Archer Management Concepts

Which of the following nursing leadership and management-related statements is accurate? A. Nurse managers possess personal accountability for not only their own specific acts but also acts of delegation and supervision. B. Nurses and nurse managers are accountable for supervising others, except for unlicensed assistive personnel (UAP). C. When delegated to the appropriate person, the delegating nurse is no longer responsible for ensuring the task is performed correctly. D. Managing care entails micromanagement of the unit's staff. Submit Answer

Explanation Choice A is correct. Accountability cannot be delegated. The delegating nurse is ultimately responsible for ensuring the task is performed correctly. When entrusting the care of clients to others, you are able to transfer the responsibility and authority to do the job while retaining the liability for the quality of care provided to the client(s). Therefore, Choice A is correct. Choice B is incorrect. Nurses and nurse managers retain accountability for the supervision of others, including those who are often unlicensed assistive personnel (UAP). Moreover, supervision includes monitoring the tasks performed, ensuring that functions are performed in an appropriate fashion, and ensuring that assigned tasks and functions do not exceed competency or require a license to perform. Therefore, Choice B is incorrect. Choice C is incorrect. No matter to whom a task is delegated, the delegating nurse will remain responsible for ensuring that the task is performed correctly. Therefore, Choice C is incorrect. Choice D is incorrect. Micromanagement is not only unnecessary, but it harbors an unfavorable work environment and decreases staff confidence levels. Effective leaders are confident in their staff and the training they have provided to their staff members, utilizing the appropriate periodic assessment methods to ensure quality. Therefore, Choice D is incorrect. Learning Objective Identify the correct statement related to nursing leadership and management. Additional Info The delegatee must have been trained and validated as competent to perform the task or responsibility. The nurse cannot delegate a task that requires nursing judgment or critical thinking. Delegation can only occur by an individual that owns delegating authority. The delegating nurse is ultimately responsible for ensuring the task is performed correctly. According to the nurse practice act, any delegated task must be within the scope of practice of the delegator and the delegatee. Within every health care setting, the delegation process is multidimensional, beginning at the administrative level. Administrators are responsible for determining the criteria and creating the policies and procedures governing the delegation of nursing responsibilities. Administrators are also responsible for the periodic assessment of the delegation process and the ongoing promotion of a healthy working environment. In 2019, the NCSBN published national guidelines outlining the five rights of delegation. These rights included the following: (1) Delegation of the right task (2) Delegation under the right conditions (3) Delegation to the right individual (4) Delegation by providing the right instructions and effective communication (5) Delegation with the right supervision and assessment Last Updated - 05, Aug 2022

The concept of management is most closely associated with: A. Decision-making, problem-solving, and priority setting. B. Inspirational abilities and coaching. C. Visionary abilities and supervision. D. Motivational and visionary abilities.

Explanation Choice A is correct. The concept of management is most closely associated with decision-making, problem-solving, priority setting, and collaboration/coordination of patient care services. Choice B is incorrect. Inspirational abilities and coaching are most closely associated with leadership and supervision, respectively, and not management. Choice C is incorrect. Visionary abilities and supervision are most closely associated with leadership and supervision, respectively, and not management. Choice D is incorrect. Motivational and visionary abilities are most closely associated with leadership and not management. Last Updated - 30, Dec 2021

You are educating a new nurse regarding sentinel events. Which of the following are examples of sentinel events? Select all that apply. A. An untimely assessment of the client. B. An incomplete assessment of the client. C. A client falls from the chair to the floor and sustains a humerus fracture. D. The wrong client is almost sent to the operating room. E. A client undergoes colectomy instead of appendectomy. Submit Answer

Explanation Choices C and E are correct. A sentinel event is defined as an event that has reached the patient and caused harm (death, permanent harm, or severe, temporary harm). A sentinel event is unrelated to the patient's illness or underlying condition. Such events are called "sentinel" because they signal a need for immediate investigation and response. All sentinel events must be reviewed by the hospital and are subject to review by the Joint Commission. A sentinel event may occur due to medical errors like wrong-site, wrong-procedure, wrong-patient surgery. Please note that the terms "sentinel event" and "medical error" are not synonymous; not all sentinel events occur because of an error, and not all errors result in sentinel events. Patient safety events occur commonly in health systems worldwide. A patient safety event is an event, incident, or condition that could have resulted or did result in harm to a patient. Safety events can be categorized into sentinel events, adverse events, near misses, and no harm events. Sentinel events are just one category of patient safety events. Others include: An adverse event: a patient safety event that resulted in harm to a patient. (e.g. an adverse event could include side effects to medications/vaccines, medical procedures. They may or may not be from negligence. For example, a patient sustaining an embolic stroke after coronary angiography is an adverse event, but not due to medical negligence.) A no-harm event is a patient safety event that reaches the patient but does not cause harm. A close call (or a "near-miss" or a "good catch") is a patient safety event that did not reach the patient. A hazardous (or unsafe) condition(s) is a circumstance (other than a patient's own disease process or condition) that increases the probability of an adverse event. "A client falls from the chair to the floor and sustained humerus fracture" is an actual event that has occurred and caused harm. This event (fall causing injury) is not a medical error but constitutes a sentinel event (Choice C). "A client undergoing colectomy instead of appendectomy" is a sentinel event due to a medical error (Choice E). Other examples of sentinel events include patients committing suicide while receiving care in the hospital or within 72 hours of discharge, hemolytic transfusion reaction, unanticipated death of a full-term infant, rape, assault, sexual abuse, invasive procedure on the wrong site/wrong person/wrong procedure, discharge of infant to the wrong family, any intrapartum maternal death, and so on. Choice D is incorrect. The event "when an incorrect client is almost sent to the operating room" did not occur here and did not cause patient harm. This event is referred to as "near-miss," not a sentinel event. The WHO defines "near-miss" as the one with the potential to cause an adverse event (patient harm) but fails to do so because of chance or because it is prevented. According to the Institute of Medicine, a "near-miss" is an act of commission or omission that could have harmed the patient but did not cause harm as a result of chance, prevention, or mitigation. An error caught before reaching the patient is another definition. It is also referred to as a close-call or potential adverse event. Near misses also must be reported, so root cause analysis can be completed. The root causes of near misses and adverse/sentinel events are similar. Therefore, detecting root causes of near misses can help us correct these causes and prevent future adverse events. Choices A and B are incorrect. Although an untimely assessment of the client and an incomplete assessment of the client can be contributory factors that led to a sentinel event, these are considered deviations from a standard of care and not sentinel events. Learning objective: Understand the various categories of patient safety events. Sentinel event is just one category of patient safety events and is defined as the one that has reached the patient and caused harm. NCSBN Client need: Topic: Management of care; Subtopic: Quality improvement Last Updated - 31, Jan 2022

Which aspects of the HEALTH belief model can you incorporate into your practice in a primary healthcare environment to maintain physical, mental, and spiritual health? A. The promotion of a healthy diet, social support systems, and religion B. The wearing of symbolic clothing, relaxation, and religious rituals C. The consumption of special foods, relaxation, and religious rituals D. The use of curanderos, massage, and meditation Submit Answer

Explanation Choice A is correct. The promotion of a healthy diet, utilization of social support systems, and practicing one's religion are examples of the HEALTH belief model that you can incorporate into your practice in a primary healthcare environment to maintain physical, mental and spiritual health, respectively. Choice B is incorrect. The wearing of symbolic clothing is a health protection aspect of the HEALTH model; relaxation and religious rituals are part of the restoration aspect in the HEALTH belief model. Choice C is incorrect. The consumption of particular foods, relaxation, and religious rituals are part of the restoration aspect of the HEALTH belief model. Choice D is incorrect. The use of curanderos, massage, and meditation are part of the restoration aspect of the HEALTH belief model. Last Updated - 10, Jan 2022

Which process is most often used by performance improvement teams to find the most basic causes of process failures? A. Root cause analysis B. Nominal group process C. Determining who failed D. Negotiation Submit Answer

Explanation Choice A is correct. The root cause analysis process is most often used by performance improvement teams to find the most basic causes of process failures. Root cause analysis is done in a blame-free environment to dig down to the most fundamental reasons why a failed process is not fail-proof. Choice B is incorrect. The nominal group process is rarely if ever, used by performance improvement teams. Choice C is incorrect. Determining who failed is not an acceptable process for performance improvement teams. Performance improvement activities are conducted in a blame-free environment. Choice D is incorrect. Although negotiation is an effective and appropriate group process, it is not used to find the most basic causes of process failures. Last Updated - 16, Nov 2021

The nurse is providing a handoff report to a nurse in the critical care unit. The nurse states that it would be helpful for the primary healthcare provider (PHCP) to refer the client to an outpatient support group at discharge. This statement represents which part of the ISBAR handoff report? A. Situation B. Background C. Assessment D. Recommendation Submit Answer

Explanation Choice D is correct. The nurse providing this statement to the critical care nurse illustrates recommendations. A recommendation is at the end of the ISBAR format, where the nurse can opine their thoughts on what would be necessary for the client. Choices A, B, and C are incorrect. ➢ The situation is where the nurse explains the reason for the notification (I am concerned that the client is developing... or This client is being transferred to critical care because...). ➢ Background explains pertinent details regarding the client's care (The client is allergic to... He/she was admitted on...) ➢ Assessment is the nurses' overall impression of the client (I believe the client is demonstrating pulmonary edema because...) Additional Info Last Updated - 09, Nov 2022

The registered nurse works with others inside and outside their immediate work environment to achieve goals and make decisions that are best for individual clients or groups of clients. Out of the following choices, which best describes the role the nurse is fulfilling in this capacity? A. The nurse as a collaborator B. The nurse as a team leader C. The nurse as a delegator D. The nurse as a manager Submit Answer

