Leadership Proctored Study
A nurse is talking with a staff nurse following a workshop on advance directives. Which of the following statements by the staff nurse demonstrates understanding of advance directives?
"A family member of a client can have the living will overturned in some cases." (family members have the right to question the mental capacity of the client at the time a living will was completed; evidence that the client was incompetent could result in the living will being revoked.)
Which of the following instructions provided by a nurse reflects effective communication regarding delegation of a task to an AP?
"Check the urinary output at 1100 for John Doe and report it to me immediately."
An AP tells a charge nurse that it is unfair that they have to take care of all the patients who are incontinent. Which of the following responses should the charge nurse make?
"I delegate tasks to personnel based on their job descriptions."
A nurse is caring for a client who recently learned they have a mutation of the BRCA2 gene. The client states that they do not plan to tell their adult children about the diagnosis. Which of the following responses displays client advocacy by the nurse?
"Let's review what you understand about this test result."
A nurse is caring for a patient who is hospitalized and has expressive aphasia. The patient's family reports that the nurse failed to obtain written informed consent before inserting an indwelling urinary catheter. Which of the following responses should the nurse make?
"This is procedure that does not require written informed consent."
A group of nurses on a telemetry unit informs a nurse manager of a need to update the cardiac monitoring system to improve arrhythmia detection. Which of the following responses should the nurse manager make?
"This purchase will need to be addressed in the capital budget plan for the unit."
A nurse is caring for a client who has a terminal illness and voices concern about performing self-care after discharge. Which of the following statements should the nurse make?
"Your case manager will coordinate the resources you will need."
A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the following actions should the nurse plan to take?
- Inform the AP of the client's weight-bearing status. - Instruct client not to cross their surgical leg beyond the midline - Instruct client not to flex their hip more than 90 degrees - Assess incision q 4 h during first day, q 8-12 h after
Advance Directives
- No special training is needed for RN to discuss with patient - health care proxy should be in agreement with, but is not required - must have a witness (does NOT need to be HCP) - Must include documentation in the medical record about whether a client has an advance directive
Examples of Client Advocacy
- Notify provider when a client has questions about a procedure - Help client make a list of questions to ask the provider - Clarifying the dosage of a medication prescribed for a client - Carrying out the end-of-life wishes outlines in the living will of an older adult client who has end-stage renal disease.
Restraint Use
- Obtain rx - HCP evaluates client w/i 1 h of initiation - assess & document q 15 min (ROM, circulation, psychological status) - constantly observe
Cues for Possible Substance Abuse
- Poor attendance - Rapid mood changes - Social isolation - Sudden change in personal hygiene - Complaints from clients that their pain meds are ineffective - Frequent bathroom usage - Offering to pass medications for other nurses' patients
Positive Strategies for Change Acceptance
- Role model a positive approach to the changes - Encourage staff members who support the changes to discuss the issue with resistant staff - Allow staff to vocalize objections in order to discuss possible solutions.
Annual Performance Review
- Uses data collected throughout the year - Evaluated on an established set of standards - Includes a performance checklist - Includes peer reviews - Includes self-appraisal
Aquathermia Pad
- ask client to report it pad gets too warm - check client 15-20 min after applying - ensure call light w/i reach - d/c if skin becomes discolored - do NOT show client how to adjust temp (burn risk)
Time Management Strategies
- document asap - group activities for several clients in the same location - delegate - prioritize tasks based on needs
A charge nurse on a med-surg unit is making assignments for the next shift. An LVN and AP are members of the team. Which of the following client care assignments should the nurse assign to LVN? a. Reinforcing teaching to a client. b. Measuring a client's VS c. Performing postmortem care d. Assisting a client with feeding
A
A nurse on a med-surg unit is caring for four clients. The nurse should recognize that which of the following clients is the priority? a. A client who has PVD and has an absent pulse in the right foot. b. A client who is scheduled for a tubal ligation in 2 h and is crying. c. A client who has DM1 and needs the first dressing change for an ulcer. d. A client who has a MRSA infection and has an axillary temp of 38 C (100.4 F)
A
A nurse on a quality improvement team is implementing a plan to decrease the rate of pressure injuries in a long-term care facility. Which of the following actions should the team take to evaluate the effectiveness of the plan? a. Compare data from clients' records regarding skin integrity with established criteria. b. Measure staff attendance at an educational program on managing pressure injuries. c. Interview clients regarding their satisfaction with their care. d. Monitor supplies used to prevent pressure injuries.
