Leadership Exam 3 Quilet

The physician orders an insulin Ivy drip at 1850 Units per hour. Insulin is provided in 25,000 units in 500ML. D5W. ml/hr?

- 37ml/hr

Insulin drip infusing at 21ml/hr. Drip is mixed at the strength of 150 units in 500ml NS. Round to nearest whole number

- 70 units

When a nurse uses a criteria such as "high risk for falls", "infection protocols" and a "special communication needs" to determine the mix and number of staff needed on a lemon tree unit, what is the nurse using? - A patient classification system. - Clinical pathways. - Diagnostic related groups. - Case management.

- A patient classification system.

A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement this incident is best identified using what term? - Casual factor - Root cause - Sentinel event - Variation in performance

- Sentinel event

Infuse 500ml D5W with 800MG of theophylline at 0.3 mg/kg/hr. The client weighs 242 pounds. Round to the nearest whole number.

- 21ml/hr

The National Database of Nursing Quality Indicators (NDNQI) identifies what clients focused events as outcome indicators ? SATA - A patient develops a catheter associated urinary tract infection - A patient develops pneumonia related to ventilator use - A patient develops bilateral pressure ulcers on their heels - A patient falls and fractures a hip - A patient develops post-surgical delirium

- A patient develops a catheter associated urinary tract infection - A patient develops pneumonia related to ventilator use - A patient develops bilateral pressure ulcers on their heels - A patient falls and fractures a hip

The team is providing emergency care to a client who received an excessive dose of opioid medication. Which task is best to assign to the LPN/LVN ? - Monitor the RR for the first 30 minutes - Applying oxygen pe nasal cannula as ordered - Calling the HCP to report SBAR - Giving naloxone and evaluating response to therapy

- Applying oxygen pe nasal cannula as ordered

Which clients can be properly assigned to a newly graduated RN who has recently completed orientation ? SATA - Client who is reporting pain at the site of a peripheral IV line - Client on the second post op day who needs pain medication before dressing changes - Client with chronic pain who is to be discharged with a new surgically implanted catheter - Client with kidney stone who needs frequent as needed (PRN) pain medication - Anxious client with chronic pain who frequently uses the call bottom - Client with acquired immune deficiency syndrome who reports headache and abdominal and pleuritic chest pain

- Client who is reporting pain at the site of a peripheral IV line - Client on the second post op day who needs pain medication before dressing change - Client with kidney stone who needs frequent as needed (PRN) pain medication

The charge nurse work on the assignment list for the shift. Which clients should be assigned to an experienced RN ? SATA - Client with chest pain who has a history of atherosclerosis - Client with abdominal cramps related to food poisoning - Client with chronic back pain related to a workplace injury - Client with a severe headache of unknown origin - Client who was in automobile crash and sustained multiple injuries -Client who has returned from surgery and has a chest tube in place

- Client with a severe headache of unknown origin - Client who was in automobile crash and sustained multiple injuries -Client who has returned from surgery and has a chest tube in place

Which client can be appropriately assigned to an LPN who will function under the supervision of an RN or team leader? SATA - Client, who underwent A to amputation and has a diabetic neuropathic pain. - Client who reports abdominal pain after being kicked, punched, and beaten. - Client who needs preoperative teaching about the patient control and analgesia pump. - Client with arthritis who needs schedule pain medication and heat application. - Client, with a leg cast who needs circulation checks and as needed hydrocodone

- Client, who underwent A to amputation and has a diabetic neuropathic pain. - Client with arthritis who needs schedule pain medication and heat application. - Client, with a leg cast who needs circulation checks and as needed hydrocodone

Which of the following it's best to defines a patient care system that establishes specific milestones throughout the course of the patient's hospital stay.

- Clinical pathways.

Healthcare organization is considering opening a new unit for patients with muscular dystrophy. What factor would be a primary driven force for the unit to open

- Cost of care

Leader wants to implement a new evidence-based practice that reduces hospital acquired infections. However, the staff is reluctant. What is the best way for the leader to get acceptance?

