informed of any abnormal blood pressure readings. c. calling the physician when the patient's vital signs are not within established parameters. d. informing the dietary department to initiate a low-sodium diet for patients who are hypertensive.

ANS: B Correct: After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN. Incorrect: a. The UAP cannot delegate to any member of the health care team; delegation is the responsibility of the RN. c. RNs are responsible and accountable for accepting physician orders. d. Dietary consults are independent nursing orders that only the RN can initiate.

The new director of nurses has instituted "walking rounds" on all nursing units, rather than the usual taped shift reports. A veteran nurse exclaims, "She doesn't know how we do things here!" The nurse is demonstrating: a. appeal to emotion. b. appeal to tradition. c. red herring. d. straw man.

ANS: B Correct: An appeal to tradition is the argument that doing things a particular way is best because they've always been done that way. Incorrect: a. An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue. c. A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue. d. A straw man occurs when a person's position on a topic is misrepresented.

During height and weight assessments at a school's health fair, a child admits to drinking a cup of coffee with his mother every morning, and another child reports enjoying a morning cup of coffee on the commute to school. These two children are both below average on the height chart, and the nurse states, "Drinking coffee stunts a child's growth." This logical fallacy is referred to as: a. appeal to common practice. b. confusing cause and effect. c. ad hominem abusive. d. red herring.

ANS: B Correct: Cause and effect are confused when one assumes that a particular event must cause another just because the two events often occur together. Incorrect: a. Appeal to common practice occurs when the argument is made that something is okay because most people do it. c. Ad hominem abusive is an argument that attacks the person instead of the issue. d. A red herring is the introduction of an irrelevant topic for the purpose of diverting attention away from the real issue.

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both of these situations? a. Blocking b. Filtration c. Empathy d. False assurance

ANS: B Correct: Filtration is the unconscious exclusion of extraneous stimuli in communication. Incorrect: a. Blocking occurs when the nurse responds with noncommittal or generalized answers. c. Empathy is the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of that person. d. False assurance is showing a lack of concern or a lack of knowledge by responding with meaningless answers such as "don't worry." The patient might even conclude that the nurse is trivializing his concern or is patronizing.

An inexperienced nurse has heard of other novice nurses who take shortcuts in providing patient care. This nurse feels that this is unacceptable and that all tasks must be performed faultlessly, which leads to her inability to complete all assigned tasks. This nurse would benefit from the seminar "Obstacles to Time Management: How to Deal With: a. Creativity." b. Perfectionism." c. Failure." d. Downtime."

ANS: B Correct: If you are a perfectionist and feel that everything should be completed at the same level of excellence, you are not keeping things in perspective. If you demand extremely high standards for every single task you undertake, you simply will not get everything done. Incorrect: a. Many creative people think that by creating an organized time management structure or approach to life, their creative nature or tendencies will be squelched. c. When you are unable to get to the things that are important to you and are unable to meet your personal goals, you may be afraid of failure. It can be very upsetting to go after your dreams and find that you cannot reach them. Sometimes it is easier to avoid making the effort. d. Some individuals fear the possibility of standing still too long. They feel guilty about "time-outs" or time off.

During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting: a. assertive communication. b. active listening. c. empathy. d. passive communication.

ANS: B Correct: In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak. Incorrect: a. Assertive communication is an overall communication style in which the person displays the presence of positive declaration and persistently demonstrates confidence; he or she has obtained the facts, carefully considered the options, and exuded confidence while forming a point of view; active listening may be a component of assertive communication. c. Empathy is the ability to mentally place oneself in another person's situation for the purpose of better understanding a person and sharing the emotions or feelings of that person. d. Passive communication is a form of communication in which the individual fails to say what is meant.

A nurse on a busy medical-surgical floor is always willing to help out any patient or staff when asked. She passes food trays, empties bed pans, and even runs errands to pharmacy. Although a pleasant co-worker, she becomes stressed when her own work falls behind, resulting in a decreased job satisfaction. The nurse's behavior type is: a. self-contained. b. open and accepting. c. indirect. d. direct.

