NUR 212 Test 2

a (Rationale When providing care in a collaborative​ team, the nurse will choose appropriate interventions related to the​ client's diagnoses within a specified time frame. The client has already been identified as high​ risk, high cost or high volume and selected for case management. Unlicensed assistive personnel may contribute to information​ gathering, but would not provide a plan of care. It is outside the scope of practice for the nurse case manager to prescribe medical orders to the client. )

A collaborative case management team is providing care for a high risk client with hypertension. What intervention is appropriate for the nurse case manager to implement as a member of this​ team? a Choosing appropriate interventions related to diagnoses within a specified time frame b Allowing unlicensed assistive personnel to develop the plan of care c Prescribing medical orders for the client d Determining whether the client represents high​ risk, high​ cost, or high volume

1. The primary role of a case manager is to coordinate the activities of all the other members of the health-care team and ensure that the patient is receiving care in the most appropriate setting.

A home health-care nurse is functioning as a case manager for a patient recently discharged from the hospital. What is the primary role of the nurse when functioning as a case manager? 1. Coordinator 2. Counselor 3. Provider 4. Teacher

a,b,e (Rationale The healthcare case management team may include unlicensed assistive personnel​ (e.g., a medical​ assistant), other licensed healthcare professionals​ (such as a​ pharmacist), and the​ client's primary care providers. Hospital administrators and the hospital attorney typically would not be represented on a healthcare case management team.)

A nurse case manager must initiate a case management team for a client with multiple medical disorders. Which team members does the nurse plan to invite to the initial care planning​ meeting? ​(Select all that​ apply.) a The hospital pharmacist b The medical assistant c The hospital administrator d The hospital attorney e The client​'s physician

4. The one who delegates a task is responsible for ensuring that the task is performed safely and according to standards of practice.

A nurse manager considers that there are "Five Rights of Delegation"—right task, right person, right communication, right time, and right: 1. Place 2. Route 3. Feedback 4. Supervision

1. This is essential to overcome resis- tance to change. There are many diff- erent reasons people resist change. Each person will respond to different strategies. There are four different types of interventions to overcome resistance: providing information, disproving currently held beliefs, maintaining psychological safety, and administrating an order or command.

A nurse manager is experiencing staff resistance when implementing change. What is the most important action by the nurse manager to overcome resistance to change? 1. Identify the reason for the resistance 2. Restate the purpose of the change concisely 3. Modify the objectives to appeal to more key people 4. Emphasize the positive consequences of the change

2. This is the most appropriate leadership style in a crisis when urgent decisions are necessary. In a crisis, one person needs to assume the responsibility for decisions. Autocratic leaders give orders and directions and make decisions for the group.

A nurse manager is informed that a large number of patients will be admitted in response to a terrorist attack. Which type of leadership style is most appropriate in this situation? 1. Collaborative 2. Authoritarian 3. Laissez-faire 4. Democratic

a,c,d (Rationale Beneficence means the​ nurse's actions should promote​ good; nonmaleficence means the nurse should do no harm and safeguard clients. Telling the truth is about​ "veracity," rather than​ "beneficence." Being fair to all possible clients is about​ "justice," rather than​ "beneficence.")

A nurse manager is talking to the night shift staff about the ethical principles supporting education of their preoperative clients. The nurse manager uses the words​ "beneficence" and​ "nonmaleficence." Which statements define these two​ concepts? ​(Select all that​ apply.) a The actions that nurses take should safeguard clients. b The actions that nurses take should be fair to all possible clients. c The actions that nurses take should do no harm. d The actions that nurses take should promote good. e The actions that nurses take should involve telling the truth.

3. Problem recognition is the first step in the problem-solving process. Once the unacceptable behavior is identified and acknowledged, then the reasons for the problem can be explored, solutions suggested, and expectations reinforced.

A nurse manager plans to provide feedback to a subordinate who needs a change in behavior. What is the best intervention by the nurse manager? 1. Be assertive 2. Explore alternatives 3. Identify the unacceptable behavior 4. Document the content of the counseling session

b (Rationale: Beneficence means "the actions one takes should promote good." A nurse teaching a class of adolescents is promoting the health and well-being of the community. Veracity is always telling the truth. The right to self-determination is autonomy. Nonmaleficence means to do no harm and safeguard the client.)

A nurse practices beneficence when teaching a class of adolescents about the risks of drinking and driving. Beneficence is best described as: a The right to self-determination b The actions one takes should promote good. c Always telling the truth d Do no harm and safeguard the client.

1. Medicaid is a federally funded, but state-regulated, health insurance pro- gram for individuals with low incomes.

A patient asks the nurse, "What is the difference between Medicare and Medicaid?" Which is the nurse's best response when describing the Medicaid program? 1. "A federally funded health insurance program for individuals with low incomes" 2. "A United States' federal health insurance program for individuals aged 65 years or older" 3. "A state program requiring practitioners to be providers of care to people living below the designated poverty level" 4. "A retrospective health-care reimbursement program that pays for the costs incurred by health-care agencies for the care of the indigent"

1. Providing for continuity of care is the major concern with early discharge as a result of DRGs. It requires careful planning to ensure that services, per- sonnel, and equipment are provided in a timely and comprehensive manner and care is not fragmented and disorganized.

A patient is discharged from the hospital 3 days after abdominal surgery because of the influence of Diagnostic Related Groups (DRGs). What should the nurse performing the discharge teaching be most concerned about? 1. Providing for continuity of care 2. Ordering equipment to be used in the home 3. Accepting discharge by the patient and family 4. Ensuring hospital reimbursement for services rendered

2. Obtaining vital signs can be delegated to a nursing assistant because it is not a complex task. It requires simple problem-solving skills and a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented appro- priately, it is within the scope of prac- tice of an unlicensed nursing assistant. It does not require the more advanced competencies of a Registered Nurse.

A patient is to be discharged from the hospital. Which discharge task can be delegate to a nursing assistant? 1. Teaching the patient how to measure weight using a standing scale 2. Obtaining the patient's temperature, pulse, and respiratory rate 3. Determining if the patient knows how to measure fluid intake 4. Demonstrating to the patient how to use a walker

2. Case management by the nurse in the home care setting includes determin- ing when the patient is ready for dis- charge. After the nurse determines that the patient is ready for discharge, it is conveyed to the practitioner and the practitioner discharges the patient. Nursing documentation supports the decision. Often the nurse needs to document objectively the status of the patient to convince the health-care provider and the insurer that the pa- tient needs a continuation of services.

A patient's contract for home care services is about to end but the patient still requires care. On which factor will the continuation of services mainly depend? 1. Presence of a practitioner's order 2. Nursing documentation of the need for care 3. Retrospective audits of quality management 4. Patient satisfaction with the care being provided

3. Generally, in the chain of command of an organization the staff nurse works under the direction of and reports to the unit's nurse manager. The nurse manager generally is an experienced nurse and is the primary resource per- son for the staff nurse. The staff nurse should seek guidance from the nurse manager when assistance is needed to solve a complex problem.

A staff nurse must solve a complex problem. Which is the nurse's most effective resource? 1. Organizational chart of the institution 2. Nursing procedure manual 3. Unit's nurse manager 4. Nursing supervisor

3. Students are accountable for the tasks assigned by the instructor or preceptor. As part of accountability, students are obligated to keep the instructor or preceptor informed about the status of the patient, how the assignment is progressing, and whether all interven- tions are implemented as planned.

A student nurse in the clinical area is given an appropriate patient assignment by the instructor. What should the student nurse do? 1. Accept the role of leader of the patient's health-care team 2. Complete the care indicated on the patient's plan of care 3. Assume accountability for the tasks that are assigned by the instructor 4. Help other students to complete their assigned tasks whenever necessary

2. This is an example of the directing function of management. Directing in- volves getting the work accomplished and includes activities such as assigning and communicating tasks and expecta- tions, guiding and teaching, and decision making.

A supervisor communicates expectations about a task to be completed and then dele- gates the task. Which management function is being implemented by the supervisor? 1. Planning 2. Directing 3. Organizing 4. Controlling

4. This is an example of expert power. Expert power is the respect one receives based on one's ability, skills, knowledge, and experience.

A unit manager mentors a new unit manager as part of orientation to the position. Which type of power is being used by the unit manager mentor? 1. Influence 2. Coercive 3. Referent 4. Expert

1. Effective management depends on care- ful planning. Planning activities include deciding what is to be done, when to do it, where and how to do it, and who will do it and with what level of assistance. Planning is multifaceted and involves assessment, problem identification, establishment of goals, identifying interventions based on priorities, and how outcomes will be evaluated.

An accurate assessment drives the rest of the steps of the nursing process. The nurse in charge understands that the management function that drives effective management is: 1. Planning 2. Directing 3. Organizing 4. Controlling

3. This is an example of assault. Assault is a verbal attack or unlawful threat caus- ing a fear of harm. No actual contact is necessary for a threat to be an assault.

An anxious patient repeatedly uses the call bell to get the nurse to come to the room. Finally the nurse says to the patient, "If you keep ringing, there will come a time I won't answer your bell." What legal term is related to this statement? 1. Slander 2. Battery 3. Assault 4. Libel

4. The DRGs, pretreatment diagnoses re- imbursement categories, were designed to decrease the average length of a hospital stay, reducing costs.

Diagnostic Related Groups (DRGs) mainly were instituted by the federal government to reduce the: 1. Number of professionals working in hospitals 2. Focus on illness and place it on prevention 3. Fragmentation of care 4. Cost of health care

A. Call for a staff meeting and take this up in the agenda. This will allow for the participation of every staff in the unit. If they contribute to the solutions of the problem, they will own the solutions; hence the chance for compliance would be greater.

Henry is a Unit Manager I the Medical Unit. He is not satisfied with the way things are going in his unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. He decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Henry? A. Call for a staff meeting and take this up in the agenda. B. Seek help from her manager. C. Develop a strategic action on how to deal with these concerns. D. Ignore the issues since these will be resolved naturally.

d (Critical pathways are always chosen through consensus by the collaborative healthcare team. Each team member has equal standing. Facility administrators and nurse case managers may have input on critical pathways when participating on the team but do not select critical pathways independently. The primary providers share equal status on the team.)

