Management of Care DX quiz
Which management style best demonstrates the end of the continuum of management behaviors referred to by Douglas McGregor as theory Y? The manager assumes employees are self-motivated and want to work toward organizational and personal goals is responsible for motivation of employees towards the organizational goals takes a hands-off attitude and makes no decisions for employees organizes teams of staff and gives compensation to the team rather than individual success
assumes employees are self-motivated and want to work toward organizational and personal goals McGregor's theory placed management behaviors on a continuum, with Y being a set of propositions that describes managers as supporting people who naturally work for organizational and personal goals.
The nurse uses the DRG (Diagnosis Related Group) manual to classify nursing diagnoses from the client's health history determine reimbursement for a medical diagnosis implement nursing care based on case management protocol identify findings related to a medical diagnosis
determine reimbursement for a medical diagnosis DRG's are the basis of prospective payment plans for reimbursement for Medicare clients. Other insurance companies often use that as a standard for their payment.
Which statement by a nurse is appropriate when directing an unlicensed assistive personnel (UAP) to assist a 69 year-old surgical client to ambulate for the first time? "Assist the client to the bathroom at least twice on this shift and as the client requests." "After you assist the client to the chair, let me know how the client feels and did." "If the client is dizzy on standing, ask the client to take a few deep breaths." "Have the client sit on the side of the bed for at least two minutes before helping the client to stand."
"Have the client sit on the side of the bed for at least two minutes before helping the client to stand." Give clear instructions to the UAP about what is expected for client safety. The clue in the situation is that the client is getting up for the first time. The other actions are not incorrect; they are just not appropriate for initial getting out of bed.
A staff nurse complains to a nurse manager that an unlicensed assistive personnel (UAP) consistently leaves the work area untidy and does not restock supplies. The initial response by the nurse manager should be which of these statements? "I would like for you to approach the UAP about the problem the next time it occurs" "I can assure you that I will look into the matter in due time" "I will arrange for a conference with you and the UAP within the next week" "I will add this concern to the agenda for the next unit meeting so we can discuss it"
"I would like for you to approach the UAP about the problem the next time it occurs" Part of the manager's role is to help the staff manage conflict among themselves. It is appropriate to urge the nurse to confront the other staff member to work out problems without a manager's intervention when possible. This is an approach at the first level of management. If the two staff members cannot resolve the issue then the manager would have a conference with the two staff to facilitate a negotiation for a win-win result.
A nurse is assigned to care for a client diagnosed with diabetes mellitus on IV insulin therapy and is comatose. Which task would be most appropriate to delegate to an unlicensed assistive personnel (UAP)? Answer questions from the client's spouse about the plan of care Obtain the peripheral blood glucose readings Measure with documentation of the hourly output in the urine collection bag Determine if special skin care is needed when reddened areas are identified
Measure with documentation of the hourly output in the urine collection bag The UAP can safely do hourly urine outputs. A national license exam has to subscribe to the lowest level of standard or scope of practice. In some states the UAPs are not allowed to obtain blood glucose readings. Thus, this is an incorrect answer.
A nurse has asked a second staff nurse to sign for a wasted narcotic, which was not witnessed by another person. This seems to be a recent pattern of behavior. What should be an appropriate initial action? Report this immediately to the nurse manager Counsel the colleague about the risky behaviors Sign the narcotic sheet and document the event in an incident report Confront the nurse about the suspected drug use
Report this immediately to the nurse manager The incident must be reported to the appropriate manager, for both ethical and legal reasons. This is not an incident that a co-worker can resolve without referral to a manager.
The nurse manager overhears a health care provider loudly criticize one of the staff nurses within the hearing range of others. The nurse manager's next action should be to take what approach? Request an immediate private meeting with the health care provider and staff nurse Allow the staff nurse to handle this situation without interference Walk up to the health care provider and quietly state: "Stop this unacceptable behavior." Notify the other administrative branch of a breach of professional conduct
Request an immediate private meeting with the health care provider and staff nurse Assertive communication respects the needs of all parties to express themselves, but not at the expense of being in front of noninvolved staff, visitors or clients. The nurse manager first needs to protect clients and other staff from this display of negative behavior and come to the assistance of the nurse employee. Privacy is a priority as well as limiting the people to only those involved.