ANS: B Correct: Individuals with open and accepting behavior type are often known as the "yes" person, always willing to help. This person likely overextends him or herself and does not share opinions or feedback. This person has the potential to become extremely stressed. Incorrect: a. Self-contained behavior types manage self evenly and will express concerns with a situation in a thoughtful, reasonable manner. This type of person is approachable and fair in decision-making. c. Indirect behavior types avoid conflict and will not challenge authority. This person may express concerns to peers, but does not address them with management. d. Direct behavior types are clear and concise about requests; sometimes perceived as curt. This person may be perceived as difficult to approach and/or intimidating.

An experienced nurse volunteers to serve on a task force intended to improve the quality of care because she possesses excellent patient care skills and has selected a career goal of working in quality management. However, the nurse is unable to concentrate on any one task or issue and is unable to view the health care milieu sensibly. Which source of energy is missing in this nurse? a. Physical b. Mental c. Spiritual d. Emotional

ANS: B Correct: Mental energy is the ability to maintain sustained concentration on a task, to move flexibly between broad and narrow issues, and to be internally and externally focused, as needed by the situation. It includes mental preparation, visualization, positive self-talk, effective time management, and creativity. Incorrect: a. Physical energy consists of the key components of successful transition to a productive, highly energizing experience by paying attention to physical energy through routine or proper eating, adequate sleep and exercise, and frequent breaks during long shifts, as well as by drinking plenty of water and focusing on one activity while collecting thoughts about what to prioritize next. c. Spiritual energy requires presence in a quiet place, often to help one identify his or her vision of life as well as purpose and direction. d. Emotional energy is dependent on physical, mental, and spiritual energy for building emotional capacity. Managing emotions skillfully in the service of high positive energy and full engagement is called emotional intelligence.

A nurse takes a day to travel to a state park where she can sit by the river alone to reflect over recent events and put things into perspective. She recalls the time she was complimented for her ability to deal with a difficult patient and another time when she was criticized for lack of teamwork. This nurse is improving which source of energy? a. Emotional b. Spiritual c. Physical d. Mental

ANS: B Correct: Spiritual energy can be increased by taking time to reflect over events in one's life and allowing time to understand feelings associated with events/happenings. A quiet environment is essential for reflection. Incorrect: a. Improving one's self-confidence, self-control, self-regulation, social skills, interpersonal effectiveness, empathy, patience, openness, trust, and enjoyment—will result in a more positive, invigorating work experience and personal life and emotional energy. c. Establishing a routine of proper eating, adequate sleep and exercise, frequent breaks during long shifts (about every 90 minutes), drinking plenty of water, and focusing on one activity while collecting thoughts about what to prioritize next improves physical health. d. Mental preparation, visualization, positive self-talk, effective time management, and creativity promote mental energy.

An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to: a. check the patient's drug packages to ensure that the correct drugs were given. b. stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner. c. contact the nurse manager and ask that the LPN/LVN's license be suspended. d. call the pharmacy and ask for replacement medications for the patients.

ANS: B Correct: The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she intervene and identify concerns with the LPN/LVN. Incorrect: a. Checking the patient's drug packages to ensure that the correct drugs were given is not proactive intervention for patient safety because an inappropriate medication could have already been given. c. The RN must intervene immediately to protect the patient but may later discuss with the nurse manager a plan of corrective action for the LPN/LVN. d. The first step is to stop the violation of the five rights of medication administration; consequently, medications will not have to be replaced.

The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse: a. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines. b. is at risk for HIPAA violations. c. has properly followed policy and protected the patient by not using her name. d. is demonstrating the logical fallacy of slippery slope.

ANS: B Correct: The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before. Incorrect: a. The nurse is showing empathy but she violated patient confidentiality when she put the patient's occupation, place of work, and fact she was seen in ED the night before on Facebook. c. It is against policy to place any patient information on social media. d. Slippery slope is the belief that one event will inevitably follow another without any real support for that belief.

A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to: a. supplement the staffing pattern when an RN is not available. b. aid the RN by performing simple, routine patient care tasks. c. replace the RN when the health care facility provides long-term care. d. provide patient teaching, allowing more direct care to be provided by the RN.

