Capstone Leadership Assessment

A hospice nurse is providing teaching to a client who has a new diagnosis of a terminal illness and her family. Which of the following statements should the nurse include in the teaching? "Hospice care focuses on disease treatment and rehabilitation." "The provider will coordinate your health care needs while in hospice." "You must choose a family caregiver before being admitted into a hospice facility." "Hospice care continues to help families with grief after a death occurs."

"Hospice care focuses on disease treatment and rehabilitation."Hospice care focuses on palliative care and symptom management and addresses the psychological, social, and spiritual needs of the client and their family. Palliative care focuses on reducing symptoms and enhances the quality of life for the client. "The provider will coordinate your health care needs while in hospice."Hospice care is nurse-directed by a case manager who coordinates care among disciplines. A provider collaborates with the nurse case manager but is not the coordinator of care. "You must choose a family caregiver before being admitted into a hospice facility."Clients are required to have a home caregiver to be eligible for home hospice services. Clients admitted into a hospice facility do not need to choose a family caregiver. "Hospice care continues to help families with grief after a death occurs."Individuals who experience the death of a loved one require extended support to facilitate grief and coping. The nurse should inform the client and her family that hospice services will continue after the client's death.

A nurse is preparing to administer the initial dose of ceftriaxone to a client who has endometritis. Which of the following statements by the client should cause the nurse to hold the medication and consult the provider? "I have a severe allergy to amoxicillin." "I get sick when I take diuretics." "I have a history of hearing problems." "I take prednisone for my asthma."

"I have a severe allergy to amoxicillin."MY ANSWERCeftriaxone is a third-generation cephalosporin. Due to the potential for cross-sensitivity reactions, clients who have serious allergic responses to penicillin should not take cephalosporins. "I get sick when I take diuretics."Difficulty taking diuretics does not indicate a need to avoid taking ceftriaxone. Trimethoprim-sulfamethoxazole is contraindicated for clients who have allergies to sulfonamides. "I have a history of hearing problems."Gentamicin and other aminoglycosides are associated with hearing loss and should be used with caution by clients who have hearing loss. However, hearing loss is not an adverse effect associated with ceftriaxone. "I take prednisone for my asthma."Prednisone, a corticosteroid medication, is associated with an increased risk of tendon rupture if taken concurrently with a fluoroquinolone antibiotic, such as ciprofloxacin. However, there is no interaction associated with prednisone and ceftriaxone.

A nurse is receiving change-of-shift report on a group of clients. Which of the following clients should the nurse assess first? A client who has urolithiasis and reports severe flank pain extending toward the abdomen A client who has acute cholecystitis and reports abdominal pain radiating to the right shoulder A client who has had a total knee arthroplasty, is 1 day postoperative, and reports a pain level of 8 on a 0 to 10 pain scale A client who has a fractured femur and reports sudden sharp chest pain

A nurse is receiving change-of-shift report on a group of clients. Which of the following clients should the nurse assess first? A client who has urolithiasis and reports severe flank pain extending toward the abdomenA report of severe flank pain extending toward the abdomen is an expected finding for the client who has urolithiasis. This client is stable, and the nurse should assess another client first. A client who has acute cholecystitis and reports abdominal pain radiating to the right shoulderA report of abdominal pain radiating toward the right shoulder is an expected finding for the client who has acute cholecystitis. This client is stable, and the nurse should assess another client first. A client who has had a total knee arthroplasty, is 1 day postoperative, and reports a pain level of 8 on a 0 to 10 pain scaleA pain level of 8 on a scale of 0 to 10 is an expected finding for the client who is 1 day postoperative following a total knee arthroplasty. This client is stable, and the nurse should assess another client first. A client who has a fractured femur and reports sudden sharp chest pain When using the stable vs. unstable approach to client care, the nurse should identify that the client who has a fractured femur and reports sudden sharp chest pain is unstable. This client has manifestations that indicate a life-threatening pulmonary embolism. Therefore, the nurse should assess this client first.