- Discuss the benefits of quality improvement to the unit

What would be the most appropriate method for the nurse to voice concern over unfair client workload assignment? - Organize a unit meeting to discuss the problem on all shifts - Invite the vice president in charge of nursing to a unit meeting - Discuss the problem with the nurse's team leader and then the charge nurse if the problem remains unsolved - Circulate a petition to all staff seeking support for change in assignment policy and present the signed petition to the nursing supervisor

- Discuss the problem with the nurse's team leader and then the charge nurse if the problem remains unsolved

A nurse recently joined a quality and improvement committee at the hospital. The nurse is excited to get started with quality improvement but finds that staff on the unit are skeptical of change. How should the nurse respond ? - Complain to the nurse manager about the poor attitudes of the staff - Explain that quality improvement is essential for magnet certification - Explain the benefits of quality improvement on the unit and to the staff - Tell staff that ensuring quality is an essential part of their job description

- Explain the benefits of quality improvement on the unit and to the staff

The charge nurse is reviewing the records of client who were assigned to a newly graduated RN.The RN has correctly documented dose and time of medication, but there is nodocumentation regarding nonpharmaceutical measures. What action should the charge nurse take first? - Quiz the nurse about knowledge of pain management and pharmacology - Make a note in the nurses file and continue to observe clinical performance - Give praise for documenting dose and time and discuss documentation deficits - Refers the new RN to the in-service education department

- Give praise for documenting dose and time and discuss documentation deficits

29 item instrument measuring patients' perception of their hospital experience - Patient focus. Which tool can provide key data?

- HCAHPS

The following documentation was entered in the client's medical record. The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied. Which statement best describe this documentation? - Appropriately written - Inappropriate because it places blame on an individual - Inappropriate because it does not include that the client family was notified - Appropriate written because it only documents the facts

- Inappropriate because it places blame on an individual

Which of the following scenarios is classified as a sentinel event?

- Incorrect infant twin undergoes surgery for a heart defect

A nurse is looking for an opportunity to develop a quality improvement project. While discussing this with colleagues. One colleague suggests "we have had a couple medication errors recently. Both made by the same nurse. You could work with the nurse to improve their medication safety". Which factor explains why this is not an example of a quality improvement project? - It focuses on individuals' improvement. Rather than process improvement. - The intervention should be delivered by a multidisciplinary team. - There is not enough data to indicate a need for improvement. - It does not focus on the patient experience.

- It focuses on individuals' improvement. Rather than process improvement.

A client has severe pain and bladder distention related to urinary retention and possible obstruction. And experience with unlicensed assistive personnel and states that she received - Measuring the urine output and obtain a specimen training and indwelling catheter insertion at a previous job. The task can be delegated to the UAP? - Evaluating the relief of pain and bladder distension after the catheter is inserted. - Measuring the urine output and obtaining a specimen - Assessing the bladder distention and the pain associated with urinary retention. - Inserting the indwelling catheter after verifying her knowledge of sterile technique.

- Measuring the urine output and obtain a specimen

Procedural changes are being planned on the unit as the direct result of client satisfaction surveys. which person is most strategically to handle how these changes are initiated? - chief executive officer? - Chief Financial officer. - Nurse manager. - Staff nurse

- Nurse manager.

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect? - One nurse has responsibility for all the needs of three clients. - One nurse has responsibility for all the medications on the unit. - One charge nurse and one respiratory therapist have responsibility for all clients. - One nurse and one nursing assistant have responsibility for 10 clients.

- One nurse has responsibility for all the medications on the unit.

A patient is ordered a low protein, low calorie diet, but patient family brings fish, lentils and unleavened bread For a meal to observe a cultural practice. The nurse works with a dietitian to adjust the next few meals to accommodate for this variance. What terms should be used to identify the situation? - Patient center care - An adverse event - The communication technique of call out. - A Sentinel events

- Patient center care

Which of the following competencies are included in the quality and safety for nursing (QSEN) initiative? SATA

- Patient centered care - quality improvement - safety

At 37-year-old female who Has just undergone allogeneic stem. Cell transplantation will need protective environmental stimulation. Which nursing task should the nurse delegate to? The nursing assistant? SATA - Posting the precautions for protective isolation on the door of the client room. - Communicating with the family members about the rationale for isolation. - Reminding the visitors to wear a face mask, gloves, and gown. - stock the client's room with the required PPE items. - Educating the client to perform careful hand washing after using the bathroom.