How are case management critical pathways chosen in healthcare​ delivery? a By the nurse case manager b By the facility administrator c By the primary provider d By the collaborative healthcare team

b (The PSDA protects the rights of clients to accept or reject aspects of their medical care. The ACA is healthcare law that provides for insurance and services. The ADA provides for access to public​ services, employment and benefits. HIPAA addresses health information privacy.)

Mr. Thomas is a​ 38-year-old client who uses a wheelchair as a result of a motorcycle accident 7 months ago. He decided that he will continue his physical​ therapy, but he will not take any more of the medications prescribed for muscle spasms because they make him feel weak. The nurse has assessed Mr. Thomas and believes that he understands his situation and is making an informed​ decision, although his healthcare provider disagrees with his choice. Which statement by the nurse is most​ appropriate? a ​"The Americans with Disabilities Act​ (ADA) protects your right to refuse​ medications." b ​"The Patient​ Self-Determination Act​ (PSDA) protects your right to refuse​ medications." ​c "The Affordable Care Act​ (ACA) protects your right to refuse​ medications." ​d "The Health Insurance Portability and Accountability Act​ (HIPAA) protects your right to refuse​ medications."

d (The nurse should practice culturally competent care by respecting the cultural values of the clients and advocating for those rights as needed. Telling the client that it is not appropriate for her husband to make her healthcare decision is not appropriate. There is no indication for the need for counseling. The nurse is passing judgment by telling the client that her husband is too controlling.)

Mrs. Rodriquez is a​ 32-year-old Hispanic client who is admitted to the hospital. Mrs. Rodriquez speaks​ English, yet her husband frequently answers for her and makes decisions about her care. The nurse notices that Mrs. Rodriquez seems to have chosen to have her husband make decisions for her. When caring for Mrs.​ Rodriquez, which statement by the nurse is most​ appropriate? a ​"I think your husband is too controlling and this is a​ problem." b ​"It is not appropriate for your husband to make your healthcare​ decisions." ​c "I would like to refer you and your husband to​ counseling." ​d "I understand that you and your husband have decided to let him speak for​ you."

2. Recognition of a problem is the first step in the problem-solving process. Once the unacceptable behavior is identified and acknowledged, then the reasons for the problem can be ex- plored, solutions suggested, and expectations reinforced.

Several nurses complain to the nurse manager that one of the patient care aides constantly takes extensive lunch breaks. What should the nurse manager do? 1. Convene a group meeting of all the patient care aides to review their responsibilities related to time management 2. Talk with the patient care aide to explore the reasons for the behavior and review expectations 3. Arrange a meeting with the nurses so that they can confront the patient care aide as a group 4. Document the patient care aide's behavior and place it in the aide's personnel file

a (Co-worker impairment, whether by drugs or​ alcohol, may interfere with job performance and may result in unsafe clinical​ practice, and must be reported immediately to a supervisor. Nurses are advocates for all​ clients, not just those in their care. Asking the nurse if she is intoxicated could cause confrontation or provide a chance to destroy evidence. The hospital administrator would be notified by the nursing supervisor.)

Tameka Whitt is a nurse who is making rounds on the surgical floor when she notices that one of the staff nurses is in the kitchen drinking from a metal flask. The staff​ nurse's eyes are​ glassy, her speech is​ slurred, and her breath smells like alcohol. Which action by Tameka reflects correct understanding of the​ ANA's Code of​ Ethics? a Contact the supervisor b Contact the hospital administrator c Ask the staff nurse if she is intoxicated d Tell the staff nurse that she should keep an eye on her

c (Rationale: Nurses acting as advocates respect their client's choice to make their own decisions. The nurse helps this family best by explaining about food and the dying client. Once the information is available to family members, they can concentrate on the care of the client instead of worrying. The nurse would not tell the family to force feed the client. Telling the family members to ignore the issue will not empower them. Fixing the client's favorite foods will most likely frustrate the family more. )

The family of a dying client is having a difficult time because the client is refusing food and is losing weight. Acting as advocate for the patient, the nurse states: a The family should force the client to eat. b The family should ignore the issue. c Food can actually cause painful problems at the end of life. d The family should make the client's favorite foods.

b (Rationale The nurse could help the client clarify values by helping the client list alternative courses of action. The nurse should stress that the client is making the​ decision, not the​ client's children. The client faces making decisions​ now, in spite of medical​ conditions, so talking about difficult matters should not be postponed.)

The home health nurse is helping a client with congestive heart failure to plan for the future. The client is having difficulty making some final decisions. What question could the nurse ask to help clarify the client​'s ​values? ​a "Are you feeling healthy enough to be making​ decisions?" b "What alternative courses of action have you been thinking ​about?" ​c "What do you think your children would like you to​ do?" ​d "Do you want to postpone talking about this difficult​ matter?"

a,b,c,d (Rationale An education pathway may include activity restrictions and​ instructions, safety​ issues, dietary planning and​ instruction, and medication administration teaching. Financial planning would not be included in the​ client's education​ plan, although it may appear in the plan for another discipline on the collaborative team.)

The nurse case manager has selected an education pathway for the client​'s course of care and will utilize actual and potential nursing diagnoses and timelines for goal achievement. Which activities may be selected for this​ pathway? ​ (Select all that​ apply.) a Medication administration b Safety issues c Dietary planning and instruction d Activity restrictions​ & instructions e Financial planning

1. Virtually everyone in the United States older than 65 years of age is protected by hospital, post-hospital extended care, and home health benefit insurance un- der Part A of Medicare. Patients pay a coinsurance of 20%, and the other 80% is paid by the government.

The nurse case manager is counseling an older adult patient about resources available to assist with the cost of health care. What organization should the nurse inform the patient provides the majority of the health-care costs for people older than 65 years of age? 1. Medicare 2. Medicaid 3. Blue Cross 4. Blue Shield

c (Rationale In order for the collaborative model of care to be​ effective, it is important for the nurse case manager to follow professional practice​ standards; reassessing the client when the client reports or the nurse observes a change in the​ client's conditions is within the scope of the nursing practice. Prescribing a​ medication, diagnosing a medical​ problem, and cancelling respiratory therapy are outside the scope of practice for the nurse. )

The nurse case manager is providing care to a client with a complex history. Which action is important when collaborating on this client​'s ​care? a Diagnosing the client with a new medical problem when the client​'s condition worsens b Cancelling respiratory therapy when the client​'s breathing improves c Reassessing the client when the client​'s condition improves d Prescribing a medication for treatment when the client​'s condition worsens

a,b,d (Rationale Critical pathways are utilized in every healthcare delivery setting. Senior centers and day care centers are not healthcare delivery settings.)

The nurse educator is preparing a lecture regarding settings that use critical pathway implementation. Which settings are appropriate for the educator to include in the​ presentation? ​(Select all that​ apply.) a Assisted living facilities b Rehabilitation facilities c Senior centers d Hospitals e Day care centers

a (Rationale: The moral principle of veracity refers to telling the truth, no matter the outcome. By lying, the nurse jeopardized the health of the client. Human dignity includes the belief of the inherent worth of the client. Autonomy is the right to self-determination. Social justice is the upholding of rules of equal treatment for all clients. )

The nurse hung a unit of blood on the wrong client, resulting in an anaphylactic reaction in the client. During the resuscitation, the nurse does not reveal that the wrong blood was given. Which moral principle was absent in the nurse's actions? a Veracity b Human dignity c Autonomy d Social justice

2. The role of advocate is the most important role of the nurse because in this role the nurse protects and supports patients' rights. Advocacy combines the roles of teacher, counselor, and leader so that the best interests of patients are protected, particularly when patients are most vulnerable.

The nurse identifies and meets the health needs of a patient. Which word best describes this role of the nurse? 1. Teacher 2. Advocate 3. Surrogate 4. Counselor

1. A case manager coordinates and links health-care services to clients and their families at single levels of care (e.g., during hospitalization) and across levels of care (e.g., progression through hospitalization, extended-care facilities, and home care).

The nurse identifies the major responsibilities of various health-care professionals. Which health care professional is best prepared to track a patient's progress through the health-care system? 1. Case Manager 2. Primary Nurse 3. Nurse Manager 4. Home Care Nurse

a (Rationale The nurse advocate must be aware of available healthcare options for treating the uninsured client. Advocacy does not involve​ transportation, scheduling, or healthcare provider preferences.)

The nurse is caring for a client at a free clinic. When advocating for this​ client, what does the nurse need to be aware of when planning​ care? a Available healthcare options b Clinic schedule requirements c Public transportation issues d Healthcare provider schedule preferences

b (Rationale The client is afforded protection in the area of​ employment, public​ services, and benefits by the Americans with Disabilities Act of 1990. The PPACA is a health insurance and assurance act. The PSDA regards rights to​ decision-making in medical care. The SSA Amendments introduced the Medicare program.)

The nurse is caring for a client with Down syndrome. The client was recently denied employment because of the​ syndrome, and the client and his mother are very upset and are requesting assistance. Which piece of federal legislation is most appropriate for the nurse to refer to when advocating for this​ client? a The Patient​ Self-Determination Act of 1991​ (PSDA) b The Americans with Disabilities Act of 1990​ (ADA) c The Patient Protection and Affordable Care Act of 2010​ (PPACA) d The Social Security Act Amendments of 1965​ (SSA)

3. Of the options offered, the word pro- tector best describes the role of the nurse when functioning as the patient's advocate. In the role of advocate, the nurse protects and supports patients' rights and assists in asserting those rights when patients are unable to defend themselves.

The nurse is functioning as a patient advocate. What word best describes this nursing role? 1. Provider 2. Nurturer 3. Protector 4. Evaluator

2. Home care agencies are responsible for coordinating and providing for a con- tinuum of comprehensive health-care services after a patient is discharged from the hospital. Because of the decreased length of stay in the hospital setting, patients are being discharged sooner than ever before and are in need of home care services.

