Leadership
A nurse in a community health clinic is planning an in-service staff training session on nationally notifiable infectious conditions. Which of the following conditions should the nurse include in the teaching? A. Clostridioides difficile B. Varicella C. HIV exposure D. Influenza
B. Varicella The nurse should identify that varicella is a nationally notifiable infectious condition. - A: C. difficile is not a nationally notifiable infectious condition. - C: HIV infection is a nationally notifiable condition, but HIV exposure is not. - D: Influenza is not a nationally notifiable infectious condition, but influenza-associated pediatric mortality is a nationally notifiable infectious condition.
After a disaster plan is enacted, a nurse in a pediatric unit is asked to prepare a list of clients who can be discharged home due to a local incident involving many children. Which of the following clients should the nurse place on the potential discharge list? (Select all that apply.) A. A preschooler with asthma who has scattered wheezes that resolve with PRN albuterol B. A school-age child with a femur fracture in an external fixation device whose pain is controlled with PRN oral codeine C. An adolescent client who is developmentally delayed, has a PICC line, and needs 6 more weeks of antibiotics D. A toddler with a ventricular septal defect and bronchiolitis who is on 28% oxygen by oxyhood E. An adolescent client who is 1 day postoperative following scoliosis repair and is on a PCA pump
A, B, C A. A preschooler with asthma who has scattered wheezes that resolve with PRN albuterol B. A school-age child with a femur fracture in an external fixation device whose pain is controlled with PRN oral codeine C. An adolescent client who is developmentally delayed, has a PICC line, and needs 6 more weeks of antibiotics - The nurse should place clients who can be quickly and safely discharged on the potential discharge list. - Children who have asthma can be managed at home once the acute phase of illness has resolved. Because the preschool client's manifestations are responsive to the prescribed medication, this child can be safely discharged home with appropriate discharge teaching and follow-up care planning. - External fixation devices are worn for weeks to months; they are often managed at home once the device is placed and the client has learned how to care for the immobilized limb. This school-age client's pain is responsive to oral codeine. Prior to discharge, the client might need instructions on ambulation and weight-bearing, as prescribed. - Long-term antibiotic therapy is typically completed in the home following PICC line placement. A visiting nurse can assist this adolescent client with home care management. The client's developmental delay has no bearing on whether the client is safe to discharge. - D: This toddler with a chronic health problem (a congenital heart defect) is now experiencing an acute illness (severe lower respiratory illness). Because the client's increased care needs may potentially cause more complex problems, the child is not considered safe to discharge. - E: Clients are typically hospitalized for 4-6 days following scoliosis (curvature of the spine) repair (spinal fusion). This client is still on a PCA pump for pain control and is only 1 day postoperative. Commonly, spinal fusion clients must be fitted for a brace and taught how to apply it prior to discharge. This client is not considered safe to discharge.
A nurse suspects that a coworker is under the influence of alcohol. Which of the following behaviors in the workplace are consistent with substance use disorder? (Select all that apply.) A. Taking extended lunch periods and breaks B. Calling in sick frequently on Mondays or Fridays C. Expressing frustration with work assignments D. Demonstrating decreased concern about personal appearance and grooming E. Using excessive amounts of cologne or mouthwash
A, B, D, E A. Taking extended lunch periods and breaks B. Calling in sick frequently on Mondays or Fridays D. Demonstrating decreased concern about personal appearance and grooming E. Using excessive amounts of cologne or mouthwash - Extended lunch periods and breaks may indicate that the individual is ingesting alcohol in a remote location. - Calling in sick frequently on Mondays or Fridays may imply that the individual is binge drinking on weekends and is too ill to come to work. - Decreased concern about personal appearance and grooming and excessive use of cologne or mouthwash are signs of substance abuse disorder. - C: Frustration with assignments is a common workplace behavior but does not necessarily indicate substance use disorder.
A charge nurse is making shift assignments for a team that includes RNs, LPNs, and assistive personnel. Which of the following clients should the nurse assign to an LPN? A. A client who was just admitted by the unit staff for recurring angina B. A client who has emphysema and pneumonia and is receiving oxygen C. A client who has breast cancer and is receiving chemotherapy D. A client who was just admitted by the unit staff for a cerebrovascular accident
B. A client who has emphysema and pneumonia and is receiving oxygen This client requires routine care, medication administration, and data collection. This is an appropriate client to assign to an LPN. - A: This client needs an initial assessment, stabilization, and care planning; therefore, this is an appropriate client to assign to an RN, not an LPN. - C: This client's care requires specialized IV and medication training and expertise; therefore, this is an appropriate client to assign to an RN, not an LPN. - D: This client needs an initial assessment, stabilization, and care planning; therefore, this is an appropriate client to assign to an RN, not an LPN.