A nurse manager is teaching a group of employees about standards for Quality and Safety Education for Nurses (QSEN). Which of the following statements by an employee should the nurse manager identify as an example of the QSEN concept of quality improvement? "We should start tracking how soon clients are discharged after laparoscopic versus open surgery." "We should be sure to log out of the computers immediately following documentation." "We should involve our clients' partners in care planning as much as possible." "We should provide change-of-shift report as a team, including the assistive personnel who assisted with care."

A nurse manager is teaching a group of employees about standards for Quality and Safety Education for Nurses (QSEN). Which of the following statements by an employee should the nurse manager identify as an example of the QSEN concept of quality improvement? "We should start tracking how soon clients are discharged after laparoscopic versus open surgery."The manager should identify this statement by the employee as an example of quality improvement. Quality improvement uses data to monitor client outcomes to improve health care delivery. "We should be sure to log out of the computers immediately following documentation."The manager should identify this statement by the employee as a part of informatics. Informatics involves proper use of information and technology in health care. "We should involve our clients' partners in care planning as much as possible."MY ANSWERThe manager should identify this statement by the employee as a part of patient-centered care. Patient-centered care involves coordinating care centered on the client's preferences and values. "We should provide change-of-shift report as a team, including the assistive personnel who assisted with care." The manager should identify this statement by the employee as a part of teamwork and collaboration. Teamwork and collaboration involves performing effectively as a health care delivery team with appropriate communication and shared respect.

A newly licensed nurse tells a charge nurse that he is unsure about accepting telephone medication prescriptions. Which of the following providers should the charge nurse identify as having the legal ability to give telephone medication prescriptions? (Select all that apply.) Anesthesiologists Physician assistants ​Hospital pharmacists Mental health technicians Nurse practitioners

Anesthesiologists is correct. Anesthesiologists are licensed practitioners who have prescriptive authority and can convey verbal medication prescriptions in person and over the telephone.Physician assistants is correct. Physician assistants have prescriptive authority and can convey verbal medication prescriptions in person and over the telephone.Hospital pharmacists is incorrect. Hospital pharmacists prepare and distribute prescribed medications. Pharmacists do not have prescriptive authority and cannot convey verbal medication prescriptions in person or over the telephone.Mental health technicians is incorrect. Mental health technicians work under the supervision of the nurse and assist clients with activities of daily living. They do not have prescriptive authority. Nurse practitioners is correct. Nurse practitioners have prescriptive authority and can convey verbal medication prescriptions in person and over the telephone.

A nurse is using the ecologic model for population health to develop interventions to address HIV in a community. Which of the following interventions should the nurse include to address financial factors affecting community health? Have adolescents lead peer discussions in schools about safe sexual practices. Distribute condoms through remote community clinics. Create commercial advertisements describing the long-term effects of HIV. Include information about perinatal HIV transmission at prenatal education classes.

Have adolescents lead peer discussions in schools about safe sexual practices.The nurse should have adolescents lead peer discussions to provide positive peer pressure in influencing safe sexual practices. This action does not address financial factors influencing care. This intervention can affect social factors, which can reduce the risk for HIV. Distribute condoms through remote community clinics.MY ANSWERThe nurse should make contraceptives available for free or at a lower cost as an intervention to address financial factors that related to community-level prevention of HIV. The nurse could also implement measures to improve transportation options to health care facilities and help residents apply for financial assistance. Create commercial advertisements describing the long-term effects of HIV.The nurse should increase awareness of the effects of HIV. This action does not address financial factors influencing care. This intervention can induce behavioral change by changing individual beliefs about the severity of the illness, according to the Health Belief Model. Include information about perinatal HIV transmission at prenatal education classes.The nurse should teach the community about the modes of HIV transmission. This action does not address financial factors influencing care. This action can address knowledge levels or cultural factors that affect a population's awareness of HIV.

A case manager completes a history and physical assessment for a client who has COPD. Which of the following actions should the case manager take next?

Identify the client's current health needs.MY ANSWERFollowing a client assessment, the next action the nurse should take using the nursing process is diagnosis. The nurse should make conclusions based on the client's assessment data to identify the client's current health needs. Call the provider with a list of client concerns.Calling the provider with a list of client concerns is a nursing action that promotes client advocacy. However, there is another action the nurse should take first. Compile a list of community resources for the client.Compiling a list of community resources for the client is a nursing intervention that promotes patient-centered care. However, there is another action the nurse should take first. Refer the client to a COPD support group.Referring the client to a COPD support group is a nursing intervention that fosters client coping. However, there is another action the nurse should take first.