A
Example of a Violation of Client Rights
A client who has schizophrenia is placed in the seclusion room of the psychiatric unit for making frequent outbursts of obscenities directed at nurses of the opposite sex.
Ethics Committee
A committee composed of members of the interprofessional team who assist with problem solving related to ethical dilemmas.
Smoothing
A conflict resolution strategy that uses complimenting or focusing on shared ideas to reduce the emotional component of the conflict.
Seclusion
A form of restraint that should only be used when a client is demonstrating violent or self-destructive behavior that jeopardizes the safety of self or others.
NLN
A national organization for faculty nurses and leaders in nurse education. It offers faculty development, networking opportunities, testing services, nursing research grants, and public policy initiatives.
A nurse in the ED is performing triage for a group of patients following a motor-vehicle crash. Which of the following patients should the nurse request the provider assess first?
A patient who has arm contusions and manifests asymmetrical thoracic movement.
AAN
A professional organization that generates, synthesizes, and disseminates nursing knowledge to contribute to health policy and practice for the benefit of the public and nursing profession.
Paternalism
A type of relationship between clients and HCPs in which the HCP believe they know what is best for the clients. (ex.: make decisions for client; deny rights)
A nurse is caring for four clients. Which of the following tasks can the nurse assign to an AP? a. Perform chest compressions on a client who is in cardiac arrest. b. Change a sterile dressing on a client's wound. c. Check the residual of a client's gastrostomy tube. d. Instruct the client on the use of a blood glucose machine.
A.
A nurse is preparing to provide discharge teaching to an older adult client. Which of the following teaching considerations should the nurse include? a. Allow frequent rest periods during teaching. b. Use colored paper with a glossy finish. c. Present the information at a 10th grade reading level. d. Use 12-point font size.
A.
A nurse is tracking the outcomes on the unit who have received postoperative pain management. This activity demonstrates which of the following competencies of the Quality and Safety Education for Nurses (QSEN) initiative? a. Quality improvement b. Safety c. Patient-centered care d. Informatics
A.
Root Cause Analysis
An analytical technique used to determine the basic underlying reason that causes a variance or a defect or a risk. A root cause may underlie more than one variance or defect or risk.
A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take to verify the client gave informed consent?
Ask the client to explain the procedure that is being performed.
A client on a general surgical unit tells a nurse that staff members are not answering the call light promptly. The client requests to be transferred to another unit. Which of the following actions should the nurse take first?
Ask the client to verbalize their expectations.
A nurse in a community health clinic is planning an in-service staff training session on nationally notifiable infectious conditions. Which of the following conditions should the nurse include in the teaching? a. C. dif b. Varicella c. HIV exposure d. Influenza
B
A nurse is receiving a change-of-shift report. Which of the following patients should the nurse assess first? a. A client who has a WBC count of 15,000/mm3 and is receiving antibiotics. b. A client who had abdominal surgery 6 h ago and has a HR of 120/min for the last 2 h. c. A client who is requesting pain meds 24 h after an ORIF of the left ankle. d. A client who has pneumonia, an O2 sat of 95%, and is refusing prescribed meds.
B
A nurse manager is coordinating staff assignments for RNs and LVNs following a local disaster. Which of the following is an appropriate assignment by the nurse manager to provide safe and effective client care? a. RNs transport class IV (black tag) clients b. LVNs provide care to class III (green tag clients) c. LVNs initiate care to class I (red tag) clients. d. LVNs facilitate care to class II (yellow tag) clients.