ANS: B Correct: The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice. Incorrect: a. The UAP and the LPN/LVN cannot supplement staffing when the RN is not available but can assume responsibility for tasks that are simple and routine and do not require adherence to the nursing process. c. An RN must oversee the care provided by UAPs and LPNs/LVNs in long-term care settings. d. Only RNs can provide patient teaching.

The nurse is demonstrating active listening when: a. while assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." b. eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. he or she states, "I know how you feel, I recently lost my father and I am still hurting." d. cultural values are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."

ANS: B Correct: The behavior demonstrates active listening. A number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak. Incorrect: a. This demonstrates assertive communication, which is an overall communication style in which the person displays the presence of positive declaration and persistently demonstrates confidence; he or she has obtained the facts, carefully considered the options, and exuded confidence while forming a point of view; active listening may be a component of assertive communication. c. This demonstrates empathy, which is the ability to mentally place oneself in another person's situation for the purpose of better understanding a person and sharing the emotions or feelings of that person. d. This demonstrates passive communication because the individual fails to say what is meant.

A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin (Dilantin) before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often take short cuts. b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." c. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." d. "This drug always occludes the line because it is so viscous."

ANS: B Correct: The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation. Incorrect: a. This represents a straw man, where the person's position on a topic is misread. c. This represents confusing cause and effect: the cause was incompatibility not patency of the line. d. This presents a slippery slope argument—based on the belief that one event will inevitably follow another without any just support for that belief.

A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy? a. "Research is identifying many risk factors for cancer besides smoking." b. "I understand how you could feel angry about the diagnosis." c. "He is still a good husband." d. "Why do you think he got cancer?"

ANS: B Correct: The nurse is placing herself in the wife's position and sharing her emotions. Incorrect: a. The nurse is not acknowledging the spouse's feelings. c. This does not place the nurse in the wife's situation. d. Asking the wife to guess why her husband got cancer does not involve empathy.

In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging

ANS: B Correct: Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking. Incorrect: a. Facial expression is only part of effective communication and is not the most common form of societal communication. c. Written messages are only part of communication and are not the most common form of societal communication. d. Electronic messaging, although it is becoming more popular, is not the most common form of societal communication; it loses the value of face-to-face communication and requires the sender to elicit feedback and/or the receiver to ask for clarification if the meaning of the communication is not clear.

17. Which of the following situations would be appropriate for the supervisory level of initial direction and/or periodic inspection? a. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis. b. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 grams of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain "next steps." d. No supervision is necessary since both are registered nurses.

ANS: B Correct: When a working relationship is established and competencies of the delegate established, the delegator may check in intermittently during the shift. Incorrect: a. Experienced nurses working as a team with neither in the position of supervising the other is a situation in which there are no supervisory responsibilities. c. A new graduate or a new employee requires regular supervision to determine competency. d. Even with RN to RN, there is a need for supervision when a nurse is performing a new task or is new to the role. Charge nurses are in the position to delegate to another RN.

A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea

ANS: B Correct: With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated. Incorrect: a. Personal perception is awareness achieved through excitation of all the senses. Perceptions can be described as all that the person knows about a situation or circumstance according to what each of the senses—taste, smell, sight, sound, touch, and intuition—discovers and interprets. c. Filtration is the unconscious exclusion of extraneous stimuli in communication. d. Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before an encounter takes place.

A nurse is having difficulty managing assignments at work, which results in a feeling of "failure" and tasks that are not completed or that are not completed satisfactorily. The mentor suggests some tips for time management. These include: (Select all that apply.) a. focusing on activities to be completed, rather than on objectives. b. planning for tomorrow today. c. making certain that the last hours are the most productive in tying up loose ends. d. maintaining a log of how the nurse spends time (no need to worry about using complete sentences). e. picking five major objectives for the day and not stopping until they are achieved.

ANS: B, D Correct: b. Planning for the future is an effective time management strategy. d. Maintaining a log of how you spend your time is an effective time management strategy. Incorrect: a. Focusing on activities to be completed, rather than on objectives, is not a good time management strategy. c. Making certain that the last hours are the most productive in tying up loose ends is not a good time management strategy. e. Picking five major objectives for the day and not stopping until they are achieved is not a good time management strategy.