A nurse working at a rehabilitation facility is attending an interdisciplinary team meeting for a client who had a left hemispheric stroke. Which of the following members of the interdisciplinary team should the nurse recommend to assist this client? (Select all that apply.) A. Nurse B. Occupational therapist C. Speech therapist D. Physical therapist E. Respiratory therapist
A, B, C, D A. Nurse B. Occupational therapist C. Speech therapist D. Physical therapist - The role of the nurse is to attend the interdisciplinary meeting to present the client's condition and possible needs. - The occupational therapist is needed to assist the client with activities of daily living and to enhance independence (e.g. eating, dressing, bathing, grooming, and feeding). - The speech therapist is needed to assist the client with difficulties related to speech and swallowing as a result of the stroke. The speech therapist can also conduct an initial evaluation, complete a swallowing assessment, and provide ongoing speech therapy. - The physical therapist is needed to discuss and manage the client's physical impairments related to mobility as a result of the stroke. Ongoing physical therapy is needed to assist the client with learning how to walk again while using an assistive device, such as a cane or a walker. - E: The client is not experiencing respiratory challenges that require the assistance of a respiratory therapist as a result of the stroke.
A charge nurse is planning a department in-service training session about radioactive implants for a group of staff nurses. Which of the following points should the charge nurse include in the presentation? (Select all that apply.) A. Clients should be placed in a private room B. Throw away an implant that has fallen out in the client's trash can C. Staff members should wear a dosimeter badge when caring for the client D. Clients should be on bed rest E. Children over the age of 12 years can visit if they are accompanied by an adult
A, C, D A. Clients should be placed in a private room C. Staff members should wear a dosimeter badge when caring for the client D. Clients should be on bed rest - Clients should be placed in a private room to avoid exposing other clients to radiation from the implant. The nurse should follow the principles of time, distance, and shielding when working with a client who is receiving internal radiation therapy. - Health care providers should wear a dosimeter badge while caring for a client who has a radioactive implant. This badge measures and records a staff member's amount of exposure to radiation. - Clients who have a radioactive implant should remain on bed rest while the implant is in place to prevent dislodgment. - B: The nurse should pick up a radioactive implant that has fallen out with forceps and place it in a lead container. - E: Children under the age of 16 years and women who are pregnant are prohibited from visiting a client who has a radioactive implant.
A nurse is caring for a group of clients on a medical-surgical unit. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? (Select all that apply.) A. Collecting a stool specimen B. Providing instructions about using a spirometer C. Measuring oral intake D. Providing postmortem care E. Changing a sterile dressing
A, C, D A. Collecting a stool specimen C. Measuring oral intake D. Providing postmortem care The nurse should delegate collecting a stool specimen, measuring oral intake, and providing postmortem care to the AP. These tasks do not require assessment, analysis, or teaching and are within the range of function for an AP. - B: Providing instructions about using a spirometer is a form of teaching and is outside the range of function for an AP. - E: Changing a sterile dressing is outside the range of function for an AP. APs cannot perform nursing actions that require assessment.
A nurse is planning care for several clients. Which of the following clients should the nurse refer to a case manager? A. A client who has neurological deficits following a stroke B. A married female client who has delivered a full-term newborn C. A client who is postoperative following a cholecystectomy D. A child who has a fracture of the dominant arm
A. A client who has neurological deficits following a stroke The nurse should refer this client to the case manager for care. A client who had a stroke will likely require long-term treatment. A client who has ongoing needs for care or rehabilitation should receive care that is directed by a case manager due to the complexity and cost of the client's needs.
A charge nurse is conducting an in-service training session on ethics to a group of newly licensed nurses. Which of the following situations should the charge nurse include as an example of the ethical principle of veracity? A. A nurse truthfully answers the client's questions about upcoming chemotherapy B. A nurse stops inserting an NG tube when the client refuses the procedure C. A nurse provides the same amount of time to all clients regardless of condition D. A nurse reports an assistive personnel who transfers a client without using a gait belt
A. A nurse truthfully answers the client's questions about upcoming chemotherapy A nurse who truthfully answers the client's questions about treatment, such as chemotherapy, is demonstrating the ethical principle of veracity. Veracity refers to telling the truth and being straightforward and clear with clients about the treatment being delivered. - B: A nurse who is inserting an NG tube but stops when the client refuses is demonstrating the ethical principle of autonomy. Autonomy is including the client in the decision-making process for all aspects of care, including treatment. - C: A nurse who provides the same amount of time with all clients regardless of condition is demonstrating the ethical principle of justice, which involves fairness. - D: A nurse who reports an assistive personnel who fails to follow the safety guidelines within the facility for transferring a client is demonstrating the ethical principle of responsibility.
A nurse manager is planning staff development activities for the unit's new unlicensed assistive personnel (UAP). Which of the following activities should the nurse manager perform first? A. Determine the learning needs of the UAPs B. Administer a skills pretest to the new UAPs C. Provide the new UAPs with a performance checklist D. Ask the UAPs about any weaknesses they may have
A. Determine the learning needs of the UAPs The nurse should apply the nursing process priority-setting framework to prioritize their actions. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision; therefore, the nurse manager should first determine the learning needs of the UAPs.
