Module 9

A nurse in an emergency department is completing a health history for a client who has diabetes mellitus. Which of the following questions should the nurse ask the client to assess his understanding of the primary health problem?

"How has your illness altered your typical daily activities?"

An 80-year-old woman has been admitted for diagnostic procedures and then potential surgery for symptoms related to an abdominal mass. Today, she was scheduled for two tests that required that she be NPO. After the first test, the patient was returned to the floor. The patient's assigned nurse was at lunch. Another nurse checked with the radiology department and was told that the test was completed and that the patient could eat. She then provided the patient with a cold cereal until lunch trays were available. Subsequently, it was learned that the second test had not been completed, the test would then be delayed to the next day, and the patient would need to be NPO again. The patient's daughter displayed considerable anger regarding the delay in testing. Which of the following is the most appropriate response?

"I am sorry that this caused a delay in your testing. What can we do now to address this?"

A nurse is caring for a client who has chronic kidney disease and tells the nurse that he no longer wants to continue hemodialysis. Which of the following responses should the nurse make? "I will call your son so you can discuss this with him." "Why do you want to end your hemodialysis treatments?" "I will cancel your hemodialysis treatments for you as of today." "I will contact your provider so you can talk with her about your decision."

"I will contact your provider so you can talk with her about your decision." As an advocate for the client, the nurse should respect the client's right to discontinue hemodialysis. The nurse should notify the provider when a client refuses treatment. By contacting the provider for the client, the nurse relays to the client that she is willing to assist him with making an informed treatment decision.

During bedside rounds, a surgeon turns to you and says, "The poor nursing care has caused this wound to become infected. Can't nurses at this hospital do anything right?" The best response is:

"Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns."

A nurse manager is providing information about advocacy to a group of staff nurses. Which of the following statements by a staff nurse indicates an understanding of the teaching? "To advocate for my client I may need to speak with the provider on his behalf." "I should provide my client with a list of the options I feel are the best treatment choices." "It is my responsibility to inform the client if I do not feel he has made a wise choice." "I can advocate for my client by making the difficult decisions for him."

"To advocate for my client I may need to speak with the provider on his behalf." It is often the responsibility of the nurse to advocate for the client by directly intervening on the client's behalf. The client may need to speak to the family or the provider, especially if the client is unable to advocate for himself.

A clinical unit is instituting hourly patient rounding. Nurses are being taught a standardized script to use when making rounds to improve patient satisfaction. One of the nurses objects to using a standardized script. What is the best response by the nurse manager?

"What are your concerns about using a standard script while you make your rounds?"

A nurse is caring for a client who has a malignancy in her left breast. The client tells the nurse that even though her daughter wants her to have both breasts removed, she only wants to remove the left breast at this time. Which of the following responses should the nurse make? "You may want to reconsider so you don't have to have a second surgery later." "Would you like for me to help you to discuss your decision with your daughter?" "Why don't you want to have both breasts removed at this time?" "I would not want to have both breasts removed at the same time either."

"Would you like for me to help you discuss your decision with your daughter?" As an advocate for the client, the nurse should respect the client's treatment decision and respond by supporting the client. By offering herself to the client to assist her in speaking with her daughter, the nurse indicates acceptance of the client's decision without attaching conditions.

What are the five modes of Conflict Resolution?

1. Accommodating 2. Competing 3. Collaborating 4. Avoiding 5. Compromising

A clinical unit just received its patient satisfaction scores for the last month and the unit's scores are lower than that of other general medical/surgical units in the hospital and much lower than previous scores. Which of the following would be appropriate strategies for addressing the low patient satisfaction scores at this time? (Select all that apply).

A. Ask staff members what they think might be the cause of the decline. B. Examine nurse turnover data from the unit in comparison to other units. C. Ask for volunteers for a committee to make recommendations to investigate and address the problem.

A newly hired nurse has observed bullying behaviors on her new unit that include gossip, demeaning, criticizing, and intimidation. She also feels other nurses are avoiding her or giving her the silent treatment. The unit manager does little to address these behaviors. The consequences of this toxic culture include all but which of the following?

An increase in teamwork and communication

A newly licensed nurse is caring for a client who requires a colostomy irrigation to stimulate peristalsis. The nurse has not performed an irrigation before and does not feel comfortable with the procedure. Which of the following actions should the nurse take? Inform the charge nurse she is unable to perform the irrigation. Review the policy and procedure and perform the irrigation. Ask an experienced nurse to assist her with performing the irrigation. Tell the oncoming nurse during change-of-shift report that the colostomy requires irrigation.