B
A charge nurse on a med-surg unit is assigning client car to the upcoming shift. Which of the following tasks should the nurse delegate to an AP? (SATA)\ a. Performing colostomy care b. Measuring a client's I&O c. Interpreting a client's lab values following surgery d. Providing postmortem care to a client e. Checking nasogastric tube to patency
B & D
A case manager is planning an interprofessional conference for a client who is 3 days postop following an open reduction and internal fixation of the right hip. Which of the following concerns is the priority for discussion at the conference? a. The client does not have transportation for discharge home. b. The client refuses to attend PT sessions. c. The client's home health nurse has not completed the home assessment. d. The client describes feelings of depression after family visits.
B.
A nurse has just received a report on four clients on a med-surg unit. Which of the following clients should the nurse plan to assess first? a. A client who has COPD and an O2 sat of 92% b. A client who is postop following a total knee arthroplasty and has a cap refill of 4 sec. c. A client who has DM and a blood glucose of 150 mg/dL d. A client who is postop following abdominal surgery and has hypoactive bowel sounds.
B.
A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery w/i the next 2 h. The client tells the nurse that they are leaving the hospital. After notifying the surgeon, which of the following actions should the nurse take next? a. Have the client sign the AMA form. b. Inform the client about the risks they may encounter by leaving the facility. c. Document the client's statements in the medical record. d. Notify the risk manager.
B.
An RN is working on the surgical unit when a client who has abdominal pain is admitted. Which of the following activities must be performed by the RN? a. Obtaining a urinalysis from the client. b. Completing the client's initial admission assessment. c. Administering PO pain medications to the client. d. Assembling the client's medical record.
B.
A charge nurse is supervising a team of LVNs and APs. The charge nurse should intervene in which of the following situations? a. An LVN delegates an AP to place a fall-risk bracelet on a client. b. An AP turns a client who is immobile q 2 h. c. An LVN develops the nursing plan of care for a client who has pneumonia. d. An AP uses a transfer board to assist a client with moving from the bed to a chair.
C
A home health nurse is planning daily visits and receives lab result for 4 adult clients. Which of the following clients should the home health nurse plan to visit first, based on their lab findings? a. A client who has CHF and has a digoxin level of 2.1 ng/mL (0.8-2 ng/mL) b. A client who is receiving chemo and has a WBC 4,800/mm3 (5,000-10,000/mm3) c. A client who is 3 day postop and has a platelet 100,000/mm3 (150,000-400,000/mm3) d. A client who is on hemodialysis and has a serum potassium level of 3.3 mEq/L (3.5-5.0 mEq/L)
C
A newborn is being discharged from the hospital. Which of the following is the best action for the nurse to take to ensure the newborn's safety? a. Require the parent to verbalize correct use of an infant car seat. b. Have the parent demonstrate proper use of an infant car seat using a demonstration unit. c. Observe the parent securing the newborn into the infant car seat in the parent's car. d. Instruct the parent to place the infant car seat facing backward in the back seat.
C
A grandparent brings their 15 yo grandchild into the ED reporting that they have sever abdominal pain and are scheduled for an immediate appendectomy. the nurse confirms that the client's guardians are unavailable. Which of the following actions is appropriate? a. Delay the procedure until the guardians can provide consent. b. Proceed with the surgery via implied consent. c. Have the grandparent sign the consent form. d. Obtain consent from the client.
C.
A nurse is following standard policy and procedure for reporting a client who has a communicable disease. Which of the following infections should the nurse plan to report to the CDC? a. C. dif b. Candidiasis c. VRSA d. Trichomoniasis
C.
A charge nurse has been asked to determine staff adherence to established standards for postoperative VS measurement. Which of the following actions should the nurse take to collect information?
Conduct a retrospective chart audit of all surgical clients for the past 6 months.
Critical Pathway
Cost-effective strategy to guide care for clients who have a specific medical diagnosis or are undergoing a specific procedure.