A community health nurse is performing client triage while participating in a disaster drill. The nurse should recommend that which of the following client injuries receives treatment first? A. Hemothorax B. Open humeral fracture C. Multiple deep abrasions on the arms and face D. Superficial partial-thickness burns on both legs
A. Hemothorax The nurse should apply the survival potential priority-setting framework in mass casualty situations, when resources are scarce and resources must be allocated to save the greatest number of lives. While it could seem that the client who is most at risk should receive priority care, this client is the lowest priority. - The nurse should assign the highest priority to the client with injuries that are severe who has the potential to survive with treatment. Therefore, the nurse should recommend that the client who has a hemothorax receives treatment first. - A hemothorax is life-threatening, but with chest-tube insertion and stabilization, the client is likely to survive. - B: A client who has an open fracture does not have an immediate threat to life and can wait for treatment - C: A client who has multiple deep abrasions does not have an immediate threat to life and can wait for treatment - D: A client who has relatively minor burns does not have an immediate threat to life and can wait for treatment
A nurse is caring for a male client who is scheduled for a procedure. The client's son asks the nurse what medication is being given to the client. Which of the following responses should the nurse provide? A. I am sorry, but you'll need to ask your father for that information B. Your father was given lorazepam to treat anxiety C. You will need to ask the charge nurse for that information D. Don't worry. We will give your father all pertinent information before discharge
A. I am sorry, but you'll need to ask your father for that information The nurse must keep the client's personal health information confidential. It is up to the client to share confidential information with his son. - B: Telling the client's son about his medication without the client's permission is a breach of confidentiality. - C: The charge nurse would also need permission from the client to give information to the son. - D: This statement does not answer the son's question and dismisses his concerns.
A nurse is walking with a client who falls after the facility-issued walker loses a wheel. Which of the following actions should the nurse take regarding the completed incident report? A. Submit the variance report to the risk manager B. Place the variant report in the client's chart C. Document the completion of the incident report in the client's medical record D. Make a copy of the variance report for the provider
A. Submit the variance report to the risk manager Incident reports are confidential documents used by the institution to improve client care. Filing an incident report does not supersede the need for documenting the assessment in the client's medical record and notifying the provider. Once completed, the variance form should be submitted to the institution's risk manager. - B: Incident reports are confidential documents used to improve client care. The nurse should not place the report in the client's chart. - C: The nurse should not document the completion of an incident report in the client's medical record. - D: The nurse should not make a photocopy of the incident report, as this would allow attorneys to subpoena a copy of the report for potential use in litigation.
A nurse is delegating a client care task to an assistive personnel (AP). Which of the following directions should the nurse give the AP? A. This client needs to ambulate using a walker three times today B. Please record strict intake and output for this client C. This client needs to have blood glucose monitoring before each meal D. Please obtain vital signs from all the clients to whom you are assigned today
A. This client needs to ambulate using a walker three times today This direction includes the type of task to be done, the frequency which the task is to be performed, the duration of the task, and information about the mechanics of ambulating the client. - B: "Strict intake and output" does not provide enough direction for the AP. It does not explain how this expectation differs from "regular" intake and output and whether the values need to be reported to the RN. - C: This direction does not provide a specific time or details for monitoring the client's blood glucose level. It does not clarify how the values should be documented and whether they should be reported to the RN. - D: This direction does not identify the frequency at which this task is to be performed on each client or the parameters for reporting findings.
A nurse manager notes that a full-time nurse has been absent from work 6 times over the last 6 weeks. Using a non punitive approach, which of the following actions should the nurse manager take? A. Verbally remind the employee about the facility's employment standards B. Recommend that the employee review the facility's policy regarding absences C. Inform the employee in writing about the facility's employment policy D. Ask the employee for a written action plan after discussing the reasons for these absences
A. Verbally remind the employee about the facility's employment standards Verbal admonishment is the first step in the disciplinary process for this type of infraction. The employee might not know or remember the existing standard, and a verbal reminder may be sufficient to change the employee's behavior. - B: Recommending that the employee reviews the policy does not ensure that the employee will read and fully understand the employment standards. - C: Written admonishment is the second step in the disciplinary process for this type of infraction. If the employee fails to make a positive behavioral change after being verbally reminded by the manager about the facility's employment standards, the nurse manager should inform the employee in writing. - D: This is an example of performance-deficiency coaching, which the nurse manager should use to correct unacceptable behaviors over time.
A nurse is making a client's bed and finds a capsule of medication in the sheets. Which of the following actions by the nurse is consistent with safe nursing practice? (Select all that apply.) A. Administer the medication to the client B. Notify the provider C. Complete a variance report D. Document the finding in the client's electronic medical record E. Place the medication back in the medication drawer
B & C B. Notify the provider C. Complete a variance report - A: Administering the medication to the client is incorrect. The nurse should not administer the medication to the client, because the nurse does not know which dose of the medication the client missed. Administering the capsule now could result in an overdose if the client has recently taken the same medication. - D: Documenting the finding in the client's electronic medical record is incorrect. The nurse should not document the finding in the client's electronic medical record. The nurse should identify that the information in the client's medical record is subject to attorney review should the client decide, for any reason, to file suit against the facility or the healthcare staff. Instead, the nurse should follow facility policy and report the incident to the nurse manager and risk management through the use of a variance report. In addition, the nurse should avoid documenting in the medical record that a variance report was filed because this can also allow for the variance report to be subpoenaed should the client decide to file suit. - E: Placing the medication back in the medication drawer is incorrect. The nurse should identify that medications that are no longer packaged are considered contaminated and should be discarded.