The nurse is preparing a patient for discharge from the hospital. Which is designed primarily to provide for a continuum of comprehensive health care after discharge? 1. Practitioners' offices 2. Home care agencies 3. Urgent visit centers 4. Respite programs

d (Rationale: The case manager is responsible for coordinating the care of the client from admission through discharge. When the client has orders for services beyond the hospital setting, the case manager arranges the care so that continuity of care is maintained. The nurse is no longer responsible for notifying the home health agency or physical therapy, but is responsible for collaborating with the case manager to assure that the services will be in place when the client is discharged. The nurse manager does not need to be notified unless a situation arises that would need a manager's expertise. )

The nurse is working with a client who will be discharged home in the next few days. The nurse notes that the client has orders for home health and physical therapy after discharge. The nurse plans to notify: a The nurse manager b The physical therapy department c The home health agency d The case manager

c (Rationale The nurse advocate is​ following-up, which is one of the four dimensions of advocacy. The other three are being a client​ advocate, providing​ resources, and going above and beyond. Routine calls are not going above and beyond. Enabling​ self-care and advising the client of legal rights are not included in the four dimensions of advocacy.)

The nurse makes a telephone call to a client who was recently discharged. The nurse wants to assess whether the client has read the discharge material and made appointments with the healthcare provider. Which dimension of advocacy is involved with this​ intervention? a Enabling​ self-care b Advising about legal rights ​c Following-up regarding care d Going above and beyond

4. The controlling function of manage- ment includes the evaluation of staff members. This is in addition to ensur- ing that plans are carried out and the outcomes evaluated.

The nurse manager evaluates the performance of a subordinate. Which management function is being implemented by the nurse manager? 1. Planning 2. Directing 3. Organizing 4. Controlling

a,b,e (Rationale Support systems that are useful to nurses who work in settings where ethical issues arise frequently include regular team conferences on subjects selected by the​ team, easy access to the use of counseling​ professionals, and availability of mentoring by experienced nurses. Protocols for advanced directives support​ evidence-based practice and primary nursing teams help to facilitate continuity of​ care, but they do not support the staff who works in an environment with frequent ethical issues.)

The nurse manager in the assisted living facility is finding that ethical issues arise frequently in this setting. The nurse manager empowers the entire clinical team to make suggestions for support activities. Which suggestions by the staff nurses are relevant to ethical​ issues? ​ (Select all that​ apply.) a Regular team conferences on subjects selected by the team b Availability of mentoring by experienced nurses c Use of primary nursing teams to facilitate care d Protocols for advanced directives for dying clients e Easy access to the use of counseling professionals

4. Health-care professionals who have prescriptive licenses (e.g., physicians, nurse practitioners, physician's assis- tants) must order home care nursing services. An order from a provider with a prescriptive license is required if a home care agency is to receive reim- bursement from third-party sources (e.g., government, medical insurance plans). Orders written by these profes- sionals direct the medical plan of care.

The nurse must initiate nursing services in the home setting. Which is the most important factor that the nurse must consider to ensure third-party reimbursement? 1. The patient must be able to perform some self-care 2. The family has the financial resources to pay for the care 3. Additional family members need to be available for support 4. Intervention must be ordered by a provider with a license to prescribe

2. Critical pathways are a case manage- ment system that identifies specific protocols and timetables for care and treatment by various disciplines designed to achieve expected patient outcomes within a specific time frame.

The nurse understands that critical pathways in health care refer to: 1. Educational career ladders for health-care professionals 2. Multidisciplinary plans with predetermined patient outcomes 3. Times during life when certain health problems are more likely to occur 4. Organizations that provide services that progress from acute care to long-term care

2. Demonstration is the safest way to assess whether a person has the knowledge and skill to safely perform a procedure. A superior delegating care is responsible for ensuring that the person implementing the care is legally qualified and competent.

The nursing team leader delegates a wound irrigation to a Licensed Practical Nurse (LPN). It has been a long time since the LPN performed this procedure. To ensure patient safety the nursing team leader should: 1. Verbally describe to the LPN how to perform the procedure 2. Have the LPN demonstrate how to perform the procedure 3. Assign another LPN to assist with the procedure 4. Delegate the procedure to another LPN

4. Managers, not leaders, have responsi- bility. Leaders can be formal or infor- mal. Informal leaders are not assigned to direct others. They are viewed as leaders by the members of the group because of their experience, vision, charisma, confidence, expertise, or age.

The primary difference between effective leaders and managers is that managers have: 1. Vision 2. Charisma 3. Confidence 4. Responsibility

b,c,e (Rationale When advocating for​ clients, it is important for the nurse to protect the​ clients' rights, and inform the public about issues and concerns through press releases and media. The nurse can also run for public office as a means of advocating for clients. Researching health disparities and making decisions for clients are not topics that would be included in a session about advocating for clients.)

The public advocate is providing an educational session to nurses regarding advocacy. Which items are appropriate to include in the teaching​ session? ​ (Select all that​ apply.) a Researching health disparities b Running for public office c Using media to inform the public d Making decisions for clients e Protecting clients​' rights

3. To inform is an important role of the nurse when functioning as a patient ad- vocate. Inform means to give informa- tion, to enlighten, and to give knowl- edge. When working with families to explore the nature and consequences of their choices, the nurse can provide in- formation so that people understand the ramifications of their choices. An in- formed decision is a decision based on an understanding of the facts and ramifications associated with the choice.

What action related to advocacy reflects the nurse's attempt to work with family members to explore the nature and consequences of their choices? 1. Affirming 2. Mediating 3. Informing 4. Interviewing

4. When the nurse manager follows policies and procedures, the manager is demonstrating the behavior that is expected. Role modeling is more effective than telling as a teaching strategy.

What activities does a nurse manager engage in who values the importance of positive role modeling? 1. Counseling subordinates who fail to meet expectations 2. Holding team meetings to review rules of the agency 3. Reviewing job descriptions with employees 4. Following the policies of the agency

1. Case management is a major role of the nurse in the home care setting. The nurse engages in activities, such as assessing, planning, coordinating nurs- ing care and professional services, making referrals, monitoring medical progress, maintaining documentation, evaluating and monitoring outcomes, determining closure, and discharging the patient after goal achievement.

What is a significant role of the nurse in the home care setting? 1. Case management 2. Discharge planning 3. Enlisting family support 4. Modifying patient values

1. This is one of the most important actions by the nurse seeking a new position. The job description provides an overview of the requirements and responsibilities of the role. Job descrip- tions include factors such as educa- tional and experiential requirements, job responsibilities, subordinates to be supervised, and to whom one reports in the chain of command.

What is the first thing the nurse should do when planning to apply for a new position within an agency? 1. Review the job description 2. Provide at least several positive references 3. Identify if power is associated with the position 4. Locate the position on the agency's Table of Organization

3. Cooperation and teamwork are essen- tial for the achievement of any goal. If a consensus is achieved about the value of the expected outcome, people are more likely to work together constructively.

What is the main reason the nurse manager achieves a consensus when making a decision within a group? 1. Explore possible alternative solutions 2. Demonstrate that staff members are flexible 3. Facilitate cooperative effort toward goal achievement 4. Ensure the use of effective autocratic decision making

1. Leaders can inspire others with their vision and gain cooperation through their persuasion and communication skills (influence power), the respect others have for their knowledge and abilities (expert power), and their charisma and prior success (referent power).

What is the major focus of leadership? 1. Inspiring people 2. Creating change 3. Controlling others 4. Producing a product

1. Although planning, problem solving, and empowering others are tasks of a manager, the bottom line is for the manager to accomplish the work of the organization.

What is the major focus of nursing management? 1. Accomplishing an objective 2. Empowering others 3. Problem solving 4. Planning

4. Primary nursing is a case management approach in which one nurse is respon- sible for a number of patients 24 hours a day, 7 days a week. It is a way of pro- viding comprehensive, individualized, and consistent nursing care.

What nursing-care delivery model is based on case management? 1. Patient classification system 2. Diagnostic Related Groups 3. Critical pathways 4. Primary nursing

1. Change that is consistent with current values and beliefs is easier to implement than change that is inconsistent with current values and beliefs. Values and beliefs are difficult to change.

What should the manager do first to overcome resistance to change? 1. Ensure that the planned change is within the current beliefs and values of the group 2. Provide incentives to encourage commitment to the change 3. Implement change in small steps rather than large steps 4. Use informational power to ensure that goals are met

3. Legally required activities must be accomplished because they are depen- dent functions that support the medical regimen of care. Although legally required activities should be accom- plished first, many independent actions by the nurse also must be implemented to maintain a basic standard of care and patient safety. Some nursing interven- tions, which are not essential, can be implemented after the required activities.

What should the nurse do to ensure efficiency when managing a daily assignment? 1. Give care to a patient in isolation first 2. Plan activities to promote nursing convenience 3. Organize care around legally required activities 4. Perform routine bed baths between breakfast and lunch

4. The word consultative is most closely related to the democratic leadership style. Democratic leaders encourage discussion and decision making within the group. The leader facilitates the work of the group by making sugges- tions, offering constructive criticism, and providing information.

When considering leadership styles, an "autocratic" leader is to "authoritarian" as a "democratic" leader is to: 1. Directive 2. Permissive 3. Oppressive 4. Consultative

3. This is the issue that the nurse man- ager needs to explore. The employee may have an acceptable reason for re- fusing to comply. When the reason is identified, then the nurse manager can take an informed action.

When delegating a specific procedure to a patient care aide, the aide refuses to perform the procedure. What should the nurse do first? 1. Assign the procedure to another patient care aide 2. Explain that it is part of the patient care aide's job description 3. Explore why the patient care aide refused to perform the procedure 4. Send the patient care aide to the procedure manual to review the procedure

4. This is a relatively new trend in health- care delivery. Nurse Practitioners gener- ally are master's-prepared individuals who work independently or collabora- tively with physicians to provide primary health-care services. Nurse Practitioners work independently under their own license, are accountable for their own practice, have prescriptive authority, and receive third-party reimbursement, depending on the state in which they work. In the states that do not permit this level of health-care delivery, Nurse Practitioners work under the license of a physician who supervises their practice.

Which health-care team member can provide independent health care with third-party reimbursement in the emerging health-care delivery system in the United States? 1. Licensed Registered Nurse 2. Clinical Nurse Specialist 3. Physician's Assistant 4. Nurse Practitioner

1. Strong communication skills are an essential competency of a nurse man- ager. Research demonstrates that 80% to 90% of a manager's day is spent communicating verbally and in writing. Managers need to express their thoughts clearly, concisely, and accurately.

Which is most basic for a nurse new to a management position? 1. Strong interpersonal communication skills 2. Awareness of when to be confrontational 3. Knowledge of the role of a change agent 4. Recognition by peers as a leader

d (​Diagnosis-related groups, or​ DRGs, allow nurses to work toward predetermined client outcomes within specific time frames and resources. DRGs are used to organize the​ client's care. Cost​ containment, health​ promotion, and resource utilization are factors that must be considered in planning​ care, but they do not assist the nurse in organizing client care.)