Explanation Choice A is correct. A nurse fulfills the role of a collaborator when the registered nurse works with others inside and outside of their immediate work environment to achieve goals and make decisions that are best for an individual client or group of clients. Choice B is incorrect. Leadership is the ability to inspire others to achieve a desired outcome. Although team leadership may occur in various forms, a registered nurse working with others inside and outside their immediate work environment to achieve goals and make decisions that are best for the individual client or group of clients does not necessarily signify that the nurse is fulfilling a team leadership position. Although Choice B could arguably be considered, the question asks for the answer which best describes the role the nurse is fulfilling. Choice C is incorrect. Nurses serve as delegators when they delegate and assign roles or specific duties to others. As a delegator, the registered nurse transfers authority and responsibility to an appropriate team member to complete a task while retaining accountability. Nurses serve as delegators when they delegate and assign roles or specific duties to others. As a delegator, the registered nurse transfers authority and responsibility to an appropriate team member to complete a task while retaining accountability. Based solely on the information contained within the question, there is no indication that delegation is occurring. Choice D is incorrect. The nurse as a manager takes on more of an administrative than a clinical role. Some typical nurse manager responsibilities include planning (i.e., budgeting), organizing, staffing, directing, and controlling (i.e., resource allocation). While part of this position may occur outside of their immediate work environment, the majority of the position will occur within their immediate work environment. Learning Objective Based on the information provided, identify the role which the registered nurse is fulfilling. Additional Info Collaboration is defined as people undertaking harmonizing roles and jointly working together to share responsibility for problem-solving and decision-making to formulate and implement plans towards a common goal or goals. The complex phenomenon of collaboration brings together two or more individuals, often from different professional disciplines, who work to achieve shared objectives, such as a specific objective for a patient or group of patients. Nurses should recognize that collaborative efforts (from either an interprofessional or a multidisciplinary team) allow the achievement of results that an individual team member would be unable to accomplish alone. Last Updated - 10, Aug 2022

The nurse is providing care for a patient recently transferred from the post-anesthesia care unit [PACU]. The chart indicates that the patient was medicated for pain 1 hour ago, yet the patient reports that he is experiencing extreme pain. He is not due for further medication until another 2 hours. How might the nurse intervene as a patient advocate? A. Contact the physician regarding the need for more effective pain management. B. Assist the patient to use non-pharmacological pain management strategies. C. Explain to the patient that giving the pain medication too soon can be dangerous. D. Provide a quiet environment to help the patient rest and cope with his pain level. Submit Answer

Explanation Choice A is correct. An essential aspect of advocacy is speaking on behalf of the patient, to help meet the patient's needs, such as when calling the physician to discuss the need for more effective pain management - since it is the patient's fundamental right to be free from pain. Choices B and D are incorrect. These are nursing interventions that can be employed to enhance the prescribed pain medication but do not meet defining characteristics related to advocacy. Choice C is incorrect. While this is factual information, it does not address the need to provide adequate pain management. Bloom's Taxonomy - Analyzing Last Updated - 01, Dec 2021

The nurse notices a unlicensed assistive personnel (UAP) passing by several call lights during the shift. What is the nurse's best initial action? A. Approach the UAP about the behavior. B. Report unsafe behavior to the charge nurse. C. File an incident report due to safety risk. D. Ask another UAP to help cover this UAP's patient load. Submit Answer

Explanation Choice A is correct. Ignoring call lights (or not responding in a timely manner) puts patients at increased risk of falls and injury. The chain of command says the nurse should address issues/conflicts with the peer (if another nurse) or subordinate (UAP), as long as the situation is not illegal or dangerous. This nurse should first address issues with the UAP to determine the reason for this behavior (i.e. negligence versus work overload) and collaborate to find a solution. If the interaction is not effective, the nurse would then bring the issue up the chain of command (charge nurse) to determine the next steps. Choice B is incorrect. The nurse should address the UAP first before reporting. If the behavior continues, the issue should be brought up the chain of command to determine if it is due to factors such as negligent behavior, alarm fatigue, or improper staffing. Choice C is incorrect. Filing an incident report would not be appropriate. Although patient safety is at risk, according to the given information, no incident/accident has occurred. Choice D is incorrect. Asking another UAP to cover additional clients does not address the problem and increasing the number of patients for the second UAP would put the safety of additional patients at risk. Assignments should be set by the unit charge nurse and based on patient acuity. Last Updated - 17, Nov 2022

The nursing director calls for a meeting of all nurse managers in the facility. She has just come back from a visit to another hospital that was recently commended for its superior patient care. She aims to formulate similar policies to improve patient care in their facility. The nurse manager is performing which management initiative? A. Benchmarking B. Continuous Quality Improvement C. Performance Improvement D. Quality Management Submit Answer

Explanation Choice A is correct. In Benchmarking, the nurse-manager compares best practices from top hospitals with her unit and adapts the unit's methods to improve unit performance. Choice B is incorrect. Continuous quality improvement continually assesses and evaluates the effectiveness of client care. Choice C is incorrect. Performance improvement establishes a system of formal evaluation for job performance and recommends ways to improve performance as well as promote professional growth. Choice D is incorrect. Quality management is the act of overseeing all activities and tasks needed to maintain a desired level of excellence. This includes the determination of a quality policy, creating then implementing quality planning and assurance, as well as quality control/improvement. Last Updated - 22, Jan 2022

A medication error has occurred in the medical ward. After a thorough investigation was performed, the nurse manager posts a memorandum regarding changes in medication administration to be implemented immediately. The nurses on the unit recognized this management style as: A. Autocratic B. Democratic C. Participative D. Laissez-faire Submit Answer

Explanation Choice A is correct. In autocratic leadership, decisions are made with little or no staff input. The manager makes all the decisions in the unit. Choice B is incorrect. In a democratic style of management, staff members are encouraged to participate in the decision-making process whenever possible. The majority of the decisions are made by the group, not the manager in this management style. Choice C is incorrect. In a participative style of management, problems are identified by the manager and presented to the staff with several solutions. Staff members are encouraged to provide input however, the manager makes the final decision. Choice D is incorrect. Little direction, structure, or support is provided by the manager in a Laissez-faire type of management. The manager abdicates responsibility and decision-making whenever possible in this type of management. Last Updated - 27, Jan 2022

While working in the emergency department. A patient has a cardiac arrest. The nurse caring for the patient quickly defines the necessary tasks and assigns them to each member of the team responding. This nurse demonstrated which of the following leadership styles? A. Autocratic B. Situational C. Democratic D. Laissez-faire Submit Answer

Explanation Choice A is correct. This nurse has demonstrated an autocratic leadership approach. She retained all authority and delegated tasks to be accomplished. This approach is useful in emergencies or crises. Choice B is incorrect. Situational leadership is a comprehensive approach that combines the style of the leader with the maturity of the group they are working with and depends on the current situation. In this situation, autocratic leadership was demonstrated. Choice C is incorrect. Democratic leadership is a person-centered leadership style focused on the relationships between the team who is working together. Democratic leadership is a good strategy for team development and encourages the growth of the participating team members. In this situation, autocratic leadership was demonstrated. Choice D is incorrect. Laissez-faire leadership is very lax in style. The leader does not retain control and instead delegates the decision-making to other team members. In this situation, autocratic leadership was demonstrated. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Risk of the potential reduction; Prioritization, delegation, and leadership Last Updated - 07, Jan 2022

You are the charge nurse on a medical-surgical unit. You have noticed over the last several weeks that one of the nurses on your team is displaying anger and negative feelings, which is not at all characteristic of this experienced nurse. What is this nurse most likely experiencing? A. Burnout B. Role confusion and dissonance C. Ineffective role performance D. Fatigue Submit Answer

Explanation Choice A is correct. This nurse is most likely affected by burnout. Burnout is a complex syndrome that occurs as a result of multiple stressors in the work-life and personal life. This syndrome is highly similar to the last stage of the general adaptation syndrome, which is exhaustion, both physically and emotionally. Choice B is incorrect. Role confusion and dissonance are not characterized by anger and negative feelings; instead, cognitive dissonance is characterized by anxiety, denial, and discomfort. Choice C is incorrect. There is no evidence in this question that indicates that this nurse is not performing their role effectively. Choice D is incorrect. Although this nurse is possibly affected by physical fatigue, this nurse is also affected by a psychological crisis as the result of the multiple stressors in their work and personal life. Last Updated - 03, Feb 2022

Which of the following nursing actions reflects effective time management? A. The nurse asks the patient what is their priority to accomplish each day B. The nurse includes a "nice to do" for every "need to do" task on the list C. The nurse "front loads" the schedule with "must-do" priorities D. The nurse avoids helping other nurses if scheduling does not permit it Submit Answer

Explanation Choice A is correct. To manage time; the nurse should establish goals and priorities for each day and include the patient in prioritizing tasks. Choice B is incorrect. "Need to do" should be differentiated from "nice to do" tasks. Choices C and D are incorrect. The nurse should establish a timeline and allocate priorities to hours in the workday. This will allow the nurse to recognize any falling behind and correct the problem before the day is lost. Additionally, using teamwork appropriately will enhance the work schedule. NCSBN Client Need Topic: Safe and Effective Care Environment, Subtopic: Coordinated Care - Prioritizing Care Last Updated - 25, Jan 2022

You have been assigned to serve on the Quality Assurance/Performance Improvement Committee. You would expect that the primary focus of this committee is which of the following? A. Outcome measures B. Process measures C. Structural measures D. Identification of individuals who have caused errors Submit Answer

Explanation Choice A is correct. You would expect that the primary focus of this committee is outcome measurements and outcome-oriented clinical indicators such as the rate of urinary tract infections over time. The focus of quality assurance and performance improvement activities has evolved from the structure to process outcome-oriented clinical indicators and related activities. All quality assurance and performance improvement activities are conducted in a blame-free environment that aims to identify why things have occurred, rather than on who erred. Choice B is incorrect. The focus of quality assurance and performance improvement activities has evolved from process measurements to another type of analysis and indicators. Choice C is incorrect. The focus of quality assurance and performance improvement activities has evolved far beyond structural measurements to another type of analysis and indicators. Choice D is incorrect. All quality assurance and performance improvement activities are conducted in a blame-free environment that aims to identify why things have occurred, rather than on who erred. Learning Objective Identify the focus of a Quality Assurance/Performance Improvement Committee. Additional Info Examples of Outcome Measures Percentage of patients who died as a result of surgery (surgical mortality rates) Rate of surgical complications or hospital-acquired infections Examples of Process Measures Percentage of people receiving preventive services (such as mammograms or immunizations) Percentage of people with diabetes who had their blood sugar tested and controlled Examples of Structural Measures Whether the health care organization uses electronic medical records or medication order entry systems Number or proportion of board-certified physicians Ratio of providers to patients Last Updated - 12, Aug 2022