A nurse manager of a rural clinic is orienting a new employee. Which of the following information should the nurse include as a characteristic of rural health? Lower maternal morbidity rates Reduced incidence of death from motor-vehicle crashes Increased rates of chronic illness More frequent dental preventative care visits

Lower maternal morbidity ratesThe nurse manager should include that residents in rural areas have overall higher infant and maternal morbidity rates. Environmental hazards, a lack of specialists (such as obstetricians), and population characteristics contribute to the increase in mortality rates of the rural client. Reduced incidence of death from motor-vehicle crashesThe nurse manager should include that increased rates of unintentional injuries overall, as well as a higher number of deaths from motor-vehicle crashes, are seen in rural populations. Increased rates of chronic illnessMY ANSWERThe nurse manager should include that adults living in rural communities are more likely than adults in urban communities to have a diagnosis of a chronic illness. Rural residents are less likely to seek preventive services, tend to have lower rates of physical activity, and have reduced access to a provider. These factors contribute to increased incidence of heart disease, diabetes, cardiovascular disease, and cancer when compared to residents of urban communities. More frequent dental preventative care visitsThe nurse manager should include that residents in rural areas have lower rates of dental preventative care visits and are less likely to have a dentist in the local area.

A home health nurse is teaching about chest physiotherapy (CPT) treatments with a client who has COPD. Which of the following client statements should the nurse identify as an indication that the teaching has been understood? "My coughing will decrease during CPT treatments." "CPT treatments will decrease my respiratory infections." "I will perform postural drainage after eating meals." "CPT treatments will help cure my COPD."

My coughing will decrease during CPT treatments."CPT treatments are designed to loosen the client's secretions. The nurse should encourage the client to cough to clear the airway after vibration is performed. "CPT treatments will decrease my respiratory infections."MY ANSWERThe desired outcome of CPT treatments is a reduction in pneumonia-related hospitalizations for the client. CPT treatments allow the client to loosen and expectorate secretions, reducing the risk of infections. "I will perform postural drainage after eating meals."Postural drainage should be performed when the patient is comfortable and has not recently eaten food. Performing postural drainage shortly after eating can cause nausea and vomiting. "CPT treatments will help cure my COPD."COPD is a chronic respiratory disorder with progressive declines in respiratory function. While CPT treatments can help manage the manifestations of COPD, it will not cure the disorder.

A nurse manager is preparing to complete staff performance appraisals. Which of the following principles should the nurse manager consider when completing the appraisals? ​Performance appraisals should be written in measurable terms. Appraisal objectives should be applicable to staff at every level. Performance appraisals should be based on the nurse manager's preferences. Completed appraisals should be approved by a provider.

Performance appraisals should be written in measurable terms.MY ANSWERObjectives on the performance appraisal should be measurable. The objectives should relate directly to the duties of the position. Appraisal objectives should be applicable to staff at every level.Objectives should be specific to the level of the staff member being evaluated. Performance appraisals should reflect the staff member's current job description and be based on facility standards. Performance appraisals should be based on the nurse manager's preferences.Performance objectives should be based on recognized and accepted standards. The nurse manager should be objective in their review of all staff members' job performances. Subjective attitudes of the manager could negatively influence the appraisal. Completed appraisals should be approved by a provider.Nurse managers are responsible for completing and presenting their staff appraisals, although input from other managers can be required at times. The provider sometimes provides feedback on staff members as part of a 360° evaluation, which the nurse manager will include in the performance appraisal.

A charge nurse is discussing HIPAA with a newly licensed nurse. Which of the following actions should the charge nurse include in the teaching as an example of a HIPAA violation?