Which item is used by the nurse case manager when organizing a​ client's care? a Use of resources b Cost containment c Health promotion ​d Diagnosis-related groups​ (DRGs)

B. Preparing a nursing care plan in collaboration with the patient The best source of information about the priority needs of the patient is the patient himself. Hence using a nursing care plan based on his expressed priority needs would ensure meeting his needs effectively

Which of the following is the best guarantee that the patient's priority needs are met? A. Checking with the relative of the patient B. Preparing a nursing care plan in collaboration with the patient C. Consulting with the physician D. Coordinating with other members of the team

b (Rationale: The nurse has an ethical responsibility to act only when actions are safe or risks minimized. This nurse is putting the client at unnecessary risk for a medication error. Many medical practices are controversial but not necessarily unethical; the nurse should follow the agency policy. Although some may view nurses' strikes as unethical, supporting others who are striking is a personal decision. A client's statement to a nurse may have ethical overtones, but it does not automatically constitute an ethical dilemma. Since the assigned primary care provider is a member of the team, principles of confidentiality do not include him or her. )

Which situation is a violation of the underlying principles associated with professional nursing ethics? a The nurses on the unit agree to sponsor a fund-raising event to support a labor strike proposed by fellow nurses at another facility. b A nurse colleague states, "I never look up medication indications. I just give what is prescribed." c The hospital policy permits use of internal fetal monitoring during labor even though there is literature that both supports and refutes the value of this practice. d A client reports that he didn't tell the doctor the truth when asked if he was following his therapeutic diet at home.

2. Change causes one to move from the comfortable to the uncomfortable and is known as unfreezing in Lewin's Change Model. It involves moving away from that which is known to the unknown, from the routine to the new, and from the expected to the unexpected. The unknown, new, and unexpected can be threatening, which can increase anxiety.

Which statement is most significant in relation to the concept of change theory in the health-care environment? 1. Barriers to change can be overcome by embracing new ideas uncritically 2. Change generates anxiety by moving away from the comfortable 3. Behaviors are easy to change when change is supported 4. Change is most effective when spontaneous

b (Client advocacy is a primary role for every nurse, so there is always a need for client advocacy. Ensuring the client has informed consent is an example of client advocacy. The other options are nursing interventions, not actions of advocacy.)

Which statement reflects the nurse acting in the advocacy intervention role? a "I am going to listen to your heart and lungs now." b "I want to make sure you understand what procedure you are about to have done." c "Can you tell me what year it is and where you are right now?" d "I am going to start your IV now and start the antibiotics that the doctor ordered."

c (Health promotion concerns itself with growth and​ development, ensuring good nutrition and​ exercise, stress​ management, and preventing disease. Safety concerns itself with injury​ prevention, neglect, and abuse. The Bill of Rights helps clients to understand their rights. The PSDA protects the rights of clients to accept or reject aspects of their medical care.)

Which type of client advocacy concerns itself with growth and​ development, ensuring good nutrition and​ exercise, stress​ management, and preventing​ disease? a Safety b Patient​ Self-Determination Act​ (PSDA) c Health promotion d Bill of Rights

a (Rationale: Adults with disabilities who work are provided with a sense of dignity. Since the adults cannot advocate for themselves, the nurse would intervene on their behalf. The nurse does not need to protect the van driver or the house manager. The nurse is not protecting the job, but the clients. )

The nurse oversees care of mentally challenged adult clients who live in a group home but work part time. The funding to transport these clients is being cut. The nurse advocates against this to protect: a The dignity of the clients b The liability of the house manager c The person who drives the van d The job of the nurse

D. Leadership is shared at the point of care. Shared governance allows the staff nurses to have the authority, responsibility and accountability for their own practice.

She surfs the internet for more information about leadership styles. She reads about shared leadership as a practice in some magnet hospitals. Which of the following describes this style of leadership? A. Leadership behavior is generally determined by the relationship between the leader's personality and the specific situation B. Leaders believe that people are basically good and need not be closely controlled C. Leaders rely heavily on visioning and inspire members to achieve results D. Leadership is shared at the point of care

b (Rationale Nurses advocate for clients in order to protect their rights and empower them to participate in making informed healthcare decisions. While enabling is a type of​ advocacy, it is not the intended goal for this client. Principles of informed consent are not involved here.​ Co-dependency is the opposite of what advocacy seeks to achieve)

The nurse provides education to the client who is facing a difficult healthcare choice. What is the intended goal of this​ action? a Enabling b Empowerment c Informed consent ​d Co-dependency

b (Rationale: The U.S. Advisory Commission on Consumer Protection addresses the client's right to choose a healthcare plan. The ANA Code of Ethics determines the practice ethics of nurses. State laws are enacted from federal laws. Medicare does not have a bill of rights. )

The nurse overhears a client on the phone arguing with someone about having the right to choose a healthcare plan. The nurse recognizes that the client's topic is addressed in: a State law b U.S. Advisory Commission on Consumer Protection c Medicare bill of rights d The ANA Code of Ethics

3. This is the safest intervention because it goes to the original source of the pre- scription.

When the nurse is administering a medication to a confused patient, the patient says, "This pill looks different from the one I had before." What should the nurse do? 1. Ask what the other pill looked like 2. Explain the purpose of the medication 3. Check the original medication prescription 4. Encourage the patient to take the medication

a (rationale: When presented with an ethical situation, identify the moral issues and principles involved. The nurse should discuss the reasons the client does not want his wife to know the diagnosis. This will clarify the benefits the client sees in his decision. The other choices are disrespectful of the client's wishes, or imply something about the client that may not be true. )

A client asks the nurse not to tell his wife that he has cancer. What would be the most appropriate response by the nurse? a "What benefits do you see from not telling your wife your diagnosis?" b "Why are you afraid to tell her?" c "I'm sorry, but the doctor already told her." d "Don't you think she has a right to know?"

d (Rationale: In an effort to return the client to normal, the nurse removes the client from an over stimulating environment to a quieter area, talking calmly to the client. Giving the client medication before trying other tactics could be considered abuse and restraint. Telling the client to calm down will not work in this case. Taking away privileges is threatening behavior. )

A client in a mental health unit is experiencing escalating agitation. As an advocate for this client, what is the nurse's initial action? a Take away the privileges the client has earned. b Give the client an emergency sedative shot. c Tell the client to calm down immediately. d Remove the client to a quieter setting.

C. Laissez faire Laissez faire leadership is preferred when the followers know what to do and are experts in the field. This leadership style is relationship-oriented rather than task-centered.

A nurse manager came across a theory which states that the leadership style is effective dependent on the situation. Which of the following styles best fits a situation when the followers are self-directed, experts and are matured individuals? A. Democratic B. Authoritarian C. Laissez faire D. Bureaucratic

a (Rationale: A moral framework guides moral decisions, but it does not determine the outcome. The decision is the family's decision, not the nurse's decision. Providing the client and his wife with more information is the most appropriate response. The other responses are judgmental and inappropriate. )

A 67-year-old male client states that he and his 37-year-old wife would like to have a child. A 23-year-old surrogate will carry the child. Which response by the nurse is most appropriate? a "I will ask our counselor to give you additional information." b "Why isn't your wife carrying your own child?" c "You will be 87 when your child is 20." d "You could adopt a child instead."

3. When a nurse renders emergency care, the nurse has an ethical responsibility not to abandon the injured person. The nurse should not leave the scene until the injured person leaves or another qualified person assumes responsibility.

A Registered Nurse witnesses an accident and assists the victim who has a life-threatening injury. What should the nurse do to meet the most important standard when acting as a Good Samaritan at the scene of an accident? 1. Seek consent from the injured party before rendering assistance 2. Implement every critical-care intervention necessary to sustain life 3. Stay at the scene until another qualified person takes over responsibility 4. Insist on helping because a nurse is the best-qualified person to provide care

c (Rationale: Many moral problems surrounding the end of life can be resolved if clients complete advance directives. Currently, all 50 states have enacted advance directive legislation. Advance directives are legal documents representing a client's end-of-life decisions; they may include how clients want medical decisions to be made or whom they would like to make those decisions. An advance directive may include a DNR clause, but it is not mandatory. )

A client requests information on completing an advance directive. The nurse knows that an advance directive: a Must always include a Do Not Resuscitate (DNR) clause b Cannot be utilized as a legal document c Legal document representing a client's end-of-life decisions d Has been used in 35 of the 50 states in the United States

c (Rationale: To protect the client effectively, the nurse needs to understand what has influenced the client's decision and whether the client has thought about the results of the decision. The other choices do not respect the client's right to choose.)

A client with cancer has decided against further treatment. Which action by the nurse would be most appropriate? a Informing the client's spouse, and encouraging the spouse to talk to the client and intervene, if necessary. b Talking to the client and trying to persuade the client to think about reversing the decision. c Making sure the client has accurate information and understands the consequences of the decision. d Accepting the decision and making no comments to the client.

c (The nurse case manager would begin by facilitating a discussion of the​ client's DRGs​ (diagnosis-related groups) to​ identify, organize and discuss issues that may be impeding progress in the​ client's care due to the complication after surgery. Once the issues are​ identified, the team may progress to defining interventions and expected outcomes within each​ member's expertise and timelines for goal achievement. Issues related to cost​ containment, such as which pharmacologic interventions are covered by​ insurance, would be part of the discussion but would not be the priority.)