A charge nurse on a medical-surgical unit is assigning client care to the upcoming shift. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? (Select all that apply.) A. Performing colostomy care B. Measuring a client's intake and output C. Interpreting a client's laboratory values following surgery D. Providing postmortem care to a client E. Checking nasogastric tube patency
B & D B. Measuring a client's intake and output D. Providing postmortem care to a client Measuring the intake and output of a client and providing postmortem care are within the range of function for an AP. - A: Performing colostomy care involves data collection, which is outside the range of function for an AP. This task should be delegated to a LPN. - C: Interpreting a client's laboratory values following surgery involves data collection and is outside the range of function for an AP. This task should be delegated to an LPN. - E: Checking nasogastric tube patency should be delegated to an LPN, not an AP.
A nurse is providing discharge teaching about wound care to a client who has a leg wound. Which of the following pieces of information should the nurse include in the teaching? (Select all that apply.) A. Use cotton balls to clean the infected areas B. Cleanse the wound with tap water C. Dry the leg wound after cleaning D. Microwave the cleaning solution before applying to the wound E. Discard soiled bandages in a moisture-proof bag
B & E B. Cleanse the wound with tap water E. Discard soiled bandages in a moisture-proof bag - Tap water of 0.9% sodium chloride should be used to cleanse the wound. - Soiled bandages and gloves should be placed in double-bagged, moisture-proof bags and not in the regular trash. This prevents the spread of contamination to other family members within the household. - A: Cotton balls should not be used because the fibers can get caught in the wound and cause an infection; therefore, gauze squares or non woven swabs should be used to clean the wound. - C: Drying the leg wound after cleaning should be avoided. The wound should be open to the air to allow the wound to retain moisture and promote healing. - D: The nurse should warm the cleaning solution to the client's body temperature if possible; however, using a microwave to warm the solution can make it too hot.
A nurse is teaching a group of newly licensed nurses about violations of client rights. Which of the following examples of a violation of client rights should the nurse include in the teaching? A. A client who is confused and recovering from abdominal trauma has mitten restraints placed to prevent disruption of an abdominal wound B. A client who has schizophrenia is placed in the seclusion room of the psychiatric unit for making frequent outbursts of obscenities directed at nurses of the opposite sex C. A health care proxy releases the medical records of a client to a long-term care facility for a placement evaluation D. The parents of a 16-year-old who has gunshot wounds decide to limit their child's visitors to family members only
B. A client who has schizophrenia is placed in the seclusion room of the psychiatric unit for making frequent outbursts of obscenities directed at nurses of the opposite sex Seclusion is a restraint that should be used when a client is demonstrating violent of self-destructive behavior that jeopardizes the safety of self or others. This client does not meet the criteria for seclusion. - A: This client is at risk of causing self-injury by disrupting the abdominal wound. The nurse should apply mitten restraints, which are less restrictive than wrist restraints. - C: The client's health care proxy has the authority to consent to the release of medical records. - D: A 16-year-old client is a minor; therefore, the client's parents have the right to make this decision for the client.
A nurse is delegating a task to an assistive personnel (AP). The AP is to transfer a client who has a below-the-knee amputation from a bed to a wheelchair. The AP has never transferred a client with an amputation before. Which of the following actions should the nurse take? A. Provide the AP with a manual on how the transfer should be done B. Assist the AP after he has practiced the transfer C. Transfer the client while the AP observes D. Ask another AP to transfer the client
B. Assist the AP after he has practiced the transfer The safest way for the nurse to determine if the AP has the knowledge and skill to transfer the client who has an amputation is by having the AP practice and demonstrate the task. By assisting the AP with the first transfer, the nurse helps ensure that delegated care is safely provided. - A: Providing a manual on the procedure alone will not adequately ensure the safety of the client during the transfer. - C: Although this strategy may be used to demonstrate to the AP how to transfer an amputee, it does not allow hands-on practice for the AP. - D: While this action will accomplish the task of transferring the client, it does not address the AP's need to learn how to transfer a client who has an amputation.
A nurse manager establishes staff nurse committees to address unit issues, institutes an open-door policy for speaking about concern, and supports professional staff development. Which of the following leadership styles is this nurse manager displaying? A. Laissez-faire B. Democratic C. Autocratic D. Transactional
B. Democratic The democratic manager encourages the staff to participate in decision-making, communicates effectively, offers constructive criticism, and believes the best of people. - A: A laissez-faire manager provides little structure or direction for a group. - C: An autocratic management style is characterized by behaviors such as making all decisions without staff input, focusing on task completion, and limiting access to communication with the manager. - D: A transactional leader focuses on getting work done and the tasks to be completed.
A nurse manager calls a meeting of the unit's staff members to discuss cost-containment issues. The nurse manager has asked for staff input regarding strategies to help reduce costs. Which of the following types of leadership is the nurse manager using? A. Autocratic B. Democratic C. Laissez-faire D. Moral
B. Democratic This is an example of democratic leadership. A democratic leader guides staff toward an objective and shares responsibility with the staff. This is the ideal type of leadership in this situation because a great amount of creativity can occur, and many strategies can be developed. - A: An autocratic leader makes decisions independently and notifies staff of the decisions made. An autocratic manager maintains a high degree of control and allows little freedom of staff members. - C: A laissez-faire leader exerts little or no leadership and control. This manager is providing staff with direction and leadership. - D: Moral leadership involves honesty and fairness under any circumstances.