The nurse preceptor is observing a newly hired nurse care for assigned clients. It would require follow-up by the nurse preceptor if the newly hired nurse is observed doing which of the following? A. Humidifies nasal cannula oxygen for a client with sarcoidosis. B. Secures a suprapubic catheter tubing to a client's inner thigh. C. Places a client with varicella-zoster in airborne and contact isolation. D. Suctions a tracheostomy for 10 seconds as they remove the catheter. Submit Answer

Explanation Choice B is correct. A suprapubic catheter should be looped and taped to the client's abdomen. Taping it to the abdomen decreases the tension on the tubing, decreasing its risk of dislodging. Choices A, C, and D are incorrect. Humidifying nasal cannula oxygen is appropriate, especially when used for the long term or at least 4 liters per minute. Varicella-zoster warrants airborne and contact precautions. Suctioning a tracheostomy for 10 seconds is appropriate as the catheter is removed in a twirling motion. Additional Info A suprapubic catheter is inserted percutaneously above the symphysis pubis into the bladder. The indications for the catheter include urethral strictures or trauma. Nursing care involves preventing infection by instructing the client to perform hand hygiene and clean the site with warm soapy water, then applying a sterile dressing around the tube. Last Updated - 30, Aug 2022

The nurse is performing a verbal hand-off report for a client. Which essential information should the nurse include in the report? A. Current medication list B. Involuntary admission status C. Food and mealtime preferences D. The presence of family at the bedside Submit Answer

Explanation Choice B is correct. Admission status is essential information provided in the hand-off report because involuntary admission requires the client to stay in the healthcare facility. This status is typically required when a client may pose a threat to themselves or others. This type of involuntary admission status also may raise the risk of the patient eloping. This should be communicated because if a client is involuntarily admitted, they may not have a rational thought process which may raise the risk of self-injury if they do successfully elope. Choices A, C, and D are incorrect. The current medication list is generally not communicated during the hand-off report. Hand-off reports should include new prescriptions or prescriptions pertinent to the client's care. The oncoming nurse may easily obtain this list by accessing the medication administration record. Food and mealtime preferences are important to delivering client-centered care but do not prioritize the client's admission status. Finally, the presence of family at the bedside may be irrelevant unless pertinent family dynamics impact care. Additional Info When a client is admitted involuntarily, the nurse should still respect the client's autonomy for treatment decisions (this includes the right to refuse medication). The exception to this rule is if the client is experiencing a behavioral crisis and requires emergent medications for stabilization. This requires the prescriber to note their reasoning. Additionally, a client's right to refuse medications may be overridden by a court order (for example, a court order stating that the client must take risperidone for stabilization). Last Updated - 15, Feb 2022

The nurse is reviewing leadership and management concepts with a student nurse. It would require further teaching if the student nurse made which of the following statements? A. "The Laissez-faire leadership style is a passive leadership approach." B. "A Registered Nurse (RN) may delegate accountability to a Licensed Practical Nurse (LPN)." C. "The rights of delegation include task, circumstance, person, direction, supervision." D. "The State Nurse Practice Act defines roles and responsibilities of nursing professionals." Submit Answer

Explanation Choice B is correct. An RN may delegate certain responsibilities to an LPN but cannot delegate accountability. The RN retains accountability when delegating patient assignments and tasks but maintains accountability. Choices A, C, and D are incorrect. The Laissez-faire leadership style is a passive leadership approach where the leader acts more as a consultant versus an active leader. This type of leader is hands-off. The delegation rights include the right task, circumstance, person, direction, and supervision. Finally, the Nurse Practice Act is unique to each state and defines the roles and responsibilities of nursing professionals. Additional Info Delegation is the process of transferring responsibility and authority to another individual. Responsibility is an obligation to complete the task. Accountability is assuming responsibility and appropriate consequences for certain actions. The RN may delegate responsibilities as appropriate but maintains accountability. Last Updated - 06, Dec 2022

You are orienting a new nurse on your unit. After identifying the need for a new portable suction machine, the new nurse attempts to connect it and tells you it is not working. The engineering department is called to assist, and tell you that this piece of equipment was working properly. You would suspect that: A. Someone is being dishonest with you. B. The new nurse did not understand how to properly configure the equipment. C. The equipment is still not functioning. D. There is an electrical shortage in the plug. Submit Answer

Explanation Choice B is correct. Based on this scenario, you would suspect that the new nurse did not properly know how to connect this portable suction machine. After identification of this learning deficiency, you would address this knowledge deficit with education and training, training the new nurse on the proper setup of the portable suction machine. Choice A is incorrect. Merely based on the information provided, you would not suspect that anyone is being disingenuous with you. Chances are much more likely that something else is occurring. Choice C is incorrect. There is no evidence that the equipment in question is not working correctly. Additionally, the engineering department assessment of the purported dysfunctional equipment subsequently showing the equipment in proper working order supports this theory. Choice D is incorrect. There is no evidence supporting an electrical shortage in the plug. Learning Objective Correlate an inability of a new nurse you are orientating to connect a portable suction machine properly to a knowledge deficit. Additional Info Portable suction machines generate negative pressure, channeled through a special plastic connecting tube called a single-use catheter. The negative pressure creates a vacuum effect that removes blood, mucus, or similar secretions, which are then automatically dispensed into a collection jar. Last Updated - 30, Aug 2022

The nursing supervisor has implemented a new assignment system for nursing staff. In order to reduce resistance to this new system, the nurse manager should A. Provide incentives to foster the change [4%] B. Allow nursing staff to discuss potential concerns [85%] C. Provide statistical support for the change [7%] D. Detail the changes in a multimedia presentation [4%]

Explanation Choice B is correct. Change can be difficult in any profession. To foster a positive change, the nurse manager should have an open dialogue with the nursing staff. This enables any concerns to be addressed (and mitigated) with a professional dialogue. This also allows the nurse manager an opportunity to assess the mood of the nursing staff regarding the change. Choices A, C, and D are incorrect. While these strategies are helpful in fostering change and minimizing resistance, open communication is superior because it allows for challenges to be addressed in real time. Additional Info To foster change, the nurse manager should encompass a democratic leadership style that enables support staff to have their voice heard. This leadership style also supports a cohesive team through active participation. Last Updated - 06, Sep 2022

The nurse manager regularly performs chart audits and room inspections in the unit. She tells the staff to address the unit's deficiencies during a meeting. Which concept of management is the nurse manager displaying? A. Benchmarking B. Continuous Quality Improvement C. Performance Improvement D. Quality Management Submit Answer

Explanation Choice B is correct. Continuous quality improvement continually assesses and evaluates the effectiveness of client care. Choice A is incorrect. In Benchmarking, the nurse manager compares best practices from top hospitals to her unit and adapts the best unit's methods to improve unit performance. Choice C is incorrect. This establishes a system of formal evaluation for job performance and recommends ways to improve performance as well as promote professional growth. Choice D is incorrect. Quality management is the act of overseeing all activities and tasks needed to maintain a desired level of excellence. This includes the determination of a quality policy, creating and implementing quality planning and assurance, as well as quality control/improvement. Last Updated - 12, Nov 2021

The nurse is assigned the case manager role. She understands that case management uses which of the following methods of patient care delivery and documentation? A. A problem-oriented documentation system. B. A critical pathway documentation system. C. A source-oriented documentation system. D. A variance-oriented documentation system. Submit Answer

Explanation Choice B is correct. Documentation is a written record of (1) the interactions between and among health care professionals, patients, and their families (2) tests, procedures, treatments, and patient education (3) test results or patient's responses to treatment interventions. Several methods are used for documentation. These include narrative charting, source-oriented charting, problem-oriented charting, PIE charting, focus charting, charting by exception (CBE), computerized documentation, and critical pathway documentation. Case management refers to the process of organizing the patient care throughout an episode of illness so that certain clinical and financial outcomes are achieved within an assigned time frame. Case management uses a critical pathway documentation system as a form of patient care delivery and documentation. Critical pathways are time-oriented multidisciplinary plans of care that are established and approved by the interdisciplinary team. Variances are deviations from the expected course that are documented within the critical pathway system. Choice A is incorrect. A problem-oriented medical record (POMR) system is a structured format of charting that enables medical professionals to standardize patient records and store them in an electronic form. An example of POMR charting is "SOAP", where S refers to subjective data, O refers to objective data, A refers to assessment data, and P refers to plan. POMR documentation is not the one used by case managers. Choice C is incorrect. Source-oriented (SO) documentation is a narrative charting by each member of the health care team. For example, all the nursing records are grouped; the physician notes are together; respiratory, physical therapy, etc, are placed together. Since this type of charting is on separate records grouped by source, it is time-consuming and can lead to fragmented care. Choice D is incorrect. Variations (variance) are interventions that are not completed or the goals that are not met within the assigned time frame. There is no separate variance-oriented documentation system. However, the differences (variations) are determined and documented on the critical pathway used with case management. Learning Objective While various documentation methods are used in the health care systems, case management uses critical pathway documentation. Last Updated - 13, Feb 2022

In a staff meeting, the nurses were asked by the nurse manager what their thoughts are on the solutions presented to them regarding medication errors. They were also asked to vote whether to apply the changes proposed or to veto it. Which management style is the unit practicing? A. Autocratic B. Democratic C. Participative D. Laissez-faire Submit Answer