A nurse hopes to improve time management skills using the ABC prioritization approach. Which tasks would be prioritized as "B"? (Select all that apply.) a. Turn in time sheet due in 3 days. b. Review dress code policy to give feedback before appointment in the morning. c. Perform blood glucose test on a patient admitted with Kussmaul respirations and change in level of consciousness. d. Complete patient teaching prior to discharge in 2 hours. e. Review procedure for inserting a PIC line to assist with procedure later this morning.

ANS: B, D, E Correct: b. Task that fall within Priority B include the medium-value items, such as tasks that are not urgent but most likely will not "fall" off the list. Since the dress code must be reviewed and feedback constructed for a morning appointment, this would be level B, it is not urgent nor will it likely fall off the list. d. Completing patient teaching for a patient to be discharged in 2 hours must be completed but does not take priority over "A" tasks. e. Reviewing a procedure to be performed later in the day is Level "B". Incorrect: a. Turning in a time sheet due in 3 days is level C. c. Performing a blood sugar test on an unstable patient is level A.

An older adult is unable to reach the phone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a. "You are just too late for that. Where were you when he needed you?" b. "Did you ever consider purchasing a cell phone for your dad to prevent this from happening?" c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." d. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."

ANS: C Correct: Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person. Incorrect: a. Telling the son that he is too late to be there for his dad is an ineffective communication technique, given this situation, and does not support empathy. b. Asking the son if he ever considered buying his dad a cell phone is an ineffective communication technique, given this situation, and does not support empathy. d. In terms of communication, it is ineffective for the nurse to share stories, and does not support empathy.

A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation? a. Baby boomers b. Traditionalist c. Generation X d. Millenniums

ANS: C Correct: Generation X individuals grew up in when there was a high rate of divorces; they tend to be more cynical, and value work-life balance and team-work. Holidays are often associated with family gatherings which may have been absent in this generation's family; belief that ALL politicians are untrustworthy may be viewed as cynical. The need to take time to form suggestions to save time and come together to reach team decision are reflective of this generation. Incorrect: a. Baby boomers grew up with prosperity and value work to the point that it interferes with life-work balance. So taking a few weeks off may not be considered. b. Traditionalists value formality in communication and dress, so comments such as above would not be consistent with this generation. d. Millenniums want immediate feedback, and alternative life styles are more associated with this generation.

A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should: a. query the state nursing association to determine their stance on the role of LPNs. b. ask the LPNs on the unit to list what tasks they routinely performed. c. contact the state board of nursing to determine legal scope of practice for LPNs. d. refer to California's nurse practice act because the scope of LPNs/LVNs is consistent across the United States.

ANS: C Correct: If the nurse practice act lacks clarity, the state board of nursing can provide guidance. Incorrect: a. The state nursing association is not the authority on the scope of practice. b. The LPNs may be performing tasks that are not within the scope of practice and the RN is accountable for all tasks assigned. d. Nurse practice acts vary from state to state.

An RN is counseled by the nurse manager regarding inappropriate delegation when the: a. RN instructs the nursing assistant to greet ambulatory surgery patients and show them to their rooms. b. nursing assistant informs the RN that she has not been trained to collect a sputum specimen and the RN states, "I will show you this time and you can show me the next time." c. RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube. d. LPN/LVN who has demonstrated competence is asked to perform a dressing change for a patient before she is discharged home.

ANS: C Correct: Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation. Incorrect: a. The RN should provide clear directions for assigned tasks, and this assignment falls within typical job duties for unlicensed assistive personnel. b. The RN received appropriate feedback and is providing directions and is demonstrating a skill for which the nursing assistive personnel (NAP) has not shown competency. d. Routine repetitive dressing changes are within the scope of practice for the LPN/LVN who has demonstrated competency for the skill.

A novice nurse is unsure of his ability to insert a nasogastric tube for one of the assigned patients who is vomiting coffee ground emesis. The novice nurse waits, hoping that someone with more experience will volunteer to do the job, or he just waits until the end of the shift. This nurse is practicing: a. energy management. b. priority setting. c. procrastination. d. introspection.