A 13-year-old female client tells the charge nurse in the pediatric unit that she does not want the male nurse assigned to care for her. Which of the following responses should the nurse make? A. I will need to discuss your request with your parents first B. I'll change the assignment so a female nurse is caring for you today C. A female assistive personnel will be helping with your bath D. The male nurse assigned is required to care for both male and female clients
B. I'll change the assignment so a female nurse is caring for you today The client has the right to respect and personal dignity and the ability to participate in decisions regarding her care. The charge nurse should change the assignment when possible to minimize any feelings of loss of control for this client.
A nurse is administering medications to a client who is recovering from a stroke and has right-sided paralysis. The nurse places the client's medications on the left side of the mouth and administers pills one at a time. Which of the following ethical principles is the nurse displaying? A. Autonomy B. Nonmaleficence C. Fidelity D. Justice
B. Nonmaleficence Nonmaleficence is the duty to do no harm and to protect clients from harm by eliminating threats. These actions taken by the nurse are important for the safety of the client by preventing aspiration. - A: Autonomy is the right to self-determination, independence, and freedom of choice. - C: Fidelity is the obligation to be faithful to commitments made to self and others. - D: Justice is the obligation to be fair and to treat people in an equal manner.
A nurse in the emergency department is preparing to obtain informed consent for surgery from a client who received a meperidine hydrochloride IV during transport from a rural hospital. Which of the following actions should the nurse take to obtain consent for surgery? A. Obtain consent from the client B. Obtain consent from a relative of the client C. Consent is implied because the client agreed to be transported to the emergency department D. Delay the surgery until the medication has been metabolized
B. Obtain consent from a relative of the client A client who has received meperidine cannot give consent because the medication can alter the ability to understand the consent process. The nurse should obtain consent from a relative of the client. - If a relative is unavailable and the surgery is determined to be critical, the surgery can proceed without client consent. - A: This client has been given a narcotic that can alter the ability to understand the consent process. The client cannot give consent under these circumstances. - C: Consent for transfer to another facility for evaluation by a specialist does not assume consent for any further procedures, surgery, or care. - D: Delaying surgery until the medication is metabolized may cause the client unnecessary pain and increase the risk of complications and client demise. If a relative is unavailable and the surgery is determined to be critical, the surgery can proceed without client consent.
A nurse is preparing a client for a lumbar puncture. The client has signed the consent form but tells the nurse that she does not remember what the doctor will do during the procedure. Which of the following actions should the nurse take? A. Page the provider stat to come and explain the procedure to the client B. Remind the client that the doctor will insert a needle to get a sample of fluid from her spine C. Explain how the assistant will position the client for the procedure D. Tell the client that someone will explain the procedure when it is time to begin
B. Remind the client that the doctor will insert a needle to get a sample of fluid from her spine A signed consent form indicates that the provider informed the client about the procedure and that at the time the client understood what to expect. If the client states she does not remember what to expect, the nurse should clarify any details the provider previously gave the client. - However, if the client expresses a further lack of understanding or states that the provider did not inform her, the nurse should either notify the charge nurse or call the provider directly. - A: The signed consent form indicates that the provider explained the procedure to the client previously. The nurse should have confirmed this when witnessing the consent. - C: Although the nurse should provide this information, this response does not clarify what the provider will do once the client is in position and directs the focus away from what the client wants to know. - D: This response is non therapeutic, rejects the client's concern, and fails to identify the need for the nurse to take further action.
A group of nurses on a telemetry unit informs a nurse manager of a need to update the cardiac monitoring system to improve arrhythmia detection. Which of the following responses should the nurse manager make? A. This purchase will require the completion of a variance analysis B. This purchase will need to be addressed in the capital budget plan for the unit C. This purchase will result in a reduction in the operating budget D. This purchase can be reimbursed by Medicare funds, as clients who use Medicare will benefit from the equipment
B. This purchase will need to be addressed in the capital budget plan for the unit The capital budget involves planning for spending related to equipment and major purchases that have a long life of use. - A: The anticipated purchase of new equipment does not require a variance analysis. Variance analysis is a process that differentiates planned budget results from actual results. - C: An operating budget is separate from the budget for large expenditures for equipment or other major purchases. This type of budget reflects expenses that change in response to the volume of service (e.g. supplies, electricity). - D: Medicare funds do not reimburse institutions for equipment purchases, even though clients who are receiving Medicare use the equipment.
A nurse is preparing to care for a group of clients after receiving change-of-shift reports. Which of the following clients should the nurse assess first? A. A client who has benign prostatic hyperplasia (BPH) and reports dysuria B. A client who has ulcerative colitis and reports diarrhea C. A client who has emphysema and reports dyspnea D. A client who has esophageal cancer and reports painful swallowing
C. A client who has emphysema and reports dyspnea
A group of providers is participating in a cardiopulmonary resuscitation effort for a client who is in cardiac arrest. Which of the following types of leadership is required for this group to function efficiently? A. Transformational B. Participative C. Autocratic D. Laissez-faire
C. Autocratic Autocratic leadership is most effective in an emergency situation. An autocratic leader will direct and issue commands that are necessary for successful cardiopulmonary resuscitation. - A: Transformational leadership is not appropriate for an emergency situation. A transformational leader gives group members responsibilities that will enhance their professional development. In cardiopulmonary resuscitation, one person must organize the group's actions and guide the resuscitation efforts. - B: Participative leadership, also called democratic leadership, is not appropriate for an emergency situation. A participative leader serves as a resource person and facilitator and is non-directive. In cardiopulmonary resuscitation, one person must organize the group's actions. - D: Laissez-faire leadership is not appropriate for an emergency situation. A laissez-faire leader demonstrated a non-directive approach. In cardiopulmonary resuscitation, one person must organize the group's actions and guide the resuscitation efforts.