A collaborative care team has been formed to assist with the care management of Ray​ Southard, who is 58 years old. Mr.​ Southard's recovery from cardiac bypass surgery has been complicated by postoperative gastric bleeding and bilateral pneumonia. The team consists of a physical​ therapist, respiratory​ therapist, dietitian,​ physician, and nurse case manager. Which topic is the priority for the nurse case manager to discuss while facilitating this​ meeting? a Prescriptions allowed by the​ client's health insurance company b The​ client's goals for physical therapy c The need to update the​ diagnosis-related groups d The​ client's respiratory interventions

c (Rationale: Some of the most frequent disturbing ethical problems for nurses involve issues that arise around death and dying. Nurses must learn to assist clients and families to discuss their options surrounding terminal care. It is appropriate for the nurse to provide the family opportunity to talk about their decisions. The family may wish to grieve on their own; however, the nurse must first assess to see if this is what the family requests. To notify the family of possible organ donation or to request the physician at the client bedside, is inappropriate. )

A family is struggling with the decision to remove life support on a child who was in a near-drowning accident. What is the best action for the nurse to take? a Allow the family to grieve on their own and only intervene if family requests. b Call the physician to be present at the client's bedside. c Provide the family opportunity to talk about their decisions. d Notify the family about the possibility of organ donation.

c (Rationale: The nurse advocate must recognize that the rights and values of clients and families take precedence when they conflict with those of health care providers. The nurse must protect the client's rights, remain objective, and intervene on behalf of the client. The nurse advocate does not make the clients' decisions for them or talk them out of their decisions if they differ from the opinions of anyone on the health care team. )

A gravely ill client wishes to establish a relationship with a nurse so that the nurse may act as an advocate when the client's health declines. Which goal exemplifies advocating for a client? a Talk the client out of a decision if it differs from the nurse's opinion. b Make decisions for the client. c Protect the client's rights. d Report the client's decisions to the family.

b (Rationale: The nurse advocate must recognize that the rights and values of clients and families take precedence when they conflict with those of health care providers. The nurse must protect the client's rights, remain objective, and intervene on behalf of the client. The nurse advocate does not make the clients' decisions for them or talk them out of their decisions if they differ from the opinions of anyone on the health care team. )

A gravely ill client wishes to establish a relationship with a nurse so that the nurse may act as an advocate when the client's health declines. Which goal exemplifies advocating for a client? a Talk the client out of a decision if it differs from the nurse's opinion. b Protect the client's rights. c Report the client's decisions to the family. d Make decisions for the client.

1 ( Assess the patient for behaviors that would warrant seclusion (i.e., represent a danger to self or to others), then discuss your concerns with the provider. If seclusion is punitive, there is a potential for violation of rights, regardless of whether the order is verbal or written. Although patients do need limit setting and clear boundaries, you must intervene in the "least restrictive" manner. After additional assessment, you may decide that documentation, seclusion, and continued care are options. However, you may also decide that you need to go up the chain of command to prevent future similar incidents. Focus: Prioritization; QSEN: TC, QI; Concept: Ethics)

A health care provider verbally directs you to seclude Ms. M for several hours because "she was belligerent and argumentative" during an interview. You request a written order, but he declines because "it is just temporary and I already explained the consequences of the behavior to the patient." What is the best approach in dealing with this situation? 1. Assess the patient for signs of aggressive or dangerous behavior and discuss your findings and concerns with the provider. 2. Refuse to follow the verbal order because you are violating the patient's rights if you do not have a written order. 3. Recognize that setting limits and enforcing consequences are part of the treatment plan, so seclude and monitor accordingly. 4. Document the situation, seclude the patient, and continue to care for her to the best of your ability.

d (Rationale: An advocate supports clients in their decisions, giving them full or at least mutual responsibility in decision making when they are capable of it. The advocate must be careful to remain objective and not convey approval or disapproval of the client's choices. Advocacy requires accepting and respecting the client's right to decide, even if the nurse believes the decision to be wrong. Asking another provider to provide the dressing change is inappropriate. The nurse might collaborate with the physician, but the nurse must adhere to basic care principles when supporting the client. Telling the client that discharge is imminent is a threat. )

A home care client is noncompliant with changing his dressing. The nurse's next action will be to: a Ask the physical therapist to do the dressing change. b Call the primary care provider for new orders that match what the client is doing. c Tell the client he will be discharged from home care services if he does not comply. d Discuss with the client his personal values and resource allocation needs at home.

b (Rationale: An advocate supports clients in their decisions, giving them full or at least mutual responsibility in decision making when they are capable of it. The advocate must be careful to remain objective and not convey approval or disapproval of the client's choices. Advocacy requires accepting and respecting the client's right to decide, even if the nurse believes the decision to be wrong. Asking another provider to provide the dressing change is inappropriate. The nurse might collaborate with the physician, but the nurse must adhere to basic care principles when supporting the client. Telling the client that discharge is imminent is a threat. )

A home care client is noncompliant with changing his dressing. The nurse's next action will be to: a Call the primary care provider for new orders that match what the client is doing. b Discuss with the client his personal values and resource allocation needs at home. c Ask the physical therapist to do the dressing change. d Tell the client he will be discharged from home care services if he does not comply.

c (Rationale: During hospice care, hospice nurses may need to provide support to both clients and families affected by conditions known to have genetic predisposition. Asking family members to have genetic testing, discussing birth control methods, and notifying the Public Health Department are all inappropriate responses. )

A hospice nurse is caring for a terminally ill client with an inherited genetic disease. The role of the nurse in caring for the client includes: a Asking all family members to be tested for the genetic disease b Discussing birth control methods to family members of the client who are of child-bearing age c Providing support to the client's family d Notifying the Public Health Department regarding the genetic disease

b (Rationale: Most agencies have patient advocates whose job is to assist the client when conflict arises and to protect the client's rights. Neither the nurse manager nor the physician is the appropriate person to deal with the client. A risk manager is concerned with client and staff injuries. )

A new nurse is assigned to the client who is disappointed by the care given by another nurse. The family of the client asks the new nurse how they can make a formal complaint. The nurse's best action is to: a Refer them to the nurse manager. b Offer to notify the agency patient advocate. c Refer them to the physician. d Have them contact the risk manager.

d (Some values basic to client advocacy include: the client is a holistic, autonomous being who has the right to make choices and decisions; the client has the right to expect a nurse-client relationship that is based on shared respect, trust, and collaboration; the nurse has the responsibility to ensure the client has access to healthcare services that meet health needs. A dependent client who requires a durable power of attorney is not a value basic to client advocacy. )

A nurse acting as a client advocate understands that the values basic to client advocacy includes all except: a The client has the right to expect a nurse-client relationship that is based on shared respect, trust, and collaboration. b The client is a holistic, autonomous being who has the right to make choices and decisions. c The nurse has the responsibility to ensure the client has access to healthcare services that meet health needs. d The client is a dependent being who requires a durable power of attorney.

a (Rationale: Political activism is a way for a nurse to become a public advocate. The nurse reads proposed laws and then contacts politicians to give opinions of the impact the new laws will have on healthcare and the public. Conducting educational classes on the unit is not public advocacy. Becoming a preceptor is advocating for the unit clients and new nurses. Obtaining a master's degree is not public advocacy. )

A nurse desires career advancement through public advocacy. The nurse plans to: a Contact the local congressman about a new health law. b Conduct educational classes for the unit respiratory therapists. c Become a preceptor on the unit. d Obtain a master's degree in nursing.

a,b,d,e (Rationale The successful nurse case management model requires​ collaboration, identified outcomes and time​ frames, continuous quality​ improvement, variance​ analysis, and professional practice. Client disability is not a factor in the​ model's success.)

A nurse educator is presenting information to a group of students regarding successful implementation of the nurse case management model. What teaching points will the educator include in the​ presentation? ​ (Select all that​ apply.) a The need for all team members to collaborate b The need to adhere to the standards of professional practice c The requirement that the client must be disabled to qualify d The role of continuous quality improvement and variance analysis e The importance of identifying expected outcomes with time frames

a (Rationale: The ethical obligation to care for an HIV-infected client cannot be set aside unless the risk exceeds the responsibility. The nurse has an ethical obligation to care for the client regardless of the client's reason for contracting the disease. The nurse's religious beliefs are not a valid reason to decline to care for the client. There are many times when caring for a client may be distasteful, but the client has the right to be cared for by the nurse. )

A nurse is asked to care for an openly gay client with AIDS. The nurse tells her supervisor that caring for the client is against her religious beliefs. Does this nurse have an ethical obligation to care for the client? a Yes, unless the risk exceeds the responsibility. b No, because the client's behavior caused him to contract AIDS. c No, the nurse does not have to violate religious beliefs. d No, it may be distasteful to the nurse.

b (Nurses have a legal responsibility to report any professional whom they suspect of engaging in illegal, immoral, or unethical activities. Normally, the nurse making such a report will do so following established procedures at the facility at which the nurse is employed. Ignoring the co-worker's behavior is not only immoral, but illegal as well. Notifying the public health department is not a part of reporting via the chain of command. It is not professional for the nurse to speak to other co-workers regarding a colleague's behavior unless the co-worker is the person who the nurse must report these suspicions. )

A nurse suspects a co-worker of engaging in illegal, immoral, or unethical conduct. What is the appropriate action by the nurse? a Ignoring the co-worker's behavior b Following established procedures at the facility at which the nurse is employed c Notifying the public health department d Inform other co-workers of the nurse's suspicions

4. Narcotics depress the central nervous system, including decision-making abilities. This person is considered functionally incompetent.

A practitioner asks the nurse to witness an informed consent. Which patient does the nurse identify is unable to give an informed consent for surgery? 1. 16-year-old boy who is married 2. 35-year-old woman who is depressed 3. 50-year-old woman who does not speak English 4. 65-year-old man who has received a narcotic for pain

b,c (Rationale: A manager is an individual employed by an organization to accomplish its goals. An organization grants managers the required authority, responsibility, accountability, and power to get their job done. Managers use the subfunctions of supervising, evaluating, negotiating, and representing. The other choices are more specific to leaders.)

A student nurse asks the nurse to explain the difference between a nurse leader and nurse manager. The nurse states that which features are exclusive to managers only ? (Select all that apply.) a Someone who uses interpersonal skills to influence others to accomplish a specific goal. b An individual employed by an organization to accomplish its goals. c Uses the subfunctions of supervising, evaluating, negotiating, and representing. d Does not have delegated authority.

a (Rationale: The nurse is aware that marijuana has been shown to be effective for a condition a client has that has not responded to mainstream therapies. Although the nurses' personal moral issues may be involved, the nurse must determine whether, ethically, the client should be made aware of a potentially effective alternative. Telling the patient that they shouldn't take drugs is inappropriate because, in this case, marijuana for medical use is legal. Refusing to provide the client information and referring the client to their doctor for information regarding therapy, are incorrect answers. )

A terminally ill client asks the nurse to provide her with information on medical marijuana use, which is legal in the state she lives in. Which is the best response by the nurse? a "Marijuana has been shown to be effective for certain conditions that have not responded to conventional therapy." b "You shouldn't take drugs." c "I cannot give you any information regarding that therapy." d "I will notify your physician regarding your desire for more information."