- Posting the precautions for protective isolation on the door of the client room. - Reminding the visitors to wear a face mask, gloves, and gown. - stock the client's room with the required PPE items.

Patients are waiting 20 to 30 minutes for PRN medications via call light. Which tool can the leader use to identify key steps for needed change?

- Process mapping

The charge nurse determines acuity levels of clients for staffing needs. Which factors should be considered when determining acuity of clients? SATA - Proximity to nurses station. - Psychosocial support needs. - Instability of vital signs. - Need for 1:1 psychiatric monitoring. - Age and functional ability.

- Psychosocial support needs. - Instability of vital signs. - Need for 1:1 psychiatric monitoring. - Age and functional ability.

A nurse manager is aware that medication errors at the hospital are much higher than it should be, and that it is possible to reduce this incidence. Which intervention carries the greatest potential to reduce medication errors? - Implementing team nursing, whereby one nurse administers every medication. - Reducing distraction to nurses while they are administering medication. - Attaching physicians order to the medication administration record. - Keeping medication administration records at the patient bedside.

- Reducing distraction to nurses while they are administering medication.

The nurse is delegating task to the team members on the medical unit. Which infection control activities can be assigned to the nursing assistant? SATA - Remind visitor to wear proper PPE in isolation room - Demonstrate correct hand washing - Asking client about the use of immunosuppressant meds - Screening clients for upper respiratory infection - Disinfecting blood pressure cuff after client discharged

- Remind visitor to wear proper PPE in isolation room - Disinfecting blood pressure cuff after client discharged

The nurse administrator has been asked to work with other administrators to change a longstanding hospital policy. What should be the nurse first action? - Research the options that will work best for the nursing staff and the hospital - Survey the staff to determine the likelihood that they will accept the change - Speak positively of the change to ensure the most buy-in from the nurses - Encourage the other administrators to choose the option that is easiest for the nurses

- Research the options that will work best for the nursing staff and the hospital

A Nurse is assisting with the delivery of twins. The first infant is placed on the scale to be waited. The physician requests an instrument Stat. The nurse Turns To hand the instrument to the physician and the infant falls off the scale. When evaluating the incident, the nurse, and her manager list contributory factors such as the need for two nurses when multiple births are known and the location of the scale so far from the delivery field. These nurses are engaged in what process? - Standardization of care. - Analysis of deployment flow short. - root cost analysis. - Process variation.

- Root cost analysis.

When delegating the RN. As science one nurse to care for a patient with shingles and a different nurse to care for a patient with HIV. This represents which category of nursing care. - Safe and effective care environment. - Psychosocial integrity. - Health promotion and maintenance. - Teaching and learning.

- Safe and effective care environment.

Nurses, physicians, and social workers finalize the plan of car and coordinate discharge, for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of experience but also recognize other members strengths. Which of the QSEN competencies are being demonstrated ? - Patient centered care - Quality improvement - Evidence based practice - Teamwork and collaboration

- Teamwork and collaboration

The nursing committee is planning change in the unit's organization. Which statement reflects the priority expected outcome of these change agents work ? - The nurses involved will demonstrate management skills - The nurses will embrace the change and totally support its adoption - The change will dictate nursing practice on the unit - The change will lead to improved client care on the unit

- The change will lead to improved client care on the unit

The surgical team arrives in the operating room and one Member States. Everyone stopped. Let's identify the patient and operative site. Now. Does anyone have any question or concern? This process is referred to by what term? - Time out. - special cause variation. - Hey critical pathway. - Lean methodology

- Time out.