Posting the name of the nurse providing care on a client's communication boardThe nurse's name should be posted on the client's communication board, so the client knows who to ask for when they need assistance. Discussing the client's new medication with a hospital pharmacistThe hospital pharmacist is a member of the interprofessional team providing client care. It is acceptable for the nurse to discuss the client's new medication with the hospital pharmacist. Faxing requested medical information for a client who is transferring to another facilityIt is acceptable for the nurse to fax requested information for a client who is transferring to another facility with permission from the client and if following facility policies. One such policy could include using a cover sheet to indicate the appropriate recipient of the information, confirming the fax numbers, and encrypting the information so the fax cannot be read without an encryption key. Emailing the client's positive hepatitis results from an unencrypted serverMY ANSWERTo prevent unauthorized access to confidential data, the nurse should not email any client information over an unencrypted server. This action is a breach of confidentiality and a HIPAA violation.

A nurse manager is implementing a quality improvement project to reduce the number of methicillin-resistant Staphylococcus aureus (MRSA) infections at the facility. Which of the following actions should the nurse manager take first?

Provide educational in-services for staff.The nurse manager should provide educational in-services to inform staff of the new MRSA protocol and to enhance compliance with newly implemented standards. However, evidence-based practice indicates that the nurse should take a different action first. Develop a MRSA protocol for implementation.The nurse manager should develop a MRSA protocol for implementation based upon reviewing the literature. However, evidence-based practice indicates that the nurse should take a different action first. Evaluate outcomes resulting from interventions.After implementing a protocol to minimize the number of clients who develop MRSA, the nurse manager should conduct an evaluation to identify whether the established benchmark has been met. If the benchmark has not been met, the nurse manager should alter the interventions and reevaluate outcomes. Therefore, evidence-based practice indicates that the nurse should take a different action first. Conduct a chart review to evaluate precipitating factors of clients who develop MRSA.MY ANSWERAccording to evidence-based practice, the nurse manager should first conduct a chart review to evaluate precipitating factors of clients who develop MRSA. This information is part of the root-cause analysis used to determine the number and type of incidents of MRSA infection as well as other precipitating factors for clients who experience them.

A nurse at a local health department is caring for a client who is newly diagnosed with listeriosis. Which of the following actions should the nurse plan to take? Provide the Centers for Disease Control (CDC) and Prevention with the client's information. Inform the client that they are required to have health department staff directly observe their treatment. Determine whether the condition is reportable under state requirements. Find out whether the condition is endemic in the client's neighborhood.

Provide the Centers for Disease Control (CDC) and Prevention with the client's information.The nurse should not provide the client's information to the CDC, because it violates client confidentiality. The nurse should report incidence of certain diseases at the state level. Inform the client that they are required to have health department staff directly observe their treatment.Direct-observed therapy (DOT) is often used in treatment of tuberculosis to promote adherence. However, the nurse should not make the client feel threatened or coerced to receive treatment in order to uphold client rights. Determine whether the condition is reportable under state requirements.MY ANSWERRegulations for communicable disease reporting are mandated by state, rather than federal law. Although the CDC has a list of Nationally Notifiable Infectious Conditions, each state determines reporting requirements. Find out whether the condition is endemic in the client's neighborhood.The nurse should recognize that public health nurses calculate the rates of disease at the community level or greater. Endemic conditions are expected in certain amounts within certain geographic locations or among specific populations. Disease rates are useful in addressing population-level interventions, but not for individual client care.

A nurse working in a mobile health clinic is assessing a migrant farm worker. Which of the following findings should the nurse identify as the priority? Report of back pain associated with twisting at the waist Absence of a dental health provider Lives in a home with 25 other migrant workers Report of muscle twitching and skin rash

Report of back pain associated with twisting at the waistA report of back pain associated with twisting at the waist indicates that the client is at risk for chronic musculoskeletal pain. However, another finding is the priority. Absence of a dental health providerAbsence of a dental health provider indicates that the client is at risk for tooth decay and periodontal disease. However, another finding is the priority. Lives in a home with 25 other migrant workersLiving in a home with 25 other migrant workers indicates that the client is at risk for infectious disease. However, another finding is the priority. Report of muscle twitching and skin rashMY ANSWERReport of muscle twitching and skin rash indicates that this client is at greatest risk for acute poisoning from pesticide exposure, which can lead to difficulty breathing and unconsciousness. Therefore, this finding is the priority. The nurse should also monitor the client for confusion, gastrointestinal changes, and eye irritation following acute exposure. Long-term effects of exposure include neurological defects, reproductive abnormalities, and liver damage.