Answer: 2. Give assignments clearly, taking staff expertise into consideration. Rationale: 1: Critical thinking is important for every RN, not just a manager 2: Giving clear assignments is a characteristic of authority. The young nurse who takes staff expertise into consideration when making assignments is likely to be more successful in leading the group. 3: Nurse managers do work in complex health care environments but must create an appropriate organizational environment as a way of exercising authority. 4: In autocratic leadership, one person has all of the power. This is not a good approach for a younger leader to adopt when working with a group of older, more experienced nurses.

A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager's authority because of the age difference. How can this nurse manager best exercise authority? 1. Use critical thinking to solve problems on the unit. 2. Give assignments clearly, taking staff expertise into consideration. 3. Understand complex health care environments. 4. Maintain an autocratic approach to influence results.

2 ( First try to determine how the nurses found out about the patient's admission. This is a serious Health Insurance Portability and Accountability Act (HIPAA) violation, and information disclosure must be immediately stopped. Unfortunately for these RNs, administration will have to be notified, but as a professional courtesy it would be better if they went directly to the supervisor and admitted the error, rather than you calling the supervisor and reporting them. Focus: Prioritization, supervision; QSEN: I, QI; Concept: Ethics)

A well-known celebrity is admitted to your psychiatric unit. Several RNs from other units drop by and express an interest in seeing the patient. What is the best response? 1. "Please be discreet and do not interrupt the work flow." 2. "How did you find out that the patient was admitted to this unit?" 3. "Please wait. I need to call the nursing supervisor about this request." 4. "I'm sorry; the patient has asked that only family be allowed to visit."

Answer: 3. Control the environment. 5. Focus on efficiency. Rationale: 1: The manager accepts the status quo, while the leader challenges it. 2: The manager controls people, while the leader influences 3: The manager controls the environment, patient care, and the staff that deliver that care. 4: The leader focuses on people while the manager focuses on systems and structure. 5: Managers focus on efficiency, while leaders focus on effectiveness.

Compare and contrast manager roles and leadership roles by choosing the options that are more aligned with the manager role. Select all that apply. 1. Focus is change. 2. Have the ability to influence others. 3. Control the environment. 4. Focus is on people. 5. Focus on efficiency.

a (Critical pathways provide the nurse case manager and nursing staff with a framework from which each​ day's expected goals and outcomes can be achieved. Potential complications in the​ client's course of care are presented on the​ nurse's care plan. All critical pathways are decided by team consensus of a team of experts in their clinical​ area; members are responsible for their own area and are not subject to the​ nurse's evaluation. The nurse is always aware of the​ client's need for privacy and would not require a critical pathway designation to achieve this goal.)

Critical pathways assist nurse managers and nursing staff to increase their awareness in which aspect of client​ care? a Outcomes the client should achieve on a given day b Potential complications that may be encountered when providing care c Privacy and confidentiality considerations in providing care d Deficiencies in care provided by other healthcare providers

a,b,d,e (Rationale Common features of all critical pathways include a timeline for goal​ achievement, determination of predictable characteristics of medical illness or​ injury, a mechanism for monitoring variances and​ trends, and utilization of appropriate resources for the care needed. A fire escape plan is not a healthcare critical pathway.)

Critical pathways share certain common features regardless of the healthcare setting. Which statements by the nurse illustrate the common features of critical​ pathways? ​(Select all that​ apply.) a "A timeline for goal achievement is a common feature of critical pathways b "The determination of predictable characteristics of the medical illness or injury is a common feature of a critical pathway. c "A fire escape plan for all clients on the unit is a common feature of a critical pathway. d "The ability to monitor variances and trends is a common feature of a critical pathway. e "Utilization of appropriate resources for the care needed is a common feature of a critical pathway.

a,c,e (Coordinating and planning​ care, collaborating with other health​ professionals, and following principles of continuous quality improvement​ (CQI) are essential responsibilities of the nurse case manager. Client billing is a function of billing and coding specialists. Nurse case managers do not write discharge orders for hospitalized patients.)

In addition to​ assessing, monitoring, and evaluating the​ client's care, what other aspects of care are responsibilities of the nurse case​ manager? ​(Select all that​ apply.) a Collaborating with other health professionals b Writing discharge orders for hospitalized patients c Coordinating and planning care d Ensuring that the client is billed appropriately e Following continuous quality improvement principles​ (CQI)

b,c (The nurse would turn to the state board of nursing or the American Nurses Association for guidance regarding the behavior of a​ co-worker. Nursing school would not be an official resource. The National Alliance on Mental Illness is an advocacy program. The nurse would not initiate consultation with the police dash- this would be done by the employer.)

In deciding to report a​ co-worker who has engaged in​ illegal, immoral, or unethical​ conduct, the nurse can turn to which organizations for​ guidance? ​(Select all that​ apply.) a The National Alliance on Mental Illness b The American Nurses Association c The state board of nursing d Nursing school e The police

A. Identify the source of the conflict and understand the points of friction This involves a problem solving approach, which addresses the root cause of the problem.

Katherine is a young Unit Manager of the Pediatric Ward. Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action that she must take? A. Identify the source of the conflict and understand the points of friction B. Disregard what she feels and continue to work independently C. Seek help from the Director of Nursing D. Quit her job and look for another employment

Answer: 4. Staff nurses provide input into planning and changes for their own unit. Rationale: 1: In participatory organizations, the control of the organization is decentralized and many decisions are made by those "on the front lines" of the organization. 2: The theory is that the staff should be nurtured to promote greater leadership competency. 3: According to Drucker, when staff participate in the core functions of management, the organization is more effective. 4: According to Drucker, when staff participate in the core functions of management such as planning and changes for their own units, the organization is more effective.

Peter Drucker's view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization? 1. The control of the organization is centralized, and decisions are made by upper-level management. 2. Staff nurses are expected to provide support and nurturing for management's decisions. 3. The organization's approach to leadership is autocratic and bureaucratic. 4. Staff nurses provide input into planning and changes for their own unit.

d (Rationale The nurse would use bilingual skills to interpret medical information for the client and then relay the​ client's needs and wishes to other healthcare professionals. The nurse would never sign documents on the​ client's behalf. The nurse would not discuss the​ client's care with anyone but other healthcare professionals who are involved in the​ client's care. The nurse would never be involved in the​ client's financial transactions.)

The bilingual nurse is caring for a client who speaks only Spanish. What is the best way for the nurse to advocate for this​ client? a Discussing the client​'s care with the client​'s visitors b Signing consent forms on the client​'s behalf c Arranging for bill payment for the client d Representing the client​'s needs and wishes to other healthcare professionals

d (Addressing client safety is always a priority for​ care, and the​ client's health history and home observation indicate a need for additional teaching related to activity restrictions and safety measures. There is no indication of elder abuse at this time. Contacting the physician is not a priority because this is not a new diagnosis for the client. The nurse would set a timeline for goal achievement after goals are set with the client and family)

The new nurse case​ manager, Claire, has been asked to identify a critical pathway for the care of an older adult​ client, Mildred Daugherty. Mrs.​ Daugherty's osteoarthritis has caused severe limitations in​ mobility, leading to a fall injury. While performing a home​ assessment, Claire determines that Mrs. Daugherty lives at home with her son and has to walk up a flight of stairs to gain entry. The house is cluttered with small throw​ rugs, excess​ furniture, and stacks of old newspapers and magazines. What is​ Claire's priority when formulating a treatment plan for Mrs.​ Daugherty? a Setting a timeline for goal achievement b Contacting the physician regarding the​ client's diagnosis c Contacting the local authorities because of suspected elder abuse d Teaching the client about activity restrictions and safety measures

d (Rationale The nurse is morally obliged to support the​ client's right to make his own healthcare decisions. The healthcare​ providers' may advise the client about best​ options, but may not make decisions for the client. The hospital does not have authority to make decisions for the client. The nurse must respect the​ client's culture and​ traditions, even if they create conflict with the​ nurse's own beliefs and values.)

The new nurse observes that her client is becoming upset with his healthcare providers because they disagree with the client​'s decision to discontinue his cancer treatment. Although the nurse feels conflicted by the client​'s ​decision, which moral obligation guides the care that is provided to the​ client? a The nurse explains to the client that he is making a mistake because his culture and traditions are leading him down the wrong path. b The nurse must defend the healthcare providers​' choice to continue cancer therapy because that is what is best for the client. c The nurse respects that the hospital has the final authority to make decisions for the client. d The nurse supports the client​'s right to make his own healthcare decisions.

b (Rationale: Medication errors do occur and the nurse is ethically bound to report these errors, regardless of whether the client had an adverse reaction or not. The nurse would notify the charge nurse of the mistake, who would document the error on an incident report, not in the patient's chart. Notifying the Board of Registered Nursing is not the nurse's responsibility, but the agency may be notified if the nurse's supervisor deems the mistake incompetent in nature. )

The nurse administers the wrong medication to the client and the client appears to have had no adverse reaction to the medication error. What is the best action for the nurse to take once she realizes her mistake? a Notify the Board of Registered Nursing. b Notify the charge nurse. c Document the error in the patient chart. d Reporting the incident is not necessary because the patient had no adverse reaction.

a,d,e (Rationale Numerous hospitalizations and injuries related to diagnoses meet the criteria for case management. Taking multiple medications increases client risk for injury and increases the​ client's medical costs. Case management is often used as a care management model to improve quality of care for high​ volume, high​ cost, high risk cases. Being cared for by a single provider and use of emergency medical services​ (EMS) are not criteria for case management.)

The nurse case manager is assigned a client who is frequently admitted to the hospital with the same diagnosis related to hypertension and diabetes. Which criteria indicate the need for case​ management? ​ (Select all that​ apply.) a The client has been hospitalized several times in the past year. b The client receives care from a single provider. c The client arrived at the hospital via ambulance. d The client has a history of falls. e The client takes multiple prescription medications.

a (Rationale The nurse case manager would evaluate whether the client has met documented outcomes. It is outside the scope of the nurse case​ manager's practice to prescribe medications or make a medical diagnosis. The nurse case manager is not responsible or able to bill for services that the hospital provides to the client. )

The nurse case manager is providing care to a client with uncontrolled diabetes. What intervention is appropriate for the case manager to provide for this​ client? a Evaluating whether the client has met documented outcomes b Billing the client for hospital services related to care c Diagnosing the client with a medical diagnosis based on lab values d Prescribing medications to control the clients blood glucose levels

b (This client represents a high volume scenario due to the number of times he has been hospitalized in this last year. Case management is used to improve the quality of care of those clients who have high​ volume, high​ cost, and high risk cases. Lack of cooperation with​ care, the age of the​ client, and the diagnosis are not reasons that case management is implemented to improve the quality of care.)