The nursing staff notices that the number of urinary tract infections varies from month to month. They plot the number of infections for each month for 1 year to determine when the periods of the greatest number of infections are occurring. The staff uses which types of graph to present this information ? - Cause and effect diagram - Time plot - Fishbone diagram - Flowchart

- Time plot

A nurse is preparing to administer and medication by using the vastus laterals site and is unfamiliar with the process. As step-by-step reference that shows how to complete the process is referred to by what term? - Control chart - Top-down flowchart - Deployment flowchart - Pareto chart

- Top-down flowchart

A patient admitted with CABG. According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient oxygen saturation decreased drastically because of chronic tobacco abuse. Subsequently the patient remained on the ventilator an additional 2-day post op. according to the clinicals practice guideline for CABG, this situation results in what type of event? - Nursing standard - Variance - Patient outcome - Care goal

- Variance

The nurse manager has decided to use evidence base practice to solve an issue and has called staff nurses together for input. Which question reflects the first step of the EBP process ? - Where can we look for information - What is the exact clinical issue with we are dealing? - Is anyone prepared to evaluate the statistics we will find? - What outcomes are we expecting from this work?

- What is the exact clinical issue with we are dealing?

A successful nurse manager is mentoring a newly promoted nurse manager, which comment by the mentor. Reflects the most important consideration of all nurse managers . - Take your role on the Strategic Planning Committee very seriously. - You must work to develop your staff competencies. - your most important role is to ensure client care accountability. - Fiscal resource management is the most important aspect of your job.

- your most important role is to ensure client care accountability.

The patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2018 National patient safety Goals protocols. SATA - Mark procedure site with an X and again ask the patient to verify correct site - The surgical team asks the patient to verify his or her name, type of surgery and limb to be removed - After arrival in the operating room, perform a time out for final identification of patient and operative site along with agreement of what procedure is scheduled - Ask each member of the surgical team to provide a copy of licensure and if applicable certification to patient and family - The surgical team uses the chart number and name/hospital number to ensure have the correct patient

-- Mark procedure site with an X and again ask the patient to verify correct site - The surgical team asks the patient to verify his or her name, type of surgery and limb to be removed - After arrival in the operating room, perform a time out for final identification of patient and operative site along with agreement of what procedure is scheduled - The surgical team uses the chart number and name/hospital number to ensure have the correct patient

In the care of clients with pain and discomfort. Which task is most appropriate to delegate to UAP? A.- Evaluating relief after applying cold compress B.- Assisting the client with preparation of Sitz bath C.- Monitoring the client for signs of discomfort while ambulating D.- Coaching the client to deep breath during painful procedure

B.- Assisting the client with preparation of Sitz bath

The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase " responsibilities include shift by shift coordination and promotion of quality client care" ? A.- Charge nurse B.- Chief financial officer C.- Staff nurse D.- Chief nurse executive

A.- Charge nurse

After shift change, the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the bag indicate the client received half of the dose ordered. Which statement should be documented in the client medical record ? A.- IV heparin restarted. Physician notified. The clients' vital signs were unchanged B.- IV heparin restarted at a rate to catch up dosage accidentally deleted C.- IV heparin turned off by the previous shift. Restarted D.- IV heparin restarted and incident report completed

A.- IV heparin restarted. Physician notified. The clients' vital signs were unchanged

The nurse is caring for a client with an open draining leg ulcer that is infected with (MRSA). Which of the following nursing actions can be assigned to an LPN/LVN ? SATA A.- Plan interventions to improve the client's oral protein intake B.- Collecting wound cultures from the site C.- Assessing risk for further skin breakdown D.- Performing dressing changes as ordered E.- Educate the client about home care of the leg ulcer

B.- Collecting wound cultures from the site D.- Performing dressing changes as ordered

A task force is considering factors that contribute to high quality safe staffing. Which statement reflects an understanding of the American Nurses Associations (ANA) recommendations ? A.- Because patients' needs remain constant on a day shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care. B.- RN staffing Is not cost effective, thus, is it important for staffing models to limits the number of RN assigned per shift. C.- Staffing should allow time for RN to apply the nursing process so decisions results in high quality safe patient outcomes. D.- Patient acuity levels affect by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RN in staff mix

C.- Staffing should allow time for RN to apply the nursing process so decisions results in high quality safe patient outcomes.

A nurse discovers that the wrong patient has been transported to surgery for a procedure in the operating room. When examining the incident, the nurse manager list contributory factors such as having two patients with the same name, A new nurse in orientation and a new admission to the transferring unit at the same time. The nurse manager is engaged in what process? - Root cost analysis. - Process variation. - Standardization of care. - Analysis of the Deployment flow chart.

Root cost analysis.