ANS: C Correct: Procrastination is evident when a person is faced with an unpleasant task, a difficult task, or a difficult decision. Usually procrastination is easily recognizable because it involves completing low-priority tasks rather than high-priority ones, and it always welcomes interruptions. Procrastination is the art of "never doing today what can be put off until tomorrow." The result consists of less productivity, less internal satisfaction, and increased stress. Incorrect: a. Energy management means ensuring that the right amount of effort matches the right task so that outcomes can be optimized, while the amount of personal energy expended/taxed to achieve the desired result is gauged. b. Priority setting is establishing superiority in rank, a preferential rating, or the state of "coming first" in order or ahead of others in a process by which that order will represent the execution of the raked items. d. Introspection is the act of examining one's own thoughts and emotions by concentrating on the inner self.

An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high risk delegation? a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin. b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound. c. An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway. d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3.

ANS: C Correct: Risk of falling is great in later stages of Huntington's disease due to chorea movements. Incorrect: a. Mixing regular and NPH insulin is within the scope of practice of an RN and all insulin should be checked by an RN prior to administration, reducing the risk of a medication error. b. Simple dressing changes are within the scope of practice for an LPN/LVN. d. An experienced nurse from an oncology unit would be familiar with care of immunocompromised patients.

When deciding whether and when a task should be completed, a nurse must: a. complete all tasks as they are thought of to prevent having to take time to consider which is most important. b. procrastinate and hope that someone will volunteer to do it. c. ask, "What will happen if I don't complete the task now?" d. view large projects holistically and not as many small pieces.

ANS: C Correct: Stopping to evaluate what is going on is important because you may have to readjust your plan and reprioritize in order to reach your goal. Incorrect: a. Completing tasks as they are remembered is not a good time management strategy, and may sabotage and hinder completion of the task at hand. b. Procrastination is not a good time management strategy, and may sabotage and hinder completion of the task at hand. d. Viewing large projects holistically is not a good time management strategy and may sabotage and hinder completion of the task at hand.

A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to others thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through: a. empathy. b. positiveness. c. supportiveness. d. accommodation.

ANS: C Correct: Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position. Incorrect: a. Empathy is feeling what the other person is feeling and seeing the situation as they see it. b. Positiveness capitalizes on agreements and uses them as a basis for approaching disagreements and impasses; conflict is viewed as positive and individuals involved express positive feelings for each other and the relationship. d. In accommodation one person puts aside his or her goals to satisfy the other person's desires.

Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria? a. The RN administers all medications to all patients. b. The LPN performs sterile dressings and IV tubing changes on all central lines. c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. d. The RN administers an enema to a stable patient who has an order "administer fleet enema prn when no bowel movement in two days."

ANS: C Correct: The UAP, when properly trained, can place patients on telemetry. This meets quality and cost containment goals because the LPN and RN have higher salaries. Incorrect: a. The LPN can administer medications except IV. The RN would need to check state practice policies and then administer only those medications not within the scope of the LPN. b. This task is not within the scope of the LPN. d. The LPN or the UAP can perform this skill to improve cost containment because the RN has the highest salary.

An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person of whom to delegate, the RN knows that: a. the role of the LPN/LVN is the same from state to state. b. the LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. c. he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN.

ANS: C Correct: The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN. Incorrect: a. Each state determines the scope of practice of the LPN/LVN. b. Specific tasks and roles cannot be delegated except to another RN who has received the training required to perform the task or role. d. The purpose of The Joint Commission is to increase the safety and quality of care provided to consumers by providing voluntary accreditation that certifies that a hospital meets established standards.

An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? a. There is no supervision, because at times the LPN/LVN is not with the RN. b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. c. Continual supervision is being provided until the RN determines competency. d. Initial supervision is being provided because this is the LPN/LVN's first day on the unit.

ANS: C Correct: This level of supervision is required when the working relationship is new, the task is complex, or the delegatee is inexperienced or has not demonstrated an acceptable level of competence. Incorrect: a. Supervision is always a required component of delegation. b. The RN does not know about the training and competencies of the LPN/LVN and has not yet developed a working relationship with this staff member. d. Initial supervision consists of oversight of a delegated task once a shift; however, this approach should be used when the RN knows the competencies of the LPN/LVN.

To conduct a productive meeting, the nurse should: a. provide each person all the time needed to discuss desired topics. b. cover all emotional topics first. c. create an agenda with specific times allotted for each agenda item. d. wait for latecomers and ask for their excuse for being late.