Explanation Choice B is correct. In a democratic style of management, staff members are encouraged to participate in the decision-making process whenever possible. The majority of the decisions are made by the group, not the manager in this management style. Choice A is incorrect. In autocratic leadership, decisions are made with little or no staff input. The manager makes all the decisions in the unit. Choice C is incorrect. In a participative style of management, problems are identified by the manager and presented to the staff with several solutions. Staff members are encouraged to provide input however, the manager makes the final decision. Choice D is incorrect. Little direction, structure, or support is provided by the manager in a Laissez-faire type of management. The manager abdicates responsibility and decision-making whenever possible in this type of management. Last Updated - 29, Dec 2021

The registered nurse (RN) is working with a licensed practical/vocational nurse (LPN/VN). Which client assignment should the RN delegate to the LPN? A client A. immediately post-operative following a thyroidectomy. B. with a paralytic ileus requiring the management of a nasogastric tube. C. receiving intravenous magnesium sulfate for status asthmaticus. D. with a hypertensive crisis requiring initiation of intravenous nicardipine. Submit Answer

Explanation Choice B is correct. Managing a nasogastric tube (NGT) is within the scope of an LPN. The other client situations lack predictability, require frequent assessments or need skills performed such as intravenous therapy that is not within the scope of an LPN. Choices A, C, and D are incorrect. These client situations require frequent assessment or skills outside the LPN's scope of practice. A client immediately post-operative needs a thorough assessment. A client receiving intravenous magnesium sulfate for status asthmatics is unstable. Finally, a client with a hypertensive emergency requiring intravenous anti-hypertensives needs the care of the RN because of the lack of predictability. Additional Info Last Updated - 17, Jul 2022

The nurse is preparing to present to the quality improvement committee to evoke a change in the facility's policy and procedure regarding restraint usage. To ensure that the nurse is providing findings from the highest quality of evidence, the nurse should include findings from a A. expert opinion. B. systematic review. C. quantitative study. D. qualitative study. Submit Answer

Explanation Choice B is correct. Systematic reviews are the highest quality scholarly evidence. In a systematic review, thorough literature is gathered, analyzed, and synthesized to form a conclusion relevant to a topic. A systematic review utilizes the highest rigor when selecting literature for analysis and provides the inclusion and exclusion criteria for research finding selection. The nurse should include findings from systematic reviews published within the past five years to ensure the results are relevant. Choices A, C, and D are incorrect. Expert opinions are the lowest quality of scholarly evidence because it is not an experiment. Expert opinions are a narrative that includes support from various studies that may allow the author to be biased. Qualitative and quantitative studies are also lower quality scholarly evidence but not as low as expert opinions. Additional Info ✓ When selecting scholarly evidence, the nurse should refer to the evidence hierarchy, which can be found below. Polit-Beck Evidence Hierarchy/Levels of Evidence Scale Last Updated - 15, Feb 2023

A mental health clinic is being constructed in a local community. A nurse manager is hired to facilitate the unit's nursing policies. Which of the following is the best resource for these policies? A. Code of Ethics B. Nurse Practice Act C. Patient's Bill of Rights D. Rights for the Mentally Ill Submit Answer

Explanation Choice B is correct. The Nurse Practice Act describes the scope of nursing practice. It directs the philosophy and standards of nursing. The formulation of policies and procedures should be based on this document. Choice A is incorrect. The Code of Ethics for nurses provides ethical guidelines regarding nursing practice. Choice C is incorrect. The Patient's Bill of Rights outlines the rights that are due to them when admitted and seeking health care. Choice D is incorrect. The Rights for the Mentally Ill provides people with mental illness the civil liberties that are due to them. Last Updated - 07, Feb 2022

A patient in the medical ward states his frustration over the way his physician is treating his medical condition. He also complains that the physician has been condescending to him a couple of times. What is the nurse's best action? A. Confront the physician about the patient's concern. B. Report the patient's concern to the unit manager. C. Talk to the client's family. D. Suggest another physician to the client. Submit Answer

Explanation Choice B is correct. The nurse should act as a patient advocate in this situation. A patient who verbalizes dissatisfaction with the physician's care should be reported to the nurse supervisor. The nurse supervisor is ultimately responsible for the care rendered to patients; he/she is the one with the authority to confront the physician regarding the client's concern. Choice A is incorrect. The nurse supervisor is responsible for the care rendered to patients; he/she is the one with the authority to confront the physician regarding the client's concern. Choice C is incorrect. Reporting to the family members violates the proper chain of command. Choice D is incorrect. Suggesting other physicians to the client is an unprofessional measure. Last Updated - 23, Nov 2021

The emergency department (ED) nurse is caring for a client who is 38 weeks pregnant and experiencing frequent contractions. The nurse observes a presenting part of the fetus during the exam. The nurse should take which priority action? A. Assess the client's previous obstetric history B. Prepare for the delivery of the newborn C. Transport the client to the labor and delivery unit D. Time the frequency and duration of contractions Submit Answer

Explanation Choice B is correct. The nurse should prepare for the delivery of the newborn because of a presenting fetal part. The nurse transporting the client to L&D would be highly inappropriate because the client could deliver the newborn during transport which is not safe. Finally, the nurse should prepare for the delivery of the newborn because the presenting part requires immediate application of fetal heart monitoring to determine the stability of the neonate. Choices A, C, and D are incorrect. Assessing the client's previous obstetric history would have very little probative value while a presenting fetal part is present. The nurse needs to act in this situation and not assess. Transporting the client to L&D would not be safe because a presenting fetal part signifies imminent delivery. Once delivery has occurred, and it is safe to do so, the client and the newborn should be transferred. The nurse should call for an L&D nurse in the ED, as that would be more appropriate. Tme the frequency and duration of contractions would be helpful but is not the priority because the delivery of the neonate is imminent, and the nurse needs to act to maintain the stability of the client and the neonate. Additional Info Supplies necessary for the delivery of a newborn include - ✓ Sterile gloves ✓ OB towelettes ✓ Drape sheets ✓ Sterile gauze ✓ Bulb syringe ✓ Umbilical cord clamps ✓ Bag valve mask ✓ Neonatal warmer ✓ Intravenous access equipment Last Updated - 12, Feb 2023

The Certified Nurse Assistant (CNA) is helping a female patient with early ambulation post-surgery. The CNA has just applied a gait belt to the patient's waist. Which of the following actions by the CNA will need interference and correction by the supervising nurse? A. Holding onto the belt's outer edge or center, preventing the patient from leaning or drooping to one side. B. Pulling from the front of the belt, keeping forward momentum. C. Bringing the client to a nearby chair when she feels dizzy. D. Keeping the patient's body weight close to her own. Submit Answer

Explanation Choice B is correct. The nurse will need to correct the CNA if the CNA is found pulling the patient in any direction. Pulling unsteady or unfit patients is dangerous and should never be performed. Instead, the nurse's aide should walk alongside the patient, moving only at the pace the patient can maintain. Choice A is incorrect. Holding the belt's side or center while the patient moves is a safe nursing action when using a gait belt. Choice C is incorrect. The CNA is practicing safe nursing skills by bringing the patient to a chair, or the bed should the patient feel light-headed or dizzy. Choice D is incorrect. The CNA is protecting herself from straining or pulling her muscles by keeping the patient's bodyweight pulled in close to her own body. This is the proper way to use a gait belt and does not need correction. NCSBN client need Topic: Basic Care and Comfort: Assistive Devices Last Updated - 02, Feb 2022

The nurse is teaching a leadership and management course and is discussing client referrals. Which of the following statements describes the purpose of referrals? A. Allows the nurse to demonstrate their leadership abilities B. Care is appropriately routed to an individual or discipline C. Ensures that care is unilateral and cost effective D. Focuses on empowering the client's decision making Submit Answer

Explanation Choice B is correct. The primary purpose of referrals is to ensure the completeness and appropriateness of the client's care. A registered nurse completes a referral to ensure that an appropriate individual or discipline meets the client's needs. For example, a client with a pressure ulcer or new ostomy is referred by the registered nurse to a wound/ostomy nurse for specialized treatment and counseling. Choices A, C, and D are incorrect. The referral process effectively allows the client to receive the appropriate care necessary for their condition(s). Client autonomy is essential in healthcare; however, it does not relate to the referral process. Additionally, referrals are not about the nurse exercising their leadership abilities despite this being an option afforded to the RN. While referrals may be cost effective, they are collaborative not unilateral. Learning Objective Identify the primary purpose of referrals. Additional Info Referrals serve numerous purposes, including: Interdisciplinary communication with experts (physical therapy, wound care, disease management) Optimizing client outcomes by having the client consult with an individual of the healthcare team that is the expert Promoting cost-effective care by minimizing return visits and disease complications Last Updated - 22, Sep 2022

Which term best describes the nurse's role as the nurse actively upholds and protects the rights of individual clients and groups of clients? A. Deontological ethical practice B. Advocacy C. Utilitarian ethical practice D. Autonomy Submit Answer

Explanation Choice B is correct. The term that best describes the role of the nurse as the nurse actively upholds and protects the rights of individual clients and a group of clients is advocacy. Choice A is incorrect. Deontological ethics is a school of ethical thought. It does not relate to the rights of individual clients and groups of clients. Choice C is incorrect. Utilitarian ethics is a school of ethical thought. It does not relate to the rights of individual clients and groups of clients. Choice D is incorrect. Autonomy is defined as the individual's right to make independent, informed decisions without any coercion. It does not reflect the nurse's upholding and protecting the rights of individual clients and groups of clients. Last Updated - 16, Nov 2021

While admitting a patient, the nurse begins to review information regarding advanced directives. Still, the patient becomes agitated and refuses to discuss the issue or accept a handout about the topic. Which is the appropriate nursing action? A. Leave the handout on the patient's bedside table instructing him that he must review the content. B. Document the patient's refusal, using the patient's own words, in quotes. C. Explain to the patient that he must make decisions about accepting or refusing treatment while in the hospital. D. Request an assessment of the patient's competency related to making decisions about advanced directives. Submit Answer