The nurse case​ manager, Candace, evaluates Clark​ Jones, a​ 52-year-old male client. Mr. Jones has been hospitalized for the fourth time this year with diabetic ketoacidosis and a left foot infection that is developing gangrene. Candace discovers that Mr. Jones has type 2 diabetes with a long history of not participating in his disease management. Mr. Jones skipped his last four diabetes clinic​ appointments, takes his insulin when he​ "feels like​ it," smokes​ tobacco, and eats a high​ fat, high sugar diet. Which factor indicates that Mr. Jones has a need for case​ management? a Diagnosis b Number of hospitalizations c Lack of cooperation with care d Client age

Answer: 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." Rationale: 1: Managers need to be honest and forthcoming with staff, which includes taking responsibility for one's own actions and errors. This also provides a positive role model for the staff. 2: When errors occur, the manager should use the opportunity for improvement, not punishment. 3: When staff feel some staff are given extra credit, staff will feel uncomfortable with the manager and resentment will build. 4: Staff need to feel that they can share their feedback, positive or negative, and not feel threatened when they disagree with the manager.

The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role? 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." 2. "Don't be too soft on the staff. If they make a mistake, be certain to reprimand them immediately." 3. "Give your best nurses extra attention and rewards for their help." 4. "Never get into a disagreement with a staff member."

a (Rationale: There are many disciplines who will participate in the care of a postoperative hip client. Critical pathways provide direction for the management of the client's care. Critical pathways have similarities to a nursing care plan; they are not a care plan, but are an outcome of goals that are directed at all disciplines caring for the client. Critical pathways do not force the client to do anything. They are individualized to meet each client's needs. Critical pathways are fluid and modified depending on the progress of the client. They are geared to facilitate healing, but do not guarantee it, since many variables may affect the progress of the client. )

The nurse is caring for a client who has been placed on a critical pathway for care following hip surgery. The client asks the nurse why there is a need for this type of care model. The best response by the nurse is: a "Critical pathways give direction to the team caring for you." b "Critical pathway is just a new term for the nursing care plan." c "Critical pathways make you adhere to the program of care." d "Critical pathways ensure that you will get well."

b (Rationale The priority action of the nurse is to determine the cause of the bruising. This can be accomplished by asking the client how the bruising occurred. If the client is unable to provide information to the​ nurse, then it is appropriate to ask family members or contact those who cared for the client. Reporting the bruising as abuse should not occur until the nurse has evidence that supports this claim.)

The nurse is caring for a client with paranoid schizophrenia who was recently transferred to the facility. Upon​ assessment, the nurse notes bruising on the client​'s wrists and ankles. What is the priority action by the​ nurse? a Call the previous facility to determine the causes of the bruising. b Ask the client how the bruising occurred. c Call the police to report abuse. d Ask the client​'s family if they caused the bruises.

c (Rationale Clients with low overall literacy and low health literacy levels have difficulty understanding their medical situation and become easily confused with navigating the healthcare system. Advocacy is needed in that situation. The client speaks English. The client feels well and is not in pain. There is not enough information to determine his income level.)

The nurse is developing the plan of care for an​ English-speaking Micronesian man with an 8th grade education who has hypertension. The client is noncompliant with taking medications and is not following up with the healthcare provider as needed. Which criteria indicates the need for an advocate to help the client access the resources he​ requires? a Low income level ​b Non-English speaking c Lower literacy level d Very ill or in pain

b,c,d,e (Rationale The decision to discontinue life support for any client is handled by the healthcare​ system, particularly its risk management and legal departments along with the family of the client. Principles of medical ethics and legal issues guide the​ decision-making process and are intended to protect the​ client's rights and the healthcare​ system's interests. Culture and diversity considerations address the values and beliefs of the client and family. Rehabilitation nursing would not be employed in an​ end-of-life scenario.)

The nurse is involved in the case of a minor client who is placed on life support after complications during surgery left her without neurologic function. The client​'s parents have retained legal counsel to prevent the hospital from discontinuing life support. Which advocacy concepts must be considered when communicating with the client​'s ​family? ​(Select all that​ apply.) a Rehabilitation nursing b Legal issues c Healthcare systems d Medical ethics e Culture and diversity

Answer: 2. If the nurses learn about and use relevant leadership and management theories and styles this is possible. Rationale: 1: A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders. 2: In today's health care environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices. 3: Control, competition, and getting the job done are past theories and styles and are not as useful in today's environment. 4: Leadership is a skill that can be learned.

The nurse manager has asked that all staff nurses develop effective leadership competencies. How should the staff nurses interpret this request? 1. This is an unrealistic expectation, because only managers are leaders. 2. If the nurses learn about and use relevant leadership and management theories and styles this is possible. 3. In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done. 4. Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation.

a (Rationale The nurse case manager is responsible for improving coordination of care. An appropriate goal for the nurse to share with the family is coordinating medical visits on the same date. Receiving all medical reports from one physician is not a realistic​ goal; the client can expect to receive medical reports for each physician group. The nurse would not independently decide on the type of care the client will require. Care would be determined in collaboration with members of the team. Setting medical goals with the client and family it outside the scope of practice for the nurse case manager.)

The nurse on a case management team must teach the client and family about the goals of care for the client. What is a priority goal for the nurse to share with the client and his family​ members? a Coordinating medical visits on the same date b Setting medical goals with the client and family. c Receiving all medical reports from one physician d Determining independently the type of care the client will need

d (Rationale Nursing diagnoses identify the overall outcomes needed and then are used in the development of critical​ paths, which assist staff in tracking client progress toward meeting the goals of the day. Nursing diagnoses are not medical diagnoses and offer no explanation of medical diagnoses. Members of the collaborative team develop their own plan of care according to the area of expertise.)

The nurse utilizes critical paths in deciding the outcomes to be achieved by the client that day. What role does nursing diagnosis play in the​ process? a Nursing diagnoses are not a part of the critical path process. b Nursing diagnoses are followed by all the members of the collaborative team. c Nursing diagnoses are used to help explain the medical diagnoses. d Nursing diagnoses identify the overall outcomes needed.

a,c,e (Rationale The three main assessment criteria to determine advocacy needs are the​ client's ability to cooperate and make​ decisions; the reliability of information provided by the​ client, especially if the client exhibits impairment of cognitive function of mental​ instability; and the​ client's medical history and family situation. Access to transportation is a service consideration. Food preferences would not determine the need for advocacy.)

The nurse wants to determine the advocacy needs of a client. Which items will the nurse include in the assessment to determine advocacy​ needs? ​(Select all that​ apply.) a Reliability of information b Access to transportation c Medical history and family situation d Food preferences e Ability to cooperate and make decisions

b (Rationale: The nurse must become aware of personal values and the ethical aspects of nursing. The nurse must collaborate with other members of the healthcare team. When values conflict, compromise is essential. The nurse might have the charge nurse administer the medication. Nurses must not impose personal values and beliefs on their clients. )

The nurse, who is opposed to abortion, is asked to give a medication to the client that will terminate the client's pregnancy. Which strategy might help the nurse in this case? a Refuse to participate in the collaboration regarding this client. b Have self-awareness of values and beliefs. c Withhold the medication until the prescribing person arrives. d Tell the client that taking the medication is immoral.

d (Rationale: Autonomy is the client's (or surrogate's) right to make his or her own decision. The nurse is obliged to respect a parent's or significant other's informed decision regarding the client. This situation is not one of nonmaleficence (do no harm) or beneficence (do good). Justice (fairness) generally applies when the rights of one client are being balanced against those of another client. )

The parents of a child with no apparent brain function refuse to permit withdrawal of life support. Which moral principle is applied with the nurse's action to support the family's decision? a Nonmaleficence b Beneficence c Justice d Respect for autonomy

Answer: 1. Autonomy. 2. Responsibility. 4. Accountability. Rationale 1: Autonomy in clinical decision making occurs whenever a nurse makes an independent judgment about the presence of a clinical issue and then provides the resolution. This nurse identified that the patient was experiencing distress and made the clinical judgment to use emergency orders. The nurse could have also made a clinical judgment not to use them. Rationale 2: This nurse was entrusted with a particular function, in this case, caring for a post-op patient. Rationale 3: There is no indication that the nurse delegated care of this patient to anyone. Rationale 4: Accountability is the acceptance of responsibility of the outcomes of care. Rationale 5: This term is not one of the critical elements of nursing.

The patient who had a colonoscopy one hour ago suddenly experiences bright red rectal bleeding, becomes diaphoretic, and is short of breath. The nurse decides to implement standing emergency orders and initiates oxygen per mask and increases the patient's IV rate while a colleague contacts the patient's physician. Which critical element of nursing is this nurse demonstrating? Standard Text: Select all that apply. 1. Autonomy. 2. Responsibility. 3. Delegation. 4. Accountability. 5. Relevance.