ANS: C Correct: You need to preplan for the meeting so it can be conducted in a timely manner. One way to have a productive meeting is to prepare a meeting agenda with time allotted for each item and the name of the person responsible for reporting on each item. Send out the agenda prior to the meeting so attendees can come prepared. Incorrect: a. Providing unlimited time to each person will hinder the timeliness and effectiveness of the meeting, as well as its productiveness. b. Covering all emotional topics first hinders the timeliness and effectiveness of the meeting, as well as its productiveness. d. Waiting for latecomers and asking why they are late will hinder the timeliness and effectiveness of the meeting, as well as its productiveness.

A nursing administrator who is considering the feasibility of an all-RN staff reviews the report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and determines that RNs: (Select all that apply.) a. are more costly and less efficient than LPNs. b. have little or no effect by being proactive but instead are reactive to patient care errors. c. have a positive effect on patient outcomes when managing patient care. d. are effective overseers of patients' overall health condition. e. lack the training to be effective delegators.

ANS: C, D Correct: c. RNs are effective at coordinating care that results in improved patient outcomes. d. RNs are valuable monitors of a patient's health status—a practice that results in improved patient outcomes. Incorrect: a. RNs improve patient safety and are cost effective, especially when delegation is used correctly. b. RNs are able to intervene and prevent serious accidents and errors in patient care. e. RNs should be educated regarding delegation to develop skills to be effective delegators. Delegation is an important part of the RN's education.

A nurse is having difficulty keeping up with the six assigned patients and serving on the ethics committee. In order to take charge of both personal and work life, the nurse focuses on improving physical energy by: (Select all that apply.) a. telling herself, "I provide safe quality care and will provide this level of care to all my patients." b. taking a deep breath and remaining calm to develop patience. c. keeping a bottle of water available to consume a minimum of 24 ounces each shift. d. going into the nurse's break room every 90 minutes to eat a healthy snack and prioritize remaining care. e. enrolling in the hospital's fitness program, Nurses Need Nurturing.

ANS: C, D, E Correct: c. Drinking plenty of water promotes physical health. d. Taking a break every 90 minutes, especially during long shifts such as 12-hour shifts, provides a much needed time to relax and reorganize. e. Proper and frequent exercise promotes physical health. Incorrect: a. Positive self-talk promotes mental energy. b. Patience is associated with spiritual energy.

A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "What exercise practices do you participate in?"

ANS: D Correct: "What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances. Incorrect: a. "Do you exercise?" is a yes-or-no question that limits the amount of information you can retrieve. b. "Do you like to exercise?" is a yes-or-no question that limits the amount of information you can retrieve. c. "When do you exercise?" inquires about only one item and does not lead to further discussion.

Which statement related to delegation is correct? a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and/or UAP have received adequate training. c. Supervision is not required when routine tasks are delegated to a competent individual. d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.

ANS: D Correct: Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice. Incorrect: a. Most state laws do not define practice for UAP. b. Nursing practice cannot be delegated; only tasks can be delegated. d. The RN must determine that tasks have been completed and were performed correctly.

Which statement accurately describes communication? a. The components of communication are mutually exclusive. b. Communication is linear. c. Communication involves only the sender and the receiver; everything else is superficial. d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.

ANS: D Correct: Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes. Incorrect: a. The components of communication are not mutually exclusive. b. Communication is not a linear process; many elements, including culture, education, experiences, preconceived ideas, and context, influence the communication process. c. Several variables, including filtration, feedback, interpretation, and nonverbal language, influence the communication process.

A student nurse assigned to work with the charge nurse is given the opportunity to help revise the nursing assessment form. She receives several compliments from management and her nursing instructor for her creative suggestions. The student nurse enjoys the project and attention she is receiving and begins to prolong the conclusion of the project. Although she constantly adds new information, she filters this out slowly to others. The student nurse is subject to the time management obstacle of: a. need for perfection. b. fear of losing creativity. c. unclear goals. d. fear of completion.