Explanation Choice B is correct. While the Patient Self-Determination Act requires health care facilities to provide information about the patient's right to refuse or accept treatment, the patient has the right to withdraw that information. Should the patient decline verbal and written information about advanced directives, the nurse should document that information was offered, and document the patient's refusal, quoting the patient's statements. Choices A and C are incorrect - The patient has the right to autonomy and self-determination, including refusing information regarding advanced directives. He is not required to have advanced instruction in place while in the hospital. Choice D is incorrect - The patient's refusal to accept information about advanced directives is not an indication of the patient's level of competence. Bloom's Taxonomy - Analyzing Last Updated - 31, Jan 2022

A patient in the prenatal clinic has stated her intention to choose formula feeding for her infant. Identify which action by the nurse is most appropriate in being a patient advocate. A. Remind the patient of why breast feeding is the best method of infant feeding. B. Request a referral to the lactation consultant. C. Determine the patient's knowledge base related to infant feeding options. D. Accept the patient's decision without further discussion Submit Answer

Explanation Choice C is correct. A central concept of patient advocacy is ensuring that the patient's decisions are based on sufficient information and understanding while supporting the patient's right to exercise autonomy. Choice A is incorrect. This answer does not serve to support the patient's right to autonomy. Choice B is incorrect. A referral to the lactation consultant is not necessarily indicated. Choice D is incorrect. While the nurse should support the patient's choice, it is essential to confirm that the patient's decision-making process is based on adequate information. Bloom's Taxonomy - Analyzing Last Updated - 14, Feb 2022

A senior RN is supervising a newly registered nurse in the emergency department. Which situation would require the senior RN to intervene? A. The new RN elevates the foot of a 13-year-old with a fractured tibia. B. The new RN calls Child Protective services for the child she suspects is being sexually abused. C. The new RN checks the tonsils of a drooling 3-year-old with a sore throat. D. The new RN gives a nebulization treatment to an 8-year-old with asthma. Submit Answer

Explanation Choice C is correct. A child with a sore throat that is drooling may be manifesting epiglottitis. Drooling may indicate that the child is going into respiratory distress and warrants timely intervention by the healthcare team. The senior RN should step in and guide the new RN in what to do. Choice A is incorrect. Elevating the foot to relieve swelling and edema in a fractured foot is an accurate nursing action. Choice B is incorrect. For any suspected child abuse, the nurse is obligated by law to report the case to Child Protective Services (CPS). Choice D is incorrect. Giving a nebulization treatment to a child having an asthma attack relaxes the bronchial walls of the child and improves respiratory status. Last Updated - 15, Feb 2022

A client who completes an informed consent is asserting and using their basic right to: A. Beneficence B. Nonmaleficence C. Self-determination D. Have choices Submit Answer

Explanation Choice C is correct. A client who completes an informed consent is asserting and using their fundamental right to self-determination. Self-determination is defined as the intrinsic right of all people, including healthcare consumers, to make their own autonomous decisions about accepting or rejecting care or treatments, as is done with informed consent. Choice A is incorrect. Beneficence is an ethical principle that states that we should "do good" for the client. It is not the basis of informed consent. Choice B is incorrect. Nonmaleficence is an ethical principle that states that we should do "no harm" to the client. It is not the basis of informed consent. Choice D is incorrect. Although the client makes choices with informed consent, making choices is not the basis of informed consent; making choices among alternatives of treatments is supported. Last Updated - 04, Feb 2022

You are a registered nurse who is performing the role of a case manager in your hospital. You have been asked to present a class to newly employed nurses about your role, your responsibilities, and how they can collaborate with you as the case manager. Which of the following is a primary case management responsibility associated with reimbursement that you should include in this class? A. The case manager's role includes the organization of wide performance improvement activities. B. The case manager's role includes complete, timely, and accurate documentation. C. The case manager's role in terms of the clients' being at the appropriate level of care. D. The case manager's role in terms of contesting denied reimbursements Submit Answer

Explanation Choice C is correct. A failure to ensure the appropriate level of care jeopardizes reimbursement. For example, care in an acute care facility will not be reimbursed when the client's current needs can be met in a subacute or long-term care setting. RN case managers have a primary case management responsibility associated with reimbursement because they are responsible for ensuring the patient is cared for at the appropriate level, consistent with medical necessity and current patient needs. Choices A, B, and D are incorrect. Nurse case managers do not have organization-wide performance improvement activities, the supervision of complete, timely, and accurate documentation, or challenging denied reimbursements in their role. These roles and responsibilities are typically assumed by quality assurance/performance improvement, supervisory staff, and medical billers, respectively. NCSBN Client Need Topic: Safe and Effective Care Environment, Subtopic: Management of Care Last Updated - 15, Feb 2022

The nurse manager receives a complaint from a client's family member regarding the client's care provided by a specific nurse. Which initial action should the nurse manager take? A. Tell the night charge nurse to ensure the night shift nurse performs the assigned duties appropriately B. Speak with the night shift nurse regarding the complaint and discuss the care provided C. Contact the client's family member who made the complaint to discuss the situation D. Take note of the complaint and place it in the applicable employee's file Submit Answer

Explanation Choice C is correct. Assuming the family member rendering the complaint is listed on the client's HIPAA release form, the nurse manager's initial action should be to contact this individual to let them know they have been heard. Additionally, this point of contact allows the nurse manager to ask additional questions regarding the complaint to ultimately help in determining whether the complaint holds merit. Once the manager has determined how reliable the information from the client's family member is, the nurse manager may speak with the client (if the client is capable) before speaking with the nurse in question. Choice A is incorrect. Although the nurse manager may have a discussion with the night charge nurse at some point, this is not the nurse manager's most appropriate initial action. Choice B is incorrect. Here, the question asks for the nurse manager's most appropriate initial action. While the nurse manager will undoubtedly speak with the night shift nurse regarding the complaint and discuss the care provided, this conversation is not the nurse manager's most appropriate initial action. Choice D is incorrect. Taking note of an unverified complaint and placing it in an employee's file would be an inappropriate and unethical action by the nurse manager. The incident may go into the nurse's file, but not without investigating the matter first. Learning Objective Identify a nurse manager's most appropriate initial action following the receipt of a complaint from a client's family member regarding a night shift nurse. Additional Info The following are identified strategies that nurse managers use to resolve conflict. These strategies are also helpful for all nurses: • Recognize conflict early. Recognizing the early warning signs of conflict is the first step toward resolution. Pay attention to body language and be mindful of the moods of the staff. • Be proactive. Address the issue of concern early, as avoiding the conflict may cause frustration and escalate the problem. • Actively listen. The ability to listen actively can improve interpersonal relationships, reduce conflicts, foster understanding, and improve cooperation. • Remain calm. Keep responses under control and emotions in check, and do not react to volatile comments. Calmness will help set the tone for the parties involved. • Define the problem. Clearly identify and define the problem, as a clear understanding of the issues will help minimize miscommunication and facilitate resolution. • Seek a solution. Manage the conflict in a way that successfully meets the goal of reaching an acceptable solution for both parties.

The nurse working on a medical-surgical unit has just received a change-of-shift report. The nurse should initially assess the client who is A. receiving treatment for chronic pulmonary emphysema with PaCO2 of 50 mm Hg. B. admitted with pulmonary tuberculosis (TB) and refuses their prescribed isoniazid. C. infected with Clostridium difficile, and is reporting dizziness. D. being treated for acute pyelonephritis and has a temperature of 101.8⁰F (38.7⁰F). Submit Answer

Explanation Choice C is correct. Dizziness is not expected with a C. diff infection. This could be regarded as a complication because the dizziness is likely associated with severe dehydration caused by diarrhea. The nurse needs to follow up with this client because of the potential for further clinical deterioration. Choices A, B, and D are incorrect. These clients do not require immediate follow-up because a client with pulmonary emphysema would have hypercapnia. Thus, an increase in PaCO2 would be expected. Further, clients have the right to refuse any aspect of their care. As long as the client has been reasonably informed of the purpose of the treatment/medication, the client may exert their autonomy and decline their treatment. Acute pyelonephritis features flank pain, fever, and dehydration. Thus, this client's situation would not require immediate follow-up. Additional Info According to the Centers for Disease Control, the transmission of C. diff can be disrupted through: ➢ Meticulous hand hygiene with soap and water. ➢ Avoid using alcohol-based hand sanitizers. ➢ Using disposable healthcare equipment, such as blood pressure cuffs and stethoscopes. ➢ Disinfect surfaces with a bleach solution. ➢ Discontinuing unnecessary antibiotics. Hydration, infection control measures, and antibiotics are key during the treatment of C. diff. Last Updated - 22, Dec 2022

The nurse has been assigned the responsibility for all aspects of providing patient care during a 12-hour shift. How would you classify this approach to nursing care? A. Team Nursing B. Case Management C. Total Patient Care D. Primary Nursing Submit Answer

Explanation Choice C is correct. In the total patient care model, the RN assumes responsibility for all aspects of care for a patient or group of patients during a shift, although care can be delegated. The RN works directly with the patient, family, and health care team members. Choice A is incorrect. With team nursing, the RN leads a team consisting of other RNs, LPNs, and NAPs, that provide direct patient care under the supervision of the team leader. Choice B is incorrect. Case management is an approach that coordinates health care services, linking patient/family to the needed services. Rather than providing direct patient care, the case manager typically supervises the care provided by the health care team. Choice D is incorrect. In primary nursing, the RN is assigned responsibility for a caseload of patients, developing the plan of care, and providing care for the workload of patients throughout their hospital stay. Bloom's Taxonomy: Analyzing Last Updated - 21, Dec 2021

The nurse is planning a staff development conference about medication reconciliation. Which of the following information should the nurse include? A. Medication reconciliation should occur just at discharge to prevent omissions. B. Prescribed medications should be obtained and omit herbs and supplements. C. This process should occur at admission, client transfer, and discharge. D. Obtain a list of the medications instead of reviewing the list with the client Submit Answer