Using high-quality monitoring tools, a facility committee identifies that clients who have congestive heart failure have an average length of stay of 5 days instead of the established standard of 3 days. Which step should the nurse implement next in the quality-improvement process? A. Educate staff members on shortening the length of stay for these clients B. Collect data regarding the length of stay for these clients C. Determine which actions can be instituted to address this problem D. Research the accuracy of the standard of care that has been accepted
C. Determine which actions can be instituted to address this problem Further analysis of data will identify factors that contribute to longer lengths of stay. Identifying actions to shorten the client's length of stay is the next step in the process.
A nurse is caring for a client who asks if the client in the next room is in pain because she cries out frequently. Which of the following statements should the nurse make? A. That client has cancer and is quite uncomfortable B. We are doing our best to keep that client as comfortable as possible C. Does the crying out bother you? D. Why don't you ask that client's family when they visit?
C. Does the crying out bother you? This therapeutic response focuses on the client's feelings rather than on confidential information concerning the client in the next room. It summarizes the client's question and poses an open-ended, relevant query for the client to expand on if desired. - A: Revealing another client's diagnosis is an invasion of privacy and a violation of HIPPA regulations. - B: This non therapeutic statement by the nurse uses a defensive response. It ignores the client's concerns because the nurse is focusing on defending the health care team. - D: This non therapeutic response by the nurse changes the subject and does not address the client's concerns. It also ignores the right to privacy for the other client.
A charge nurse is coordinating the evacuation of clients from a facility following a bomb threat. Which of the following actions should the nurse take when implementing the evacuation process? A. Call the client's family members to provide additional help with moving the clients B. Ask clients who are able to ambulate to assist in moving the unstable clients C. Instruct clients who are able to ambulate to leave D. Direct staff members to close the doors and windows as each room is evacuated
C. Instruct clients who are able to ambulate to leave Clients who are able to ambulate should leave first in an evacuation process, as this quickly reduces the number of clients who require evacuation assistance. - A: Moving the clients is the responsibility of the facility's staff. Asking family members to come to the facility in an emergency puts them at risk and delays the evacuation process. - B: Staff members should not ask clients to rescue unstable clients since this puts clients at great risk. In some situations, ambulatory clients can assist clients who are stable and in a wheelchair. The nurse should use critical thinking to determine the safety of this practice for some clients. - D: Staff members should evacuate all clients prior to enacting containment measures. Taking the time to close doors and windows delays the evacuation process.
A nurse is caring for a client who is on bed rest and states, "I would prefer not to have all of the side rails on my bed raised." After assessing the client is safe without the four side rails raised, which of the following interventions should the nurse implement? A. Request a prescription from the provider to leave the client's side rails down B. Inform the charge nurse of the client's feelings about the side rails C. Leave the side rails down and document this decision as per the client's request D. Arrange for the client to discuss these feelings with another client who uses side rails
C. Leave the side rails down and document this decision as per the client's request - Raising all four side rails can be considered a form of restraint if they restrict the client's ability to get in and out of bed. - This client is on bed rest and does not require that level of mobility; however, if the client expresses a wish for the rails to be down, the client's level of consciousness is not impaired, and there is no other specific safety hazard posed by lowering the side rails, the client's request should be respected.
A charge nurse is teaching a group of unit nurses about alternative restraints for clients who are confused and wandering. Which of the following pieces of information should the nurse include in the teaching? A. Distract the client by leaving on the television B. Plan to administer a sedative to the client C. Provide the client with a rocking chair D. Place full-length side rails on the bed
C. Provide the client with a rocking chair The nurse should advise providing the client with a rocking chair to expend some of the client's energy through rocking rather than walking, which leads to wandering. - A: The nurse should advise decreasing stimulation by reducing the noise level and dimming the lights - B: The nurse should advise limiting the administration of sedatives and psychotropic medications as an alternative restraint. The need for restraints can be related to over-medicating. - D: The nurse should replace full-length side rails with half-length or three-quarter-length rails to reduce the risk of falling if the client has confusion.
A nurse is caring for a client who is a local public official. A newspaper reporter repeatedly phones the unit seeking information and states, "The public has a right to know the health status of elected officials." Which of the following actions should the nurse take? A. Acknowledge that the person is a client on the unit but give no specific details of the client's condition B. Refer any calls directly to the client's room so that the client and her family can decide what to tell the press C. Refer all media inquiries to the nursing supervisor D. Hang up on the media callers because nursing staff members are not required to speak to them
C. Refer all media inquiries to the nursing supervisor The HIPPA Privacy Rule prohibits disclosing client information to individuals who are not involved in care without the client's express consent. The reporter should be told that, due to confidentiality issues, no information can be given about any client. The nurse should refer the reporter to the nursing supervisor. - D: Hanging up on callers from the news media is unprofessional. The nurse should refer calls to the nursing supervisor.