A nurse is caring for a client who has recently been prescribed lithium carbonate. Which of the following assessment findings is the priority for this client? a. Fine hand tremors b. Weight gain of 2.7 kg (6 lb) c. Report of nausea d. Poor motor control
D
A nurse is caring for several clients who require diagnostic testing and is delegating tasks to an AP. Which of the following tasks should the nurse direct the AP to perform first? a. Change the transparent dressing on a client who has a stage 2 pressure ulcer. b. Bring a pitcher of fresh water to a client who has just had a lumbar puncture. c. Transport a client to the radiology department for a routine chest x-ray. d. Take an arterial blood gas specimen to the lab.
D
A nurse manager is presenting an in-service about preventing readmission of clients d/t complications following joint arthroplasty. Which of the following leadership tasks is the nurse performing? a. Collaboration b. Compromising c. Smoothing d. Advocacy
D
While participating in a continuous quality-improvement program, a nurse is reviewing medical records to determine the time of first postoperative ambulation of clients who had abdominal surgery. In which type of quality audit is the nurse participating? a. Outcome b. Structure c. Strategic planning d. Process
D
A nurse in an ED is admitting clients following an earthquake. The emergency disaster plan has been implemented d/t the anticipated arrival of a large number of casualties. Which of the following clients should the nurse recommend the provider evaluate first? a. A client who has a penetrating head injury and RR of 4/min b. A client who has a comminuted fracture of the femur. c. A client who has a 4 in laceration to the scalp with clotted blood visible. d. A client who has a sucking chest wound
D.
A nurse is witnessing a patient sign a consent form for a surgical procedure. The patient has a question regarding alternative treatment. Which of the following actions should the nurse take? a. Review the procedure on the consent form with the patient. b. Provide the patient with educational materials about the procedure. c. Answer the patient's question and have the patient sign the consent form. d. Call the surgeon to discuss alternative treatments with the patient.
D.
NPA
Defines the scope and boundaries of professional nursing practice. Varies by state.
Patient Self-Determination Act (PSDA)
Designed to help clients make informed decisions about care
A charge nurse is leading a committee that is revising the policy for client discharge. After developing the initial plan, which of the following actions should the nurse take next?
Determine goals and objectives.
A nurse is reprimanded by a provider in front of a client. Which of the following actions should the nurse take to resolve this conflict?
Discuss the situation with the provider in private.
A client is being discharged with a postop infection, requiring daily home IV antibiotics through a PICC line. Which of the following actions should the case manager perform prior to discharge?
Ensure that home infusion therapy has been arranged.
A facility has identified an increase in health care-associated urinary tract infections (UTIs) on the medical-surgical unit. A nurse is participating in a quality improvement process to address this problem. Which of the following should be the first step in the process?
Establish best practice guidelines for reducing the incidence of UTIs.
Outcome Audit
Evaluates how the client's health status changed as a result of an intervention.
Structure Audit
Evaluates the relationship between quality care and appropriate structure and includes input such as the environment in which care is delivered.
Compromise
Giving up a demand while asking another to also give up a demand.
Cooperation
Giving up one's own desire for the desires of others.
A facility has been notified of a train derailment resulting in multiple clients experiencing life-threatening injuries. The external disaster plan has been activated. Which of the following actions should charge nurse on the PACU take?
Identify stable clients for transfer to a surgical unit.
EMTALA
Includes guidelines for care within a health care facility for all clients, regardless of financial status.
A nurse manager is implementing a team nursing approach on the unit, hiring LVNs and APs as additional staff. Which of the following actions should the nurse take to facilitate acceptance of this change?
Introduce the new approach and facilitate the development of a task force to plan implementation.
Strategic Planning
Is done as part of the planning process. It typically examines the purpose, mission, philosophy, and goals of an organization.
A nurse is working in the ED when there is an explosion in a local chemical plant. Multiple victims are expected at the facility. Which of the following should be the nurse's priority intervention upon client arrival?
Isolate the clients and irrigate with water.