Explanation Choice C is correct. Medication reconciliation was designed to prevent omission and duplicate errors related to medication administration. Choice A, B, and D are incorrect. This process should occur at admission, transfer, and discharge - not just at discharge. The medications that should be obtained should be the prescribed and over-the-counter medications. This process should involve the client as they should confirm their adherence to the medication. Additional Info Medication reconciliation is an essential process designed to promote client safety. The client's complete list of medications (including over-the-counter medications) should be collected during this process. This process should occur at admission, client transfer, and discharge. The nurse must obtain the most recent medications from the client and their adherence (for example, a client is prescribed omeprazole, but the client indicates that they do not take the medication). This process should be thorough and involve the client. Last Updated - 13, May 2022

The movement of a client from a lower to a higher level of care and intensity of care is an example of: A. A decreasing level of acuity B. Retrospective reimbursement C. Movement along the continuum of care D. Prospective reimbursement Submit Answer

Explanation Choice C is correct. The movement of a client from a lower to a higher level of care and intensity of care is an example of change along the continuum of care. The continuum of care is a concept involving a system that guides and tracks a client over time through a comprehensive array of health services to span all levels and intensity of care. Choice A is incorrect. The movement of a client from a lower to a higher level or intensity of care indicates that the client has an increased acuity level, not a decreasing level of acuity. Choice B is incorrect. Retrospective reimbursement was a complicated payment system previously utilized by Medicare. Even when retrospective reimbursement was standard, nothing about this reimbursement method correlated with the client's movement from a lower to a higher level of care or the intensity of such care. Choice D is incorrect. Prospective reimbursement is a method of reimbursement currently used by Medicare in which payment is made based on a predetermined, fixed amount. Although reimbursement often correlates with a client's movement through the healthcare system based on medical necessity, compensation is not based solely on the progression of care. Learning Objective Understand the concept of the continuum of care and how this is used to monitor clients. Additional Info Within the continuum of care, healthcare providers follow clients from preventive care through medical incidents, rehabilitation, and maintenance (often referred to as primary prevention, secondary prevention, and tertiary prevention). Last Updated - 24, Nov 2021

The nurse is caring for the following assigned clients. Which client should the nurse see first? The client A. going for an echocardiogram and is allergic to contrast dye. B. refusing to eat their meal following an injection of glargine insulin. C. scheduled for discharge in three hours and needs transportation. D. requesting diphenhydramine after starting an intravenous antibiotic. Submit Answer

Explanation Choice D is correct. A client requesting diphenhydramine following the initiation of an antibiotic requires immediate follow-up because the client could be experiencing an allergic reaction ranging from mild to severe. Thus, the nurse should quickly assess the client. Choices A, B, and C are incorrect. A client scheduled for an echocardiogram will not receive contrast dye, and follow-up is unnecessary. Further, for an individual receiving glargine insulin, meals are not necessary as this long-acting insulin does not peak. Finally, arranging discharge transportation is a low-priority item for the nurse. Additional Info If a client is experiencing anaphylaxis, the nurse should promptly stop the antibiotic, activate the rapid response team, and administer prescribed epinephrine - not diphenhydramine, as it is ineffective for upper airway closure. Diphenhydramine is an anticholinergic medication intended for minor to moderate allergies. Last Updated - 08, Nov 2022

The nurse is precepting a graduate nurse as they perform resuscitation on an adult with cardiac arrest. Which action by the graduate requires immediate follow-up by the nurse? A. Assesses the client's pulse by palpating the carotid artery. B. Allows for chest recoil after every chest compression. C. Compresses at a depth of 2 inches on the center breastbone. D. Asks for an automatic external defibrillator after one cycle of CPR. Submit Answer

Explanation Choice D is correct. An automatic external defibrillator (AED) should be requested immediately upon establishing that the client is in cardiac arrest. Waiting to request an AED could result in the delay of life-saving care. Choices A, B, and C are incorrect. An adult client should have their pulse palpated using the carotid artery. Chest recoil after every compression is essential to ensure optimal perfusion. Chest compressions for an adult should have a depth of two inches and be over the center breastbone. Additional Info When performing CPR, the nurse needs to minimize interruptions and focus on providing effective compressions and ventilations ➢ A compression rate of 100-120/minute is desired ➢ An AED should be made available as urgently as possible ➢ Assessing for a pulse should not take more than ten seconds ➢ When obtaining a pulse for an infant, the nurse should assess the brachial artery. For a child and adult, the nurse will use the carotid artery ➢ Immediate family members should be allowed to be present during resuscitation as this has promoted better grieving Last Updated - 04, Dec 2022

The nurse is providing patient care working in a unit that uses the total patient care model for delivering nursing care. The nurse recognizes which of the following as an aspect of this nursing care delivery model? A. The RN assumes responsibility for a caseload of patients. B. The RN supervises team members providing direct patient care. C. The RN provides care for the same patients during their hospital stay. D. The RN is responsible for all aspects of care during a shift of care. Submit Answer

Explanation Choice D is correct. Characteristics of the total patient care model include: the RN being responsible for all aspects of care during a shift of care, care can be delegated, and the RN works directly with the patient, family, and health care team members. Choices A and C are incorrect. The RN having responsibility for a caseload of patients and providing care for the same patients during their hospital stay are characteristics related to the primary nursing model. Choice B is incorrect. In team nursing, team members provide patient care under the supervision of the RN team leader. Bloom's Taxonomy: Analyzing Last Updated - 14, Feb 2022

The nurse manager on the unit is heard talking to his staff, saying, "As long as patients don't die on your shift, it's okay. Just do what you wish." The nurses also notice very infrequent staff meetings, and unit policies have not been updated for years. The nursing director takes note of this style of leadership and recognizes this as: A. Autocratic B. Democratic C. Participative D. Laissez-faire Submit Answer

Explanation Choice D is correct. Little direction, structure, or support is provided by the manager in a Laissez-faire type of management. The manager abdicates responsibility and decision-making whenever possible in this type of management. Choice A is incorrect. In autocratic leadership, decisions are made with little or no staff input. The manager makes all the decisions in the unit. Choice B is incorrect. In a democratic style of management, staff members are encouraged to participate in the decision-making process whenever possible. The majority of the decisions are made by the group, not the manager in this management style. Choice C is incorrect. In a participative style of management, problems are identified by the manager and presented to the staff with several solutions. Staff members are encouraged to provide input however, the manager makes the final decision. Last Updated - 24, Oct 2021

The unit manager notices that the nurse has been taking an extra 15 minutes for their lunch break, three times in the past week. Which action by the nurse manager is most appropriate? A. Continue to observe the nurse's behavior. B. Make written notes on the nurse's file. C. Ask the nurse to check in with her before and after taking their lunch break. D. Mention to the nurse, in an informal manner, that the incident is concerning. Submit Answer

Explanation Choice D is correct. The nurse manager should talk to the nurse regarding the behavior informally. This is to find out the reason behind the issue and provide solutions. Choice A is incorrect. The behavior is becoming a pattern and should warrant intervention by the nurse manager. The manager should express her concern and talk to the nurse regarding the situation. Choice B is incorrect. This is only the third time that the incident occurred and did not warrant any formal documentation of behavior. Choice C is incorrect. This is a punitive action for the nurse manager to take. The manager should talk to the nurse first before implementing action. Last Updated - 09, Jan 2022

The nurse overhears another nurse state to a client "If you do not behave, I will restrain you." This statement demonstrates an example A. battery. B. libel. C. slander. D. assault. Submit Answer

Explanation Choice D is correct. Verbal assault means any willful spoken threat to inflict physical injury on another person. The nurse should not threaten a client with punitive actions in an attempt to gain their adherence. Choices A, B, and C are incorrect. Battery is a physical act that results in harmful or offensive contact with another person without that person's consent. Libel is committed when written documentation causes damage to an individual's reputation that is malicious in nature. Slander is false verbal statements that are made to erode an individual's character. Additional Info The nurse should conduct themselves legally and ethically. Threatening a client with restraints, tubes, or devices is assault. The nurse should maintain a professional relationship with the client that fosters the client to have autonomy. If a conflict arises in the nurse-client relationship, the nurse should be professional and establish concordance with the client versus engaging in a power struggle. Last Updated - 18, May 2022

The nursing supervisor is preparing to complete performance appraisals on subordinate staff members. In order to minimize bias when conducting the evaluations, the nurse supervisor should A. compare the performance of the nurse with another nurse. B. focus on a positive experience and rate all areas based on that measure. C. review the employee's previous evaluations before completing the new evaluation. D. gather feedback from peers regarding skills, performance, attitude, and competencies. Submit Answer

Explanation Choice D is correct. When conducting performance reviews, it is essential to avoid evaluator bias. Two methods that are becoming popular to minimize evaluator bias and get a full picture of the nurses' performance are using peer review or 360 feedback. Choices A, B, and C are incorrect. Comparing performance with another nurse would create bias. An employee should be evaluated based on their sole performance. Focusing only on an employee's positive attributes would bias the evaluator in their rating of the employee. Reviewing the employee's previous evaluations would create an evaluator bias as the performance evaluation should occur on the employee's current performance. Additional Info A peer review may involve observations or a skills test. The format involves feedback from peers regarding skills, performance, attitude, and competencies. The benefits of this format are that it can give the manager a more well-rounded view of the employee's strengths and challenges. Bias may occur; this is why the evaluator needs to get input for multiple peers. 360-degree feedback This appraisal involves multiple individuals who interact with the employee, specifically, the supervisor, peers, patients, families, staff from other departments, and outside vendors. Last Updated - 06, Jul 2022

You are supervising a nursing assistant and observing their competency in providing personal care and hygiene for a group of clients. As you review this nursing assistant's documentation, you see that the nursing assistant has documented shaving one of the clients, who is taking warfarin. What should you do? A. Tell the nursing assistant that shaving clients who are taking warfarin is prohibited. B. Complete an incident report because shaving clients is outside the nursing assistant's scope. C. Tell the nursing assistant to cross off the documented evidence of shaving the client. D. Ask the nursing assistant what kind of razor was used and about the client's response. Submit Answer