A nurse suspect that a coworker may be in an impaired state when providing care to clients. Which of the following actions should the nurse take? A. Ask other coworkers if they feel the same way B. Speak directly with the impaired coworker C. Report these observations to the nurse manager D. Refuse to work with the impaired coworker
C. Report these observations to the nurse manager The nurse who observes an impaired coworker's performance should report this behavior to the nurse manager. If the coworker is found to be impaired, this action will initiate an appropriate intervention and support, and clients will be protected from the actions of an impaired coworker. - A: The nurse should not share this concern with other coworkers. - B: The nurse should not discuss this issue with the impaired coworker. If the concern is unfounded, the nurse could cause unnecessary conflict with the coworker. This action can also delay the initiation of an appropriate intervention and support for the impaired coworker. - D: The nurse should not refuse to work with the impaired coworker, as this may cause conflict on the unit and create scheduling difficulties.
A nurse manager notes several conflicts among nurses on different shifts. Which of the following strategies should the nurse manager use to resolve these conflicts? A. Have the charge nurses for each shift get together and discuss the issues between shifts B. Direct the nurses from each shift to discuss their issues and present solutions to the nurse manager C. Set up a series of meetings for all staff members to attend to discuss issues D. Remain uninvolved and allow the nurses from each shift to resolve the issues among themselves
C. Set up a series of meetings for all staff members to attend to discuss issues Through this approach, the nurse manager is using the conflict-resolution strategy of collaboration by encouraging all staff members associated with the conflict to communicate and work together to devise and implement win-win solutions. - A: This approach does not allow any of the staff members involved in the conflicts to contribute to solutions. - B: This does not allow the nurse manager to participate in and facilitate the creation of win-win solutions. It only allows approval or disapproval after the staff members have spent time and energy devising potential solutions. - D: This approach does not allow the nurse manager to facilitate the creation of win-win solutions.
A nurse is caring for a client who is dying and unable to make decisions for himself. The client's adult children disagree about his code status. Which of the following sources should the nurse depend on for decisions regarding the client's end-of-life care? A. The client's oldest child B. The attending provider C. The client's health care proxy D. The facility's ethics committee
C. The client's health care proxy If the client cannot speak for himself, the nurse should follow the directions of the client's health care proxy, as this is the person the client chose to make decisions under these circumstances. - A: If the client does not have advance directives or has not named a health care proxy, the family may be asked to make end-of-life decisions. - B: The attending provider may offer suggestions on end-of-life care, but the client or the client's health care proxy directs treatment. - D: In the absence of advance directives, the facility's ethics committee may be called upon to intervene if conflict occurs regarding end-of-life decisions.
A home health care nurse is conducting a home hazard assessment. For which of the following findings should the nurse intervene? A. The client's hot water temperature is set to 46.1c (115f) B. There are 8 steps to enter the client's home C. The client's household lamps have 40-watt light bulbs installed D. The bathroom has a handheld shower attachment for bathing
C. The client's household lamps have 40-watt light bulbs installed The nurse needs to intervene for low-wattage light bulbs. Inadequate lighting increases the risk of falls and presents a safety hazard for the client. - A: Hot-water heater temperatures should be set to a maximum of 49c (120f) - B: The nurse does not need to intervene for the steps leading into the client's home. The nurse should, however, assess any broken or loose steps and note the security of handrails on both sides of the stairway. - D: The nurse does not need to intervene for a handheld shower attachment, as this will assist the client in bathing. The nurse should inspect the tub for a nonstick surface.
A nurse is following standard policy and procedure for reporting a client who has a communicable disease. Which of the following infections should the nurse plan to report to the CDC? A. Clostridioides difficile B. Candidiasis C. Vancomycin-resistant Staphylococcus aureus D. Trichomoniasis
C. Vancomycin-resistant Staphylococcus aureus The nurse should follow policy and procedure for reporting a client who has vancomycin-resistant S. aureus (a communicable disease) to the CDC. - A, B, & D: The nurse does not need to report C. difficile, candidiasis, or trichomoniasis to the CDC.
A nurse overhears two other nurses discussing a conflict they are having about who should complete certain client-care tasks. The nurses agree that they are tired of the conflict and will let the nurse manager decide who should complete the tasks. The nurse should identify this outcome as which of the following approaches to conflict management? A. Win-win B. Win-lose C. Win-yield D. Lose-lose
C. Win-yield A win-yield approach involves both parties no longer trying to resolve the conflict. Instead of taking the initiative to end the conflict, they agree to honor whatever the nurse manager decides. - A: A win-win strategy is a collaborative approach. There is no power struggle, and both parties work together for a positive outcome that meets a common goal. - B: A win-lose strategy involves one party emerging victoriously and the other losing the struggle. If the losing party continues to pursue the situation, it becomes a competing strategy. - D: A lose-lose strategy is also an avoidance approach. The two parties abandon the struggle and take no further action, but the conflict remains. In this outcome, no one wins.