Ask an experienced nurse to assist her with performing the irrigation. As a client advocate, the nurse should seek the assistance of an experienced nurse who can provide her with the proper supervision. In this way, the client receives competent care and the nurse is able to increase her skill level, competence and confidence with the new skill. The nurse should respect the client's right to have the skill performed competently, which demonstrates client advocacy.

How can a leader deal fairly with employees who fail to meet established standards of care?

Ask questions of the employee that can reflect the employee's knowledge base.

When the leader observes the employee has a significant increase in errors and may have some emotional problems, the most appropriate response is:

Ask the employee some questions ending with a suggestion that Employee Assistance might be an option

Upon entering a patient's room, the Emergency Department nurse observes a visitor attempting to choke the patient. The visitor appears agitated and is screaming at the patient. The patient is gasping and looks cyanotic. What should the nurse do first?

Call security for help.

Ms. Viola questioned if her staffing ratios demand the use of high-level delegation strategies. What Delegation Right is she assessing?

Circumstances

A nurse on a mental health unit is admitting a client who has generalized anxiety disorder. Which of the following tasks should the nurse plan to include in the orientation phase of the relationship between the client and the nurse?

Develop a contract with the client about how private information will be handled

An Iranian woman is admitted with a tentative diagnosis of Pneumocystis Carinii. She is being tested for HIV. The patient has limited English proficiency and her 21-year-old daughter has been translating for her. The daughter asked the nurse why blood tests are being done and when the results can be expected. The nurse indicates she wants to speak to the mother alone. However, both mother and daughter indicate that the nurse should proceed with the explanation. Which of the following is the best response?

Insist that a telephone language translation service be used.

A nurse on a med/surg unit has arrived late to work multiple times over the past several weeks. The nurse manager is planning to use progressive discipline to address this problem. Identify the sequence the nurse manager should follow. Please write the number next to each sentence by order.

Issue an informal verbal reprimand. (1) Give the nurse a formal written reprimand. (2) Suspend the nurse without pay. (3) Terminate the nurse's employment. (4)

Two employees disagree about who should work Christmas Day. The bottom line is that one employee will have to work and the schedule must be posted tomorrow. As the nurse manager, how can you best help them resolve the conflict?

Meet with both employees at the same time. Engage them in the problem-solving process.

A nurse is caring for a client who does not speak the same language as the nurse. The client is scheduled for a diagnostic procedure later in the day. Which of the following actions should the nurse take? Obtain an interpreter to explain the procedure to the client. Ask the client's daughter to serve as an interpreter. Acknowledge the client's understanding of the procedure by her head nods and smiles. Consult the hospital ethics committee to review the situation.

Obtain an interpreter to explain the procedure to the client As an advocate for the client, if the nurse and the client do not speak the same language, an interpreter should be consulted. The interpreter can explain the procedure to the client and ensure the client understands what will be done.

A nurse on a quality management team is developing written educational material for clients who have varying degrees of health literacy. Which of the following strategies should the nurse include to aid the clients in effective learning?

Provide instructional materials to the client that focus on desired behavior rather than medical facts

The nurse has received her assignment for the day and notices that her peer has a much lighter assignment in both number and acuity of patients. This is not the first time the nurse has noticed this inequity in assignments. She also has seen her peer and the charge nurse go to lunch together and knows that they spend time outside of work socializing. The nurse feels that this constant inequity in assignment is not fair. What is the best course of action for the nurse to address this problem?

Share her concerns with the charge nurse and find a mutually acceptable compromise for the situation.

You are caring for a 15-year-old female who has been admitted to the Emergency Department (ED) with severe abdominal pain. The teen's mother is present in the patient's room and does not let the teen really answer any questions. Which of the following is an appropriate strategy in continuing with the history and physical exam?

Thank the mother for her concerns, indicating that some time will be spent examining the teen alone.

A nurse is treating a plan of care for an older adult client who has a hearing impairment. Which of the following communication strategies should the nurse plan to use to enhance verbal dialogue with the client?

Pause between sentences to verify the client's understanding.

A nurse is caring for a client who has a new diagnosis of Lyme disease. The client states, "I've decided on a therapy plan, but I wish I knew more about how this happened to me! I always take good care of myself." Which of the following responses should the nurse make?

"You say you've made a decision about treatment, although you seem to be focusing on how it could've been prevented."

Factors that influence the ease with which conflict is resolved include all except which of the following?

Avoidance of the issue or concern.

Delegation, a multifaceted decision-making process, is implemented for all of the following reasons except to:

Decrease the registered nurse's accountability

The ability to transfer selected nursing activities in a given situation to a competent individual is known as:

Legal authority.

In the delegation process, all of the following factors need to be assessed except:

Medical insurance of the patient.

AIDET for excellent service stands for:

Acknowledge Introduce Duration Explanation Thank You