4 ( Administering placebos is generally considered unethical. Consult the charge nurse as a resource person who can help you clarify the situation and locate and review the hospital policy. If the physician is insistent, suggest that he or she could give the placebo. (Note: Use "could," not "should" when talking to the physician. This provides a small opportunity to rethink the decision. "Should" is more commanding and elicits a more defensive response.) While following your own ethical code is correct, you must ensure that the client is not abandoned and that care continues. Focus: Prioritization; QSEN: PCC, QI, TC; Concept: Ethics)

The physician has ordered a placebo for a client with chronic pain. You are a newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take? 1. Prepare the medication and hand it to the physician. 2. Check the hospital policy regarding the use of a placebo. 3. Follow a personal code of ethics and refuse to participate. 4. Contact the charge nurse for advice.

a

The school nurse identifies a need for a vaccination program in the school district. The nurse is acting in which role? a Advocate b Opponent c Reactionary d Adversary

c (Rationale: Nurses who function responsibly as professional and public advocates are in a position to effect change. To act as an advocate in this arena, the nurse needs an understanding of the ethical issues in nursing and health care, as well as knowledge of the laws and regulations that affect nursing practice and the health of society. Opponent, reactionary, and adversary are not roles that effect positive change. )

The school nurse identifies a need for a vaccination program in the school district. The nurse is acting in which role? a Opponent b Adversary c Advocate d Reactionary

a (Rationale: A nurse's actions in an ethical dilemma must be defensible according to moral and ethical standards. The nurse may have strong personal beliefs, but distancing oneself from the situation does not serve the client. A team is not always required to reach decisions, and the nurse is not obligated to follow the client's wishes automatically when they may have negative consequences for self or others. )

Which action is the most important nursing responsibility when an ethical issue arises? a Being able to defend the morality of one's own actions b Ensuring that a team is responsible for deciding ethical questions c Remaining neutral and detached when making ethical decisions d Following the client and family wishes exactly

Answer: 3. Laissez-faire. Rationale: 1: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur. 2: Bureaucratic leaders depend upon policy and rules. This is not always a good style of leadership, but it is unlikely the complaints in this scenario would occur. 3: This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptions of the patients. 4: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is likely the complaints in this scenario would occur.

There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing? 1. Autocratic. 2. Bureaucratic. 3. Laissez-faire. 4. Authoritarian.

d (Rationale The pediatric nurse would provide​ adequate, age-appropriate information about the disease and treatment options. The​ client's mother would be included in the teaching process before being called upon to explain things to her child. A child who wants to be involved in her care is not a problem. Distraction would be inappropriate and counter to the concepts of advocacy.)

The​ ten-year-old client is very interested in learning about her cancer care and in participating in the decisions about her care. What is the most appropriate action by the pediatric​ nurse? a Informing the healthcare team that the child is going to be a problem b Telling the client​'s mother that she needs to explain things to her child c Distracting the child with a video game d Providing​ adequate, age-appropriate information about the disease and treatment options

d (Rationale: Contingency planning is when the manager identifies and manages unplanned and unexpected events that interfere with getting work done efficiently, effectively, and in a timely manner. Strategic planning refers to the process of continual assessment, planning, and evaluation to guide the future. Continuous quality improvement is an example of the controlling role of the management theory, not planning. Staff planning is not a feature of management theory. )

Two registered nurses call in sick for the 12-hour night shift. In order to solve the staffing problem, the nurse manager displays which management theory duty? a Staff planning b Continuous quality improvement c Strategic planning d Contingency planning

Answer: 2. Autocratic. 4. Directive. 5. Authoritarian. Rationale: 1: This style is focused on organizational rules and policies. 2: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 3: This is a "hands-off" approach. 4: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 5: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

Typically the nurse manager of a unit uses a participatory style of leadership. Today a patient suffered a cardiac arrest; the manager took over the patient's care, issuing orders, and expecting staff to obey them immediately. Which type of leadership did this manager exhibit today? Select all that apply. 1. Bureaucratic. 2. Autocratic. 3. Permissive. 4. Directive. 5. Authoritarian.

b,c,d,e (Rationale Because the client is the primary​ decision-maker, the nurse should facilitate client involvement and organize care around the​ client's schedule. Licensed and unlicensed care providers are to be monitored for participation in quality management and goal achievement. Clients and families often require education before discharge.​ Diagnosis-related groups​ (DRGs) are used to organize priorities.)

What are the activities that a nurse case manager can employ to facilitate the goals of the case management​ group? ​(Select all that​ apply.) a Scheduling client activities around the​ nurse's schedule b Providing appropriate educational activities related to the diagnosis c Prioritizing case management activities using an appropriate​ diagnosis-related group d Engaging the client in planning care e Coordinating and monitoring care provided by a medical assistant

Answer: 1. Staffing. 3. Program evaluation. 4. Allocation of resources. 5. Long-range planning. Rationale 1: This is a responsibility of the nurse manager in most shared governance models. Rationale 2: In most shared governance models, the nurse manager is not responsible for providing direct patient care. Rationale 3: This is a responsibility of the nurse manager in most shared governance models. Rationale 4: This is a responsibility of the nurse manager in most shared governance models. Rationale 5: This is a responsibility of the nurse manager in most shared governance models.

What are the responsibilities of the nurse manager in most shared governance models? Standard Text: Select all that apply. 1. Staffing. 2. Direct patient care. 3. Program evaluation. 4. Allocation of resources. 5. Long-range planning.

d (Cost containment is an important ultimate goal of the collaborative care team. Improved client nutrition may be a goal of the​ dietitian, but is not an ultimate goal of the team. Shortened hospitalization time is desired over complications or extension of stay. In a​ team, decisions are made by​ consensus, not by one person.)

What is a goal of the multidisciplinary collaborative care​ team? a Extended hospitalization b Improved client nutrition c Paternalistic​ decision-making d Cost containment

a (When assessing a child and family for advocacy​ needs, it is most important for the nurse to look at the healthcare options available to the child and family. The nurse would take the client​'s ability to manage symptoms into account when working with a client with a mental health disorder. The nurse would not be involved in health insurance planning through the ACA. The ADA would not be part of the initial assessment of needs.)

When initially evaluating the needs of children and​ families, it is most important for the nurse to have knowledge of which​ item? a Healthcare options b Ability to manage symptoms c The Americans with Disabilities Act​ (ADA) d The Affordable Care Act​ (ACA)

a,d,e (Abusive​ and/or unprofessional behaviors by professional staff include making privileges contingent on​ favors, supplying clients with drugs or​ alcohol, and making general threats of harm if clients do not behave as they were told. The advocate would immediately report any of these behaviors to the supervisor. Refusing to share homemade cookies and using restraints are not abusive behaviors.)

Which actions by professional staff are considered abusive or unprofessional behavior toward clients with mental health​ disorders? ​ (Select all that​ apply.) a Making privileges contingent on favors b Refusing to share homemade cookies with the client c Using restraints for a client who is a threat to others d Supplying clients with drugs or alcohol in return for favors e General threats of harm if clients do not behave as they were told

Answer: 3. The nurse supports team members. Rationale: 1: While technical skill is important for all nurses, it is not a hallmark of a competent leader. 2: Chaos theory states that solutions are not always clear and policies might not always be applied easily; other options might need to be considered. 3: In Emotional Intelligent theory, team members support each other and feel supported by the team leader. 4: This statement reflects the country club leadership style.

Which behavior demonstrates the nurse's competency as an emotionally intelligent leader? 1. The nurse is proficient in technical skills. 2. The nurse relies on policies, not options. 3. The nurse supports team members. 4. Productivity is not a major concern.

a,b,d,e (Clients who do not speak​ English, have lower literacy​ levels, are very ill or in​ pain, or are of low income levels have more difficulty navigating the healthcare system and would benefit from the assistance of a nurse advocate. Clients who have family support may also have better resources for obtaining information needed for decision making.)

Which client groups are more likely to need an advocate when accessing healthcare​ resources? ​(Select all that​ apply.) a A client who has a lower literacy level b A family whose primary language is Spanish c A client diagnosed with cancer who has family support d A family who is living in poverty e A client in chronic pain

c,d (Planning care and​ decision-making as well as educating about the disease process are client centered activities. Organizing case management by DRGs and collecting and analyzing baseline data are administrative functions. Monitoring care provided by unlicensed personnel is a supervisory function.)

Which collaborative care team activities provided by the nurse case manager would be considered​ client-centered? ​(Select all that apply​.) a Monitoring care provided by unlicensed personnel b Collecting baseline data for​ decision-making c Educating about the disease process d Planning care and​ decision-making e Organizing case management priorities by DRG

2. The National Council of State Boards of Nursing is responsible for the NCLEX examinations; however, the licensing authority in the jurisdiction in which the graduate takes the examination verifies the acceptable score on the examination.

Which organization is responsible for ensuring that Registered Nurses are minimally qualified to practice nursing? 1. Sigma Theta Tau 2. State Boards of Nursing 3. American Nurses Association 4. Constituent Leagues of the National League for Nursing

d (The overall goal of client advocacy is to safeguard clients from harm and to represent their needs to other healthcare professionals. Speaking for clients and educating clients are actions that support the protection of the​ client's rights. All nurses are client​ advocates, with or without special training.)

Which statement describes the overall goal of client​ advocacy? a The overall goal of client advocacy can only be achieved by specially trained nurses. b The overall goal of client advocacy is to speak for clients. c The overall goal of client advocacy is to educate clients. d The overall goal of client advocacy is to safeguard the client from harm.

3 ( The staff member who is most knowledgeable about the regulations regarding HIV prophylaxis and about obtaining a client's HIV status and/or ordering HIV testing is the occupational health nurse. Performing unauthorized HIV testing or asking the client yourself would be unethical. The charge nurse is not responsible for obtaining this information (unless the charge nurse is also in charge of occupational health). Focus: Prioritization; QSEN: PCC, S; Concept: Ethics)

You have received a needlestick injury after giving a client an intramuscular injection, but you have no information about the client's HIV status. What is the most appropriate method of obtaining this information about the client? 1. You should personally ask the client to authorize HIV testing as soon as possible. 2. The charge nurse should tell the client about the need for HIV testing. 3. The occupational health nurse should discuss HIV status with the client. 4. HIV testing should be performed the next time blood is drawn for other tests.

1 ( First, the situation should be assessed to determine if a HIPAA (Health Insurance Portability and Accountability Act) violation has occurred. Client information should be released only to facilitate continuity of care (i.e., in a shift report) and only to those who are directly involved in the care. If HIPAA rules were violated, the incident would be reported to the nurse manager for potential complaints related to the UAP's actions and so that the UAP could receive the proper remediation. Giving positive feedback for sincere efforts to assist clients and families is appropriate, but guidelines must be recognized and followed. Focus: Supervision; QSEN: TC, I, QI; Concept: Ethics)

You overhear one of the UAPs talking to someone on the phone. The UAP says, "Yes, Mr. D is doing much better than when he first got here. I will tell him that you called and I will give him your message." What will you do first? 1. Ask the UAP about the phone conversation that you just overheard. 2. Remind the UAP that release of information is outside her scope of practice. 3. Report the UAP to the nurse manager for a HIPAA violation. 4. Give positive feedback for trying to help the client and the caller.