Explanation Choice D is correct. You would ask the nursing assistant what kind of razor was used and about the client's response to the shave after finding out the nursing assistant shaved one of the clients taking warfarin. You would determine what kind of razor was used because an electric or battery-operated razor is much safer than a dull razor blade for clients on an anticoagulant like warfarin. If the nursing assistant used a regular razor blade instead of an electric or battery-operated razor, you would ask the nursing assistant about the client's response to the shave. For example, you would determine whether or not there was any skin nicking or bleeding. After these things are determined, you would also ask the nursing assistant to document the type of razor used in addition to the client's responses to the shave. Choice A is incorrect. You would not tell the nursing assistant that shaving clients taking warfarin is strictly prohibited in all settings because this is not accurate and true. Clients taking warfarin should be shaved with an electric or battery-operated razor because these razors are much safer than a dull razor blade. Choice B is incorrect. You would not complete an incident report. Shaving, personal care, and hygiene are within the legal reach of unlicensed assistive personnel, including nursing assistants and patient care technicians, provided they have the training and documented competency to do so. Choice C is incorrect. You would not tell the nursing assistant to cross off the documented evidence of shaving the client. If the person is cut, this documentation must remain in place. Additional Info Last Updated - 20, Jun 2022

The nurse should understand the regulations of nursing practice as put forth by the Nurse Practice Act. Which of the following statements are correct? Select all that apply. A. Some other issues covered by the Nurse Practice Act include grounds for disciplinary action—licensure requirements and the rights of the nurse licensee if disciplinary action is taken. B. The Nurse Practice Act defines the scope of nursing practice. C. Nurses do not have the responsibility to know the provisions of the act for the state or province in which they work. D. The Nurse Practice Act is a series of statutes enacted by the federal government to regulate the practice of nursing. Submit Answer

Explanation Choices A and B are correct. Nurse practice acts (NPAs) contain a provision that creates and empowers a state board of nursing to regulate the practice of nursing in that state. All 50 states, the District of Columbia, and the four U.S. territories have established boards of nursing. Although NPAs can vary from state to state, they all have standard components because states use the ANA guidelines in developing their regulations. A state's nurse practice act usually includes the following: The authority of the board of nursing, its composition, and powers A definition of nursing and the boundaries of nursing practice Standards for the approval of nursing education programs The requirements for licensure of nurses Grounds for disciplinary action against a nurse's license Choices C and D are incorrect. Nurses do have the responsibility to be familiar with the NPA. Nurses are responsible for knowing the laws affecting their practice as most boards maintain ignorance of the law is no excuse for non-compliance and substandard nursing practice. Nurse practice acts are created by the state, not the federal government. NCSBN Client Need Topic: Safe and Effective Care Environment, Subtopic: Nurse Practice Acts Last Updated - 12, May 2022

The nurse reviews the nursing process with a group of students. Which of the following would demonstrate implementation? Select all that apply. A. Performing a sterile dressing change B. Interviewing the client about their social determinants C. Inputs risk for impaired skin integrity into the care plan D. Establishing a peripheral vascular access device E. Determining if the prescribed pain medication was effective Submit Answer

Explanation Choices A and D are correct. Implementation is when the nurse performs an action. These activities reflect the implementation portion of the nursing process. Implementation is based on the client's assessment. The nurse utilizes evaluation to determine the efficacy of the intervention. Choices B, C, and E are incorrect. The nursing process's assessment step includes obtaining physiological data and psychological, sociocultural, spiritual, economic, and lifestyle data. The nursing diagnosis step includes not just primary diagnosis but also formulating diagnoses. The North American Nursing Diagnosis Association (NANDA) defines nursing diagnosis as "a clinical judgment about the human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community." The diagnosis is the basis for the nurse's care plan. Interviewing a client is an assessment because the nurse forms appropriate questions to obtain the necessary information to formulate an accurate nursing diagnosis. Determining the efficacy of an intervention exemplifies evaluation which is the last part of the nursing process. Additional Info Last Updated - 15, Feb 2023

The nurse is participating in a quality improvement project to reduce urinary tract infections (UTIs) for older adult clients in long-term care. It would be appropriate for the nurse to recommend Select all that apply. A. the addition of more liquids to meal trays. B. standardizing the dosing times of prescribed diuretics. C. audio reminders for turning bed-bound clients. D. daily bathing using bath basins. E. a staff in-service on hand hygiene. Submit Answer

Explanation Choices A and E are correct. A significant intervention the nurse can implement to reduce UTIs in older adults is offering more liquids. The older adult has a reduced thirst reflex, and this reduced reflex may cause the client to experience a fluid volume deficit, which is a major precipitating factor in the development of a UTI. Offering more fluids during mealtime and in-between meals is effective in mitigating UTIs. Hand hygiene is an effective intervention in curbing healthcare-acquired infections, including UTIs. This would be an appropriate recommendation. Choices B, C, and D are incorrect. Standardizing the dosing times of diuretics would not reduce UTIs. This may help reduce falls because if diuretics are dosed in the evening hours, this causes the older adult to ambulate to the bathroom when it is darker, raising the risk of falls. Audio reminders for turning bed-bound clients are an effective intervention to reduce pressure ulcers, not UTIs. Bath basins are a reservoir for bacteria, and their use is now discouraged. If they are used, they should only be used once and then discarded. Additional Info ✓ Urinary tract infections (UTIs) are a serious problem for clients residing in long-term care ✓ The nurse can reduce UTIs by encouraging non-caffeinated hydration ✓ Other interventions include hand hygiene reminders and using indwelling urinary catheters sparingly. ✓ Manifestations of a UTI in older adult includes altered mental status, increased urinary frequency, foul-smelling urine, and hematuria. Last Updated - 14, Feb 2023

The nurse is providing handoff report to the oncoming nurse. Which information should be included? Select all that apply. A. As needed (PRN) medications that were administered B. Normal assessment findings for the shift C. Normal laboratory results D. Scheduled medications that were administered E. Abnormal vital signs Submit Answer

Explanation Choices A and E are correct. Medications administered as needed should be included in the nursing handoff and abnormal vital signs. Nursing handoffs should accurately and quickly review the client's condition during the past shift. As needed, medications are administered for a change in the client's condition, and abnormal vital signs will require follow-up. Choices B, C, and D are incorrect. Normal assessment findings for the shift are not a necessary component of the nursing handoff. Reviewing all normal assessment findings would not only take too long but is not necessary information. Any changes in assessment findings, abnormal findings, and current problems should be included as they will likely require follow-up. The client's scheduled medications are not a necessary component of the nursing handoff. This information may be obtained from the medication administration record (MAR) by the oncoming nurse. Additional Info Topics to include during the handoff report include - Following the ISBAR format (identify the client, situation, background, assessment abnormalities, and recommendations) Abnormal vital signs PRN medications administered Abnormal laboratory values Pending orders/diagnostic tests Change in condition Pertinent family dynamics Discharge plan Last Updated - 09, Oct 2022

The nurse is caring for assigned clients. Which of the following actions would reflect effective care coordination? Select all that apply. A. Arranging for an interdisciplinary conference B. Consulting with case management for a discharge plan C. Initiating appropriate outpatient referrals D. Performing post-discharge phone calls E. Implementing transmission-based precautions Submit Answer

Explanation Choices A, B, C, and D are correct. The nurse arranging for an interdisciplinary conference, consulting with case management, initiating outpatient referrals, and performing post-discharge phone calls are all relevant to effective care coordination. These actions work to improve care delivery through effective communication with other members of the healthcare team. Choice E is incorrect. While appropriate transmission-based precautions are important to implement and maintain, they are not relevant to care coordination, focusing on organizing client care, and sharing information with pertinent individuals involved in the patient's care. Additional Info Effective care coordination involves providing organized, cost-effective care involving multiple disciplines through good communication. Effective care coordination aims to reduce costs by decreasing hospitalization and mitigating errors through linear communication. Last Updated - 15, Nov 2021

Which of the following are components of the definition of critical thinking? Select all that apply. A. Reasoned thinking B. Openness to alternatives C. Adherence to established guidelines D. Ability to reflect E. Loyalty to traditional approaches F. Desire to seek the truth Submit Answer

Explanation Choices A, B, D, and F are correct. Critical thinking is a combination of reasoned thought, openness to alternatives, the ability to reflect, and a desire to seek the truth. There are many definitions of critical thinking. It is a complex concept and people think about it in different ways. Any situation that requires critical thinking is likely to have more than one "right" answer. You do not need critical thinking to add 2 + 2 and come up with the solution. However, you do need critical thinking to problem-solve essential decisions. A crucial aspect of critical thinking is the process of identifying and checking your assumption. This is also a necessary part of the research process. Critical thinking is a combination of reasoned thought, openness to alternatives, the ability to reflect, and a desire to seek the truth. Choices C and E are incorrect. Adhering to established guidelines does not require critical thinking (Choice C). Loyalty to traditional approaches does not demonstrate critical thinking and could actually hinder it (Choice E). NCSBN Client Need Topic: Safe & Effective Care Environment; Subtopic: Management of Care Last Updated - 14, Jan 2022

The nurse manager is completing an annual performance apprasial/evaluation on a staff nurse. Which elements should the nurse manager include when completing the evaluation? Select all that apply. A. The nurses' bar-code medication administration scan rate B. The number of times the nurse has been absent or tardy C. The nurse achieving a national certification D. The nurses' performance compared to other staff nurses E. The number of medication errors the nurse has self-reported. Submit Answer

Explanation Choices A, B, and C are correct. The performance appraisal/evaluation goal is to provide a broad review of the employee's performance with minimal evaluator bias. The more objective the evaluation, the less the bias. Objective metrics such as bar-code medication administration rate, attendance, and national certifications are logical elements to include in the appraisal. Choices D and E are incorrect. The nurses' performance should not be compared/contrasted with other nurses. The annual performance review should be focused solely on the nurses' performance. Self-reporting is valued by the nursing profession and promotes a culture of safety. Using self-reports of a medication error against the nurses' performance would likely discourage future reporting. If the nurse manager observes unsafe practices by the nurse, they should be corrected. However, self-reporting should be encouraged and not weaponized against the nurse. Additional Info Performance appraisals/evaluations serve a variety of functions, including: Appraisals help the nurse manager in updating personnel records and making decisions on staffing, including hiring, scheduling, promotions, or termination Sets expectations for what the employer will provide, such as fair treatment, acceptable working conditions, and feedback on their job performance. Develops the nurse-manager relationship leading to increased employee retention and morale. Ensures legal compliance if consequential decisions such as termination should occur. Last Updated - 07, Jul 2022