The nurse is teaching a group of parents about poisoning risks in the home and how to report information in the event of an accidental poisoning. The nurse should instruct the parents to first state the ingested substance and then to state which of these points of information? The estimated time of the accidental poisoning with a confirmation to bring the ingested substance containers The affected child's current age and most recent weight The parents' name and telephone number The currency of the immunization and allergy history of the child
The affected child's current age and most recent weight All of the points above are important. However, after the substance is given, the current age and the most recent weight are the priorities. This gives the health care providers an opportunity to calculate and prepare the needed dosage for an antidote in preparation for when the child arrives. After this information, the time of the accidental poisoning would be next in importance with the history of immunizations of a last item of concern.
Which client data should a nurse act upon when a home health aide calls the nurse from the older adult client's home to report these items? "The partner says the client has gotten slower for doing things every other day." "The family wants to discontinue the home meal service called Meals on Wheels." "The urine in the urinary catheter bag is of a deeper amber, almost brown color." "The client reports not sleeping well for the past week."
"The urine in the urinary catheter bag is of a deeper amber, almost brown color." Home health aides often report diverse information to nurses through phone calls and documentation. The nurse who develops the plan of care for a specific client, and supervises the aide, must identify potential danger signs which require immediate action and follow-up. The color of the urine requires first an evaluation for follow-up. The other options may need further assessment after the change in urine color is dealt with first.
A nurse has just received a written medication order which is not legible. Which statement to the health care provider reflects assertive communication? "I cannot give this medication as it is written. I have no idea of what you mean." "Please print in the future so I do not have to spend extra time attempting to read your writing." "I am having difficulty reading your handwriting. It would save me time if you would be more careful." "Would you please clarify what you have written so I am sure I am reading it correctly?"
"Would you please clarify what you have written so I am sure I am reading it correctly?" Assertive communication respects the rights and responsibilities of both parties. This statement is an honest expression of concern for safe practice and a request for clarification without self-depreciation. It reflects the right of the professional to give and receive information.
Staffing for the shift includes three registered nurses (RNs) and one licensed practice nurse (LPN). Which of these clients should the charge nurse assign to an RN? An 80 year-old client recovering 24 hours post right hip replacement A 60 year-old client with a history of asthma and reports shortness of breath using oxygen at 2 L/min A 24 year-old post-op client newly diagnosed with type 1 diabetes mellitus, who is in the process of being discharged A 56 year-old diagnosed with atrial fibrillation who recently started taking dabigatran (Pradaxa)
A 24 year-old post-op client newly diagnosed with type 1 diabetes mellitus, who is in the process of being discharged The RN can delegate the care of a client if it is not too complex or variable, and there is a low likelihood of emergency. Also, only RNs can teach; LPNs can reinforce the plan or care and information already taught by the RN. Therefore, discharge teaching can only be done by the RN.
The charge nurse on the evening shift is asked to determine which client is a candidate for discharge following an internal disaster in the hospital at 9:00 pm. Which of these clients should the nurse select as a potential candidate for discharge? A middle-aged adult with a history of type 1 diabetes and one day post diabetic ketoacidosis An adolescent, admitted on the day shift to rule out acute pancreatitis, who reports a history of alcohol abuse A young adult, admitted at the beginning of the shift, with an exacerbation of asthma An older adult female who is actively dying and has a "do not resuscitate" order
A middle-aged adult with a history of type 1 diabetes and one day post diabetic ketoacidosis The client selected to be discharged should be one whose condition is more stable than the others and where there's less of a risk for complications or instability after discharge. Although the client with asthma has a chronic condition, s/he was just admitted and is experiencing an acute exacerbation of the condition. The adolescent is experiencing an acute condition, probably brought on by his/her alcohol abuse. Neither of these clients are stable enough for discharge. It is a humane choice to allow the client who is in the process of dying to stay in the hospital.
An external disaster has occurred in the town. The triage nurse from the emergency department is transported to the site and assigned to triage the injured. Which of these clients would the nurse tag as "to be seen last" by the providers at the scene? A middle-aged person with deep abrasions that are over 90% of the body A teenager with small amount of bright red blood dripping out of the nose An infant with bilateral fractured lower legs with no active bleeding An older adult person with a open fracture of the left arm
A middle-aged person with deep abrasions that are over 90% of the body The clients that are least likely to survive are to be tagged as the "last to be seen." Deep abrasions are usually treated as second or third degree burns since the fluid loss is great.