A charge nurse receives a call from the nursing supervisor about an explosion at a local factory and an urgent need for facility beds for newly admitted clients. Which of the following clients should the nurse recommend for discharge? A. A 60-year-old client with type 2 diabetes mellitus who was admitted 48 hr ago with uncontrolled glucose levels B. A 58-year-old client who is 12 hr postoperative following a total knee arthroplasty C. An 80-year-old client admitted 24 hr ago for vomiting and dehydration D. A 44-year-old client with asthma who was admitted for carpal tunnel surgery
D. A 44-year-old client with asthma who was admitted for carpal tunnel surgery A client who is admitted for carpal tunnel surgery is stable and having an elective procedure. Therefore, the nurse should recommend this client for discharge. - A: A client who was admitted 48 hours ago with uncontrolled glucose levels is considered unstable. - B: A client who is 12 hours postoperative following a total knee arthroplasty is considered unstable. - C: A client who was admitted 24 hours ago for vomiting and dehydration is considered unstable.
A nurse manager is observing the staff members working on her unit. Which of the following actions should the nurse manager recognize as an example of paternalism? A. A nurse asking to care for an older adult client every day who reminds the nurse of a favorite grandparent B. A male nurse caring for an adolescent male client because the client is uncomfortable around female nurses C. A middle-aged adult assistive personnel (AP) mentoring a younger less-experienced AP on the unit D. A nurse practitioner withholding information from a client who is dying to avoid causing the client distress
D. A nurse practitioner withholding information from a client who is dying to avoid causing the client distress Paternalism is a type of relationship between clients and health care providers in which the health care providers believe they know what is best for the clients. - In this example, the nurse practitioner withholds information so as not to cause the client distress. This practitioner is making the decision for the client and denying the client the right to be informed. - A & B: In these examples, the nurse is appropriately caring for the client - C: In this example, the AP is taking appropriate action
A nurse is teaching a group of newly licensed nurse managers about the principle of justice. Which of the following statements by a nurse manager indicates an understanding of this teaching? A. I will refer an unhappy employee to the individual with whom a conflict arose B. I will allow staff members to schedule their birthday holidays on alternate days, as long as staffing levels are maintained C. I will encourage staff participation in choosing new telemetry monitors for the unit D. I will compose staff schedules so that each person works two holidays a year
D. I will compose staff schedules so that each person works two holidays a year Justice means treating everyone fairly. By scheduling each person to work two holidays per year, the nurse manager is requiring staff members to work an equal share of holidays. - A: This is an example of the appropriate use of conflict management. By referring unhappy staff members to the individuals with whom they have conflicts, the nurse manager is encouraging individual problem-solving behaviors. - B: This demonstrates the principle of autonomy. By allowing staff members to participate in scheduling while maintaining appropriate levels of staffing, the nurse manager is encouraging independent, professional behavior. - C: This is an example of change theory. By allowing staff members to participate in decision-making for the unit, the nurse manager is encouraging staff input in the change process.
A nurse is caring for a client who has recently been prescribed lithium carbonate. Which of the following assessment findings is the priority for this client? A. Fine hand tremors B. Weight gain of 2.7 kg (6 lb) C. Report of nausea D. Poor motor coordination
D. Poor motor coordination The nurse should determine that the priority finding is poor motor coordination, which is an advanced manifestation of lithium carbonate toxicity. - The nurse should hold the client's medication and notify the provider - A: Hand tremors are an expected finding for a client who has recently been prescribed lithium carbonate, and the tremors may continue for a few weeks before subsiding. Therefore, another finding is the nurse's priority. - B: Weight gain is an expected finding for a client who has recently been prescribed lithium carbonate and can be addressed using diet and exercise. Therefore, another finding is the nurse's priority. - C: Nausea is an expected finding for a client who has recently been prescribed lithium carbonate, and it may continue for a few weeks before subsiding. Therefore, another finding is the nurse's priority.
While participating in a continuous quality-improvement program, a nurse is reviewing medical records to determine the time of first postoperative ambulation of clients who had abdominal surgery. In which type of quality audit is the nurse participating? A. Outcome B. Structure C. Strategic planning D. Process
D. Process A process audit measures the interventions used to facilitate expected and desired outcomes for clients. Early ambulation is essential for the prevention of postoperative complications. - A: An outcome audit evaluates how the client's health status changed as a result of an intervention. - B: A structure audit evaluates the relationship between quality care and appropriate structure and includes inputs such as the environment in which care is delivered. - C: Strategic planning is done as a part of the planning process. It typically examines the purpose, mission, philosophy, and goals of an organization.
A nurse manager is orientating newly licensed nurses to a facility and is emphasizing the importance of practicing within standards of care. To which of the following legal concepts is the nurse manager referring? A. Punitive damages B. Intentional torts C. Good Samaritan laws D. Professional negligence
D. Professional negligence Standards of care establish safe nursing practice. Professional negligence occurs when a nurse is acting in a manner that a reasonable and prudent nurse would not, resulting in unsafe care. Professional negligence constitutes malpractice. - A: Punitive damages are a form of financial compensation awarded to a client who has been injured. The compensation goes beyond the costs of the loss and is intended as a punishment to the party who caused the damage. - B: Torts are wrongdoings committed against a person. An intentional tort is an