The nurse manager plans to reduce supply-related costs within the nursing unit. While evaluating nursing staff, which observation demonstrates an ineffective use of resources? Select all that apply. A. Gloves being worn to pass out meal trays B. Sterile water used to irrigate nasogastric tubes C. Single-use blood pressure cuffs for clients with contact precautions D. Sterile gloves used to provide perineal care during bed baths E. New intravenous (IV) tubing with each bag of total parenteral nutrition (TPN) Submit Answer

Explanation Choices A, B, and D are correct. These observations indicate an ineffective use of resources. To promote cost-effective care, the nurse manager should correct these by instructing staff that gloves are not used during the passing or retrieving of a meal tray. Gloves would only be used during preparing the client's food, as required for dietary staff. Warm tap water is used to irrigate an NGT. The gut is not sterile; therefore, using sterile water would waste resources. Sterile gloves used to provide perineal care during bed baths are not used. During a bed bath regular (clean) gloves are used and changed frequently during a bed bath. Choices C and E are incorrect. These observations indicate an effective use of resources. Single-use equipment should be used for clients on isolation precautions. This prevents the transmission of pathogens via vital sign equipment. A new filter and IV tubing are used every time a new bag of TPN is initiated. The risk of infection increases with TPN, and part of a mitigation strategy is always to use new sterile tubing and filter with each TPN change. Additional Info ✓ Utilizing supplies effectively promotes cost-effective care ✓ The nurse should use supplies pertinent to the planned procedure/task ✓ Taking unnecessary supplies in the client's room may cause contamination resulting in waste ✓ Safety and infection control practices should not be compromised to achieve a reduction in supply cost Last Updated - 10, Feb 2023

The nurse is teaching a group of students on incident reports. Which of the following situations would require an incident report? Select all that apply. A visitor A. refusing to wear personal protective equipment (PPE). B. activating a client's patient-controlled analgesia (PCA) device. C. requesting that their family member get pain medication. D. assisting their family member with brushing their teeth. E. stating that they fell while using the bathroom. Submit Answer

Explanation Choices A, B, and E are correct. Incident (sometimes termed occurrence or event) reporting is required when any activity deviates from the norm. Incident reporting may be completed for visitors. Events that warrant reporting would include the refusal to wear PPE, activating a client's PCA device, and stating that they fell while using the bathroom. Choices C and D are incorrect. A visitor advocating for a client to receive pain medication does not require reporting—the same for a visitor assisting a client with oral hygiene. Additional Info Incident (sometimes termed occurrence or event) reporting is a tool to mitigate future risks. Incident reporting should also be completed for events involving clients and visitors. Such events include: Verbal and physical displays of aggression Tampering with medical devices Reports of sexual or physical abuse by staff Adverse reaction to a blood transfusion Client elopement Damage (or loss) of client possessions Falls or injuries Injuries related to a medical device Complaints Medication and treatment errors Interfering with client care The incident should not be logged in the medical record or nursing notes. The documentation should be objective and factual and include what occurred, any injuries, if the provider was notified, care administered after the event, and any witnesses. Last Updated - 06, Dec 2022

Which of the following nursing improvements follow the recommendations of the Institute of Medicine's Committee on Quality Healthcare in America? Select all that apply. A. Basing patient care on continuous healing relationships B. Customizing care to reflect the competencies of the staff C. Using evidence-based decision making D. Having a charge nurse as the source of control E. Using safety as a system priority F. Recognizing the need for secrecy to protect patient privacy Submit Answer

Explanation Choices A, C, and E are correct. Standards are the levels of performance accepted and expected by the nursing staff or other healthcare team members. They are established by authority, custom, or consent. The Committee on Quality Health Care in America of the Institute of Medicine, in its report Crossing the Quality Chasm, highlights six aims to be met by health care systems about quality care: Safe: Avoiding injury Useful: Avoiding overuse and underuse Patient-centered: Responding to patient preferences, needs, and values Timely: Reducing waits and delays Efficient: Avoiding waste Equitable: Providing care that does not vary in quality to all recipients Choices B, D, and F are incorrect. NCSBN Client Need Topic: Safe and Effective Care Environment, Subtopic: Coordinated Care; Ensuring Quality Outcomes Last Updated - 27, Jan 2022

The supervising nurse watches a newly hired nurse take care of a client who is at risk of developing a pressure ulcer. Which of the following interventions by the newly hired nurse requires follow-up? Select all that apply. A. Applies zinc oxide to the client's perineal skin. B. Provides a donut pillow while the client is sitting in the chair. C. Maintain the head of the client's bed at 90 degrees. D. Encourages the client to consume foods rich in carbohydrates. E. Uses a pillow to float the client's heels. Submit Answer

Explanation Choices B, C, and D are correct. If the newly hired nurse provides a donut pillow while the client is sitting in the chair, this will require follow-up because this pillow creates pressure and damages capillary beds. Maintaining the client's position at 90 degrees would require follow-up because this contributes to the client sliding, therefore creating shearing. It is recommended that they be kept at 30 degrees (if not medically contraindicated). A diet rich in carbohydrates is unhelpful to a client at risk for a pressure ulcer. A diet dense in protein is recommended to maintain skin integrity and mitigate any edema. Choices A and E are incorrect. Applying zinc oxide to the client's skin is recommended. This product is a common ingredient in topical creams because it repels moisture. Floating the client's heels is essential as it helps with offloading pressure. This can be done using a device comprised of foam or a pillow. Additional Info Recommended interventions for a client at risk for developing a pressure ulcer include the following: ▪ Utilize standardized assessments to evaluate a client's risk for a pressure ulcer. ▪ Ensure that nutritional goals are being met by providing adequate fluid and protein in the diet. ▪ Keep the head of the bed at 30 degrees or less to prevent shearing. ▪ Offload bony prominences using foam or pillows. Reposition the client at least every two hours. ▪ Do not use any products comprised of plastic and avoid using donut pillows. ▪ Moisturize the skin with products containing zinc oxide. ▪ Do not massage reddened areas. Last Updated - 14, Nov 2022

Which of the following are management functions that nurse managers fulfill? Select all that apply. A. Empowering B. Directing C. Planning D. Organizing Submit Answer

Explanation Choices B, C, and D are correct. The five major management functions are planning, organizing, staffing, directing, and controlling. Each of these functions are discussed in detail in the additional information section below. Choice A is incorrect. Although effective leadership often utilizes empowerment, it is important to note that leadership and management differ from one another. Empowering others is not considered a management function. Learning Objective Identify the major management functions used in nursing management. Additional Info As noted above, the five major management functions are planning, organizing, staffing, directing, and controlling. Of note, some sources list coordinating in place of staffing. Planning describes the decision-making process regarding what needs to be done, how it will be done, and what resources/individuals will be utilized in the process. This process is continuous, with the nurse manager needing to continuously reassess the process and evaluate if changes are needed. Organizing refers to the organizational structure which determines the chain of command and the method decisions are made. Staffing is the acquisition and management of adequate staff as well as the correct staffing combination. Directing refers to a leadership role assumed by a manager which influences and motivates the staff to perform assigned roles or duties. Although empowerment may be one method a manager may utilize when directing, leaders are more likely to use empowerment than managers. Controlling involves continuously evaluating data (i.e., staff performance, feedback, and other measurable data) to ensure previously identified outcomes are being met and, if needed, making necessary adjustments. Last Updated - 10, Aug 2022

The nurse is educating staff on adult basic life support. It would be appropriate to include which of the following? Select all that apply. A. Carotid pulse check should not take more than 20 seconds. B. The rate of chest compressions should be 100-120 per minute. C. Chest compression depth should be 2 inches on the center breastbone. D. Chest tube insertion should be prepared after five minutes of CPR. E. Early defibrillation is essential in the survival of ventricular fibrillation. Submit Answer

Explanation Choices B, C, and E are correct. High-quality CPR involves a compression depth of two inches on the center breastbone. The rate of the compressions should be 100-120 per minute. The nurse should utilize early defibrillation as it is the most effective treatment for ventricular fibrillation. Choices A and D are incorrect. A carotid pulse check should not exceed ten seconds. Poor quality CPR has been linked to prolonged pulse checks and pulse checks occurring too frequently. A chest tube is not in the BLS algorithm and would only be utilized for chest trauma causing injuries such as pneumothorax. Additional Info The key to successful basic life support is high-quality CPR and prompt defibrillation. When responding to a confirmed cardiac arrest, the nurse should immediately initiate an emergency response (call a code blue or 911). Start chest compressions at a rate of 30 compressions to 2 rescue breaths. A request for an AED should be given as soon as possible; it should be applied and used immediately. The key to effective CPR is to minimize interruptions. The immediate utilization of an AED dramatically enhances the survival of ventricular dysrhythmias. Auditory cues from the AED should be followed precisely to minimize CPR interruptions. Last Updated - 06, Dec 2022

The characteristics of the crisis include which of the following? Select all that apply. A. A prolonged period of time occurs before the actual anticipated crisis. B. Crises result from anticipated life-threatening events. C. A crisis results from a rapid and unanticipated life threatening event. D. Crises result from actual and perceived threats to the person. E. Crises can be quite brief and self-limiting in terms of their nature. Submit Answer

Explanation Choices C, D, and E are correct. A crisis results from a rapid and unanticipated life-threatening event. Crises can be precipitated in response to both actual and perceived threats to the person, and emergencies can be quite brief and self-limiting in terms of their nature. Choice A is incorrect. Crises are typically sudden and without appropriate time to be able to cope. Choice B is incorrect. Crises are most often unanticipated, and they can occur as the result of an actual or perceived life-threatening event. Last Updated - 25, Jan 2022