ANS: D Correct: Fear of completion is a time management obstacle that may occur if you are afraid of completing a project that is creative and fun. To overcome this obstacle, take the time to understand why you are not completing the task or major project that has been with you for some time. Correct: a. If you are a perfectionist and feel that everything should be completed at the same level of excellence, you are not keeping things in perspective. If you demand extremely high standards for every single task you undertake, you simply will not get everything done. b. Many creative people think that an organized time management structure or approach to life may squelch their creative nature or tendencies. c. The student's goal is clear: to revise the assessment form. However, if goals are unclear, managing time to meet your desires becomes a futile task.

Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegatee has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.

ANS: D Correct: Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation. Incorrect: a. Evaluation requires the expertise of the RN; assessing the gag response may prevent aspiration after surgery and is not within the scope of practice for UAP. b. Assisting a patient who is ambulating after surgery is not an appropriate task to delegate. An RN will have to assess the patient's tolerance and coordinate care on the basis of this assessment. c. Changing the tracheotomy cannula is a skill that requires critical thinking and carries a high risk for injury, making the task inappropriate for delegation.

When planning, a nurse should: a. delay planning until the "first task of the morning" has been completed. b. recognize that rewarding oneself has a negative consequence. c. rotate between several tasks to stimulate creativity. d. remember that most tasks take longer than anticipated to complete.

ANS: D Correct: One must consider many factors when planning a project. Some of the following factors influence how priorities should be established: (1) urgency of a situation, (2) demands of others, (3) closeness of deadlines, (4) existing time frame, (5) degree of familiarity with the task, (6) ease of task completion, (7) amount of enjoyment involved, (8) consequences involved, (9) size of the task, and (10) congruence with personal goals. When the use of time is considered, not all of these factors carry the same weight, and adjustments will be needed. Incorrect: a. Delaying planning until the "first task of the morning" has been completed is not a good time management strategy and may inhibit appropriate planning and goal achievement. b. Recognizing that rewarding oneself has a negative consequence is not a good time management strategy and may inhibit appropriate planning and goal achievement. c. Rotating between several tasks to stimulate creativity is not a good time management strategy and may inhibit appropriate planning and goal achievement.

A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? a. Assertive b. Aggressive c. Passive d. Passive-aggressive

ANS: D Correct: Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering. Incorrect: a. Assertive communication is healthy. Assertive individuals pronounce their basic rights without violating the rights of others. b. Aggressive communicators often feel superior to others and behave in very controlling ways. c. Passive communicators do not stand up for what they want or believe; they allow others to make decisions for them.

Positive time management skills include: a. maintaining an open-door policy. b. retaining all paperwork. c. returning all phone calls immediately. d. scheduling daily activities.

ANS: D Correct: Planning is the most important step in time management. Planning allows people to better use their time and can lead to closure in relation to those goals that will produce the greatest internal satisfaction. Incorrect: a. Having an open-door policy lends to multiple distractions, which may hamper goal completion. b. If you retain all paperwork, your desk or files become cluttered, and this may have a negative effect on work completion. c. Returning all calls immediately disrupts completion of work.

A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of a(n): a. interpretation. b. context. c. precipitating event. d. preconceived idea.

ANS: D Correct: Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver's acceptance and understanding of the message. Incorrect: a. Interpretation is the individual's analysis of communication that is based on context and environment, precipitating event, preconceived ideas, personal perceptions, style of transmission, and past experiences. b. Context refers to the entire situation that is relevant to the communication. c. The precipitating event refers specifically to the event or the situation that prompted a particular communication.

A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance

ANS: D Correct: Right circumstance involves the delegation of tasks that do not require independent nursing judgments. Incorrect: a. Right supervision of delegation involves providing feedback to monitor how the process is working and to suggest improvements to the process. b. Right communication involves giving clear explanations about tasks and expected outcomes; information is provided about when the delegatee should report to the RN. c. Right person involves delegating to someone who is qualified and competent. Because the UAP is a new hire, the RN cannot evaluate the competency level of the delegatee.

A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the State Board of Nursing to determine scope of practice for Licensed Practical Nurses (LPN) and Unlicensed Assistive Personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include: a. the RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. b. the RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. c. since the LPN is licensed, they practice professional nursing. d. to determine what tasks can be safely delegated; the RN must first assess the patient.