A new nurse manager on a busy oncology unit keeps her door closed when she is in the office and does not offer to help resolve daily staffing issues. Which of the following types of leadership behavior is the nurse manager displaying?
Laissez-Faire
Process Audit
Measures the interventions used to facilitate expected and desired outcomes for clients.
Does this patient chart indicate professional negligence? 0800: Nurse administering IM injection to client using standard precautions. During injection client flinched and nurse sustained needlestick injury. 0830: Nurse reported needlestick injury to nurse manager. Needlestick injury protocol initiated.
No.
AHRQ
Part of the US Dept of Health and Human Services, which supports research and is designed to improve the outcomes and quality of health care.
A nurse manager finds that there has been an increase in UTIs on the unit. To address this problem, which of the following actions should the nurse manager take first?
Perform a chart review to gather data about the clients who developed infections.
Example of a Breach of Confidentiality and Privacy
Photocopying diagnostic test results.
Critical Pathways
Prevent unnecessary expense. (promote cost-effective care for clients who have a specific, common diagnosis.)
Good Samaritan Laws
Provide protection to HCPs, however, they are still accountable for maintaining a reasonable standard of care.
Collaboration
Putting aside individual desires and focusing on shared decision making.
What action should a nurse take upon noticing that a pain assessment is not being performed for all clients as required by policy?
Report the issue to the nurse manager.
When participating in the informed consent process prior to surgery, which of the following actions should a nurse take?
Review previously provided information about the procedure.
A nurse asks a newly hired AP to remove a patient's foley. Which of the following actions should the nurse take to ensure the AP is qualified to perform this task?
Review the AP's skill competency checklist.
A nurse is caring for a client who is comatose. The client has living will that declines the use of artificial enteral nutrition as a life-sustaining measure, but the client's family has requested that the staff begin tube feedings. Which of the following actions should the nurse take?
Review the client's request with the family.
A nurse is reviewing facility data on hand hygiene adherence and finds that nurses are not performing hand hygiene after client contact 28% of the time. Which of the following is the first action the nurse should take when developing a plan to increase employee hand hygiene adherence?
Set a goal for improvement in adherence.
A nurse is caring for a client who has renal failure. The client tells the nurse that they have decided to stop hemodialysis treatment. Which of the following actions should the nurse take to act in the role of an advocate for the client?
Support the client's decision regarding treatment.
A nurse finds that a new IV pump has infused 400 mL of solution over 2 h when the rate was set to 100 mL/hr. After notifying the provider and verifying that the pump was properly programmed, which of the following is the nurse's priority?
Tag the pump for maintenance and acquire a new pump for the client.
A nurse is developing a plan of care for a school-age child whose family is without housing. Which of the following findings should the nurse identify as the priority?
The child has red fissures at the corners of the mouth. (ind. vit. B def.)
A nurse manager is planning an educational program about the role of the nurse as a client advocate. Which of the following should the nurse include in the presentation?
The distribution of confidentiality disclosure information to clients.
In an emergency or developing situation, what is the most up-to-date way to know what medications to give the patient?
The doctor's orders. (MAR does not update rapidly)
A nurse is caring for a 12 y.o. patient who has a laceration to the right forearm that occurred during soccer practice. The patient was brought into the ED by the soccer coach and a friend's parent. The nurse should ensure that informed consent is given by which of the following people?
The patient's parent or guardian.
Priority Action for Fire in Patient's Room
Transport patient to the hallway.
How to Fax Patient Information
Use security measures, such as verifying the number before sending information, using a cover sheet, and ensuring permission to share information with receiver.
Active Herpes Simplex Lesions
Wear gown and gloves when caring for the patient.
Does this patient chart indicate professional negligence? 2000:Nurse administered prescribed dose of IV phenytoin to client 4 h after indicated administration time. Medication verified, client allergy status verified, client has no known allergies. Administration of medication documented. 2130: Client sustained grand mal seizure. Rapid response initiated.
Yes
Intrapersonal Conflict
conflict that occurs within an individual. (competing personal and professional values, etc.)