The hospital has a mentor program for novice nurse managers. Which of these actions is a priority for the mentor-mentee relationship and will result in a positive experience? The mentee accepts feedback objectively The mentor is randomly assigned by administration A teacher-coach role is used by the mentor Information is clarified as needed
A teacher-coach role is used by the mentor The mentor needs to adopt the role as teacher-coach. Teaching and coaching are essential elements of the professional role and will facilitate the transition from one role to another, e.g., from staff nurse to nurse manager. The mentor will also assist the novice manager to manage familiar clinical situations and to achieve a level of comfort in solving clinical problems with which s/he is less familiar.
A home health nurse is at the home of a client diagnosed with diabetes mellitus and arthritis. The client exhibits a difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to which resource? Another client diagnosed with diabetes mellitus who takes insulin A social worker from the local hospital An activity therapist from the community center An occupational therapist to improve fine motor coordination
An occupational therapist to improve fine motor coordination An occupational therapist can assist a client to improve the fine motor skills needed to prepare an insulin injection. The other resources would not be helpful for this problem.
During the initial physical assessment on a client who is a Vietnamese immigrant, a nurse notices small, circular, ecchymotic areas on the client's knees. What is the best action for the nurse to take at this time? Document the findings on the admission sheet Report the bruising to social services for follow-up Ask the client for more information about the nature of the bruises Discuss with the client and then the family about the findings
Ask the client for more information about the nature of the bruises "Cupping" is practiced by Vietnamese. The principle is to create a vacuum inside a special cup by igniting alcohol-soaked cotton inside the cup. When the flame extinguishes, the cup is immediately applied to the skin of the painful site. The belief: the suction exudes the noxious element. The greater the bruise, the greater the seriousness of the illness. There is no need to ask or discuss with an adult's family members.
The RN is planning the care of a 79-year-old client with skin abrasions from a fall in the home. What aspect of this client's care is the primary responsibility of the nurse? Identification of a change in skin color Report the finding of any break in the skin Assessment of the integumentary condition Apply lotion to unaffected areas
Assessment of the integumentary condition The RN is ultimately responsible for thorough, ongoing assessment and evaluation of integument for this client. Because the nurse is responsible for all care-related decisions, only implementation tasks that do not require independent judgment can be delegated.
A client has an order for 1000 mL of D5W over an eight hour period. The nurse discovers that 800 mL has been infused over the past four hours. What is the priority nursing action at this time? Check the vital signs for changes from the baseline Ask the client if there has been any changes in their breathing Place the client in a mid to high fowler's position Auscultate the lungs bilaterally at the bases
Auscultate the lungs bilaterally at the bases All of the options would be part of the evaluation for the effects of the large amount of fluid over a short period of time. However, the most severe complication would be heart failure with lung congestion so the auscultation of the lungs at the bases is the priority action.
The nurse is assessing a client who experienced a head injury using the Glasgow Coma Scale (GCS). During the last assessment, the client scored a 14. Now the client opens eyes to verbal command (GCS 3), has purposeful movement to painful stimulus (GCS 5) and is using inappropriate words (GCS 3). Which intervention by the nurse should be implemented first? Increase the flow of oxygen Raise the head of the bed Call the rapid response team and health care provider Continue to monitor level of consciousness
Call the rapid response team and health care provider The GCS measures the patient's highest motor response, verbal response, and eye response (scores range from 3 - 15).The GCA can be used to help measure progress and predict the a client's outcome or prognosis. A decreased score of 2 or more indicates "neuroworsening" and a need for urgent intervention. It's possible the change is due to increased intracranial pressure (ICP), but this needs to be determined first before other actions are taken.
Which activity should a RN ask an unlicensed assistive personnel (UAP) to perform? Ask a client who is receiving chemotherapy about pain Adjust the rate of a gastric tube feeding Check the blood pressure of a two hour postoperative client Take a history on a newly admitted client
Check the blood pressure of a two hour postoperative client UAPs must be assigned tasks that are routine, have expected outcomes, and require no nursing judgment or decision making situations. Vital signs on stable clients are commonly assigned to unlicensed staff.
Which of the following methods are used to correctly identify a client? (Select all that apply) Check the client identification bracelet Have the client state his/her birth date Ask the client to state his/her name Ask a family member or visitor Compare person to a labeled photograph
Check the client identification bracelet Have the client state his/her birth date Ask the client to state his/her name Compare person to a labeled photograph
During the admission process, the staff nurse realizes that the information on the identification (ID) bracelet does not match the information on the client's admission face sheet. What action should the nurse take? Use a permanent marker to change the incorrect information on the ID bracelet Write the corrected information on the white board in the client's room Communicate with staff that the two-identifiers requirement must be verified using the admission face sheet Contact the admission department to create a new ID bracelet
Contact the admission department to create a new ID bracelet The admissions office has the responsibility to verify the client's identity, apply the correct bracelet and keep all the records in the system consistent. While the Joint Commission does not require the use of arm bands, correct identifying information must be attached to the client at all times. The other options are unsafe practices.