ANS: D Correct: The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient's condition is critical. Incorrect: a. The RN is both accountable and responsible for the delegated task. b. Only tasks that are within the scope of practice of the LPN or UAP can be delegated. c. Only registered nurses practice professional nursing.

During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that: a. the health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. UAPs cannot be held responsible for their own actions or inactions. d. the nurse practice act and state regulations related to delegation override the organization's policies.

ANS: D Correct: The state's nurse practice act is the deciding factor regarding what can legally be delegated. Incorrect: a. Although on-site training may increase the competency of the individual, legal rules of delegation remain with the state's nurse practice act. b. Accountability remains with the RN who delegated the task. c. UAPs are responsible for accepting tasks which they are competent to perform, but accountability remains with the RN.

A nurse realizes that much time is wasted during shift report when co-workers discuss personal items such as recent movies or department store sales. Which statement would help with time management during this critical interaction? a. "Let's talk only about one movie you recently watched." b. "I like to know about department store sales, but we need to get through this report, so let's talk about sales as we walk between patient rooms." c. "I know your shift has been busy. What went wrong?" d. "I have the list of patients; let's start with revisions to the plan of care and scheduled activities for the next shift."

ANS: D Correct: The statement "I have the list of patients; let's start with revisions to the plan of care and scheduled activities for the next shift" focuses the conversation during report, keeping personal conversations to a minimum. Incorrect: a. Shift report allows the nurse to prioritize the upcoming shift; personal discussions should occur at break or after the end of the shift. b. The time available between each patient is a time to organize thoughts and plan care. c. Asking what went wrong in a shift opens up a lengthy conversation that may not provide essential information needed to provide care.

Which component of an e-mail shown below would be effective? a. Subject: A short concise subject line: Meeting b. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5:00PM in the first floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582

ANS: D Correct: This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication. Incorrect: a. The subject line does not convey enough information to be valuable. b. Too many questions are asked in succession, making it easy for the reader to miss responding to one of the questions. c. Announcing that each department must reduce staff by 2% provides sensitive information that can personally affect several staff members; sensitive information should be shared in a face-to-face meeting, not through e-mail or electronic announcement boards.

During a staff meeting, a nurse who is mentoring new BSN graduate states, "We are lucky to have a new nurse join our staff who is a BSN graduate from our local university." Another staff nurse is heard saying, "BSN. BSN is you don't have a BSN you aren't valued. You don't see anyone welcoming any nurses with associate degrees—we are not valued." The conversation places the mentor in a negative position when her intention was simply to welcome the new employee. The staff nurse's negative response represents which logical fallacy? a. Straw man b. Appeal to tradition c. Confusing Cause and Effect d. Appeal to Common Practice

ANS: A Correct: Straw man occurs when a person's position on a topic is misrepresented. Incorrect: b. Appeal to tradition is the argument that doing things a certain way is best because they have always been done that way. c. Confusing cause and effect occurs when one assumes that one event must cause another such as walking under a ladder is bad luck after observing a painter walk under a ladder then fall and break his leg. d. Appeal to common practice is accepting an answer or situation because most people do it that way.

1. The most important step in time management is ____________.

ANS: Planning It is important to plan before beginning any task, project, or day's activities. Planning involves (1) setting goals and establishing priorities, (2) scheduling activities, and (3) making to-do lists.

1. The healthiest form of communication is the ________ style.

ANS: assertive Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing.

When choosing to delegate, the nurse should delegate the task to the most qualified person or to the person he or she wishes to: a. develop. b. promote. c. punish. d. reward.

ANS: A Correct: Delegating is giving other people tasks to be accomplished. The benefits of delegation involve (1) assisting in developing the initiative, skills, knowledge, and competence of others; (2) maintaining the level of responsibility and decision-making of others; (3) freeing time for more important tasks; (4) extending results that can be accomplished from what one person can do alone to what he or she can manage through others; and (5) ensuring that completing the task is cost effective. Incorrect: b. Delegating an activity to a person for promotion is not appropriate; the act of delegating requires multiple considerations, and promotion is not one of them. c. Delegating to punish a person is not appropriate; that person may sabotage the goal to be accomplished. d. Delegating is a process that is used to attain a goal, not to reward a person for a job well done.