A community nurse is instructing a group of newly licensed nurses about diseases that require airborne precautions. Which of the following diseases should the nurse include?

RubellaRubella requires droplet precautions. Droplet precautions are initiated for communicable diseases that are transmitted via droplets larger than 5 microns. PertussisPertussis requires droplet precautions. Droplet precautions include placing the client in a private room and wearing of a mask when within three feet of the client. InfluenzaInfluenza requires droplet precautions. Diseases that require airborne precautions include rubeola, disseminated herpes zoster, and mycobacterium tuberculosis. VaricellaMY ANSWERVaricella requires airborne precautions. Airborne precautions are initiated for communicable diseases that are transmitted via droplets smaller than 5 microns. Airborne precautions include placing a client in a private room with negative-pressure airflow. The door to the room should be kept closed. Health care providers should wear an N95 HEPA filter mask when providing care for the client.

A nurse in an emergency department is preparing change-of-shift report for an adult client who is transferring to a medical-surgical unit using the SBAR communication tool. Which of the following information should the nurse include in the report? (Select all that apply.) The client has a do-not-resuscitate order. The client has a continuous IV of lactated Ringer's. The client was straight catheterized for 350 mL 2 hr ago. The client has Medicare insurance. ​The client lives in a one-story home.

The client has a do-not-resuscitate order is correct. The nurse should include the client's current prescriptions, including code status, in a change-of-shift report. The client has a continuous IV of lactated Ringer's is correct. The type of IV solution being administered is an element of the "Background" portion of the SBAR tool. The nurse should provide a summary of any medications or treatments the client has received to date, which will prevent medication errors and promote client safety.The client was straight catheterized for 350 mL 2 hr ago is correct. The amount of urine output is an element of the "Background" portion of the SBAR tool. Other pertinent elements of this category are vital signs, pain rating, and any change from previous assessments.The client has Medicare insurance is incorrect. This information is not relevant to the client's clinical care and is not an element of the SBAR communication tool.The client lives in a one-story home is incorrect. This information is not relevant to the client's clinical care and is not an element of the SBAR communication tool.

A nurse manager is teaching a group of staff members about proper body mechanics. Which of the following statements by a staff member indicates an understanding of the teaching? "I should get assistance when lifting more than 35 pounds." "I will twist at my waist when moving an object." "I should hold objects 1 ft away from my body when I walk." "I will roll my shoulders forward to reduce strain on my back."

"I should get assistance when lifting more than 35 pounds."MY ANSWERThe nurse should identify that this statement by the staff member indicates an understanding of the use of proper body mechanics. Staff members should seek assistance when lifting objects heavier than 15.9 kg (35 lb). Staff members can get assistance from other personnel, or they can use a mechanical assistive device. "I will twist at my waist when moving an object."Staff members should maintain an erect trunk and should not twist at the waist. Using proper body mechanics when moving objects decreases the risk for musculoskeletal injuries. "I should hold objects 1 ft away from my body when I walk."Staff members should carry objects as close to the body as possible. Following proper ergonomic principles for carrying objects decreases the risk for falls and musculoskeletal injuries. "I will roll my shoulders forward to reduce strain on my back."Staff members should maintain correct posture to prevent recurrent lower back pain. Staff members should use proper body mechanics to decrease the risk for musculoskeletal injuries.

A nurse is preparing an in-service about family violence for a group of newly licensed nurses. Which of the following statements should the nurse include in the teaching? "Perpetrators of family-directed violence recognize their behavior as abnormal." "Female clients who experience partner violence are at greater risk for acute diseases." "The victim's risk for homicide is greatest when they decide to leave the relationship." "The level of violence of the events decreases over time."

"Perpetrators of family-directed violence recognize their behavior as abnormal."Individuals who engage in family-directed violence often believe that the violence is part of a normal behavior pattern. Several factors, including living conditions, stressors, and previous experience with family violence, contribute to this pattern of behavior. "Female clients who experience partner violence are at greater risk for acute diseases."Female clients who experience partner violence are at greater risk for chronic diseases, such as autonomic nervous system disorders, atherosclerosis, and cardiovascular disease. "The victim's risk for homicide is greatest when they decide to leave the relationship."MY ANSWERHelping to ensure the safety of victims of family violence is a primary nursing focus when caring for families who experience violence. The nurse should include in the teaching that the greatest risk for homicide occurs when the victim makes the decision to leave the relationship. "The level of violence of the events decreases over time."