The staff nurse informs the charge nurse about an issue between two of the unlicensed assistive personnel (UAP) on the unit. What is the most important guideline for the nurses to remember when resolving this conflict between the UAPs? Explain the consequences of not resolving their differences Require the UAPs to reach a compromise Deal with the issues, not personalities Encourage the UAPs to ventilate their anger and use humor to minimize the conflict
Deal with the issues, not personalities Dealing with the issues, and not the personalities, is one of the important key behaviors in managing conflict. Issues tend to be more concrete, whereas personalities involve emotional issues. When there is conflict, emotions run high and it would be best not to let the UAPs ventilate their anger. If necessary, potential consequences of not resolving any differences between the UAP would be discussed last.
Nurse colleagues are discussing their practice during lunch. Which statement is correct? Each state has specific regulations for licensed registered nurses (RNs) and practical nurses (PNs). National nurses' associations work collaboratively to update the social policy statement for nursing. The employing agency is ultimately responsible to provide practice guidelines for licensed nurses. The federal government ensures the safety of clients by defining the scope of nursing practice.
Each state has specific regulations for licensed registered nurses (RNs) and practical nurses (PNs). This is the only correct statement. State governmental agencies license nurses in each state.
The medication benztropine mesylate (Cogentin) is ordered; the nurse incorrectly administers carvedilol (Coreg) to the client. What actions should the nurse take to report this medication error? (Select all that apply) Notify the health care provider Notify the client Monitor and document the client's blood pressure Document the administration of carvedilol (Coreg) Notify the charge nurse
Notify the health care provider Monitor and document the client's blood pressure Document the administration of carvedilol (Coreg) Notify the charge nurse
Two staff members call in sick on the medical-surgical unit and no additional help is available. The team consists of the RN, LPN and an unlicensed assistive personnel (UAP). Which of these activities should the RN assign to the UAP? Provide basic hygiene care to all clients on the unit Take the vital signs for all clients on the unit Maintain the turning schedule of all clients on the unit Assist with plans for any clients with discharge orders
Provide basic hygiene care to all clients on the unit Basic client care, which is routine, should be delegated to a UAP since the unit is short on help. The vital signs and turning schedules can be done by the RN and PN as they make rounds since this data is more critical to making judgments and decisions about the care of the clients.
The provisions of the Americans with Disabilities Act require nurse managers to take which approach? Consider both mental and physical disabilities during interviews Provide reasonable accommodations for individuals with a disability Maintain an environment free from associated hazards Make all necessary accommodations for individuals with a disability
Provide reasonable accommodations for individuals with a disability The law is designed to permit persons with disabilities access to job opportunities. Employers must evaluate an applicant's ability to perform the job and not discriminate on the basis of a disability. Employers also are required to make "reasonable accommodations."
A client has been scheduled for a transesophageal echocardiography (TEE). Prior to the procedure, which activity could be delegated to the unlicensed assistive personnel (UAP)? Obtain a signed consent Provide basic instructions about the procedure Remove the pitcher of water from the bedside table Assess the client's psychological state
Remove the pitcher of water from the bedside table Removing the water pitcher would be an appropriate task since the client would be NPO. The health care provider is responsible for instructions about the procedure and needs to address client questions or concerns. The nurse is typically responsible to obtain a signed consent form and to assess the client both physically and psychologically before the procedure.
Which statement correctly describes time management strategies applied to the role of a nurse manager? Delegate manager tasks to reduce conflicts associated with direct care and meetings Assume a fair share of direct client care on a daily basis to act as a role model Schedule staff efficiently to cover the anticipated needs on the unit Set daily goals with a prioritization of the issues and management tasks
Set daily goals with a prioritization of the issues and management tasks Time management strategies include setting goals and prioritization of not only management tasks but issues that arise on a daily basis on the unit. This is similar to time management of direct care for clients which has tasks and issues for prioritization. The approach for a manager to do a "fair share" of direct client care on a daily basis is a poor use of the managers time. Direct client care should be done by a unit manager in only in extreme circumstances.