A parent of a child who is terminally ill tells a nurse that she wants to take her child home. Which of the following responses should the nurse make?

"Your provider will be here later today."The nurse is changing the subject, which is a nontherapeutic communication technique. The nurse should encourage the parent to further share their feelings by showing empathy and using therapeutic communication techniques, such as asking open-ended questions. "I can give you information on what that would involve."MY ANSWERThe nurse is providing relevant information, which is a therapeutic communication technique. The nurse should advocate for the parent by supporting the choices they make regarding their child's care "I understand how you feel. I felt the same way when my sister was terminally ill."The nurse is minimizing the client's feelings, which is a nontherapeutic communication technique. The nurse should encourage the parent to further share their feelings by showing empathy and using therapeutic communication techniques, such as asking open-ended questions. "I think you should speak with social services about your request."The nurse is giving a personal opinion, which is a nontherapeutic communication technique. The nurse should encourage the parent to further share their feelings by showing empathy and using therapeutic communication techniques, such as asking open-ended questions.

A nurse is providing a report to an occupational therapist about a client who weighs 210 lb and has a prescription for one-third weight bearing on the right leg to prevent injury and falls. How many kg of weight should the client bear on the right leg? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

32 kg

A nurse manager is asked to select clients for early discharge from the unit following a mass casualty event. Which of the following clients should the nurse manager recommend?

A client awaiting a screening colonoscopy later that dayMY ANSWERThe nurse should include in the plan for early discharge any ambulatory client who is admitted for a screening. This client is stable and does not require special treatment that needs to be administered via inpatient care. The client could return at another time to have the screening procedure. A client whose discharge was cancelled the prior day because they developed respiratory distressThe nurse should identify that this client needs to remain in the facility. Recommendations for early discharge include sending home clients who have not had a critical change in condition within the prior three days. A client who is 6 hr postoperative following an open cholecystectomyThe nurse should identify that this client needs to remain in the facility. Recommendations for early discharge include sending home clients who were admitted for observation or could soon be discharged home. This client will have a surgical dressing and drain for about 24 hr and will likely be ready for discharge 1 to 2 days following surgery, if solid food is tolerated. A client who is prescribed gastric lavage treatments to treat acute aspirin toxicityThe nurse should identify that this client needs to remain in the facility. Recommendations for early discharge include sending home clients who could receive treatment at another location, such as a long-term care facility or rehabilitation center.

An occupational health nurse in a factory is planning interventions to reduce environmental stressors for employees. Which of the following interventions should the nurse use to affect physical agents in the environment? (Select all that apply.) Teach workers to choose personal strategies to cope with work stress. Limit the amount of time workers spend in temperatures over 43.3° C (110° F). Provide ear plugs for use at workstations throughout the factory. Obtain dosimeters for employees to wear when using new machinery that emits radiation. Require more frequent disinfection of work surfaces during influenza season.

Teach workers to choose personal strategies to cope with work stress is incorrect. The nurse should identify the use of personal coping mechanisms as an intervention to reduce psychosocial stressors. Psychosocial agents are internal factors for the employee.Limit the amount of time workers spend in temperatures over 43.3° C (110° F) is correct. The nurse should identify environmental temperature as a physical stressor. Reducing the amount of time employees spend in high temperatures can help to reduce the risk for heat exhaustion and heat stroke. Provide ear plugs for use at workstations throughout the factory is correct. The nurse should identify environmental noise as a physical stressor. Providing ear plugs can prevent damage to internal ear structures and subsequent hearing loss. Obtain dosimeters for employees to wear when using new machinery that emits radiation is correct. The nurse should identify environmental radiation as a physical stressor. Obtaining dosimeters will help monitor each employee's amount of radiation exposure to prevent overexposure. Require more frequent disinfection of work surfaces during influenza season is incorrect. The nurse should identify the influenza virus, and other pathogens, as biological agents in the environment. Requiring more frequent cleaning can prevent employees from being exposed to strains of the influenza virus and minimize the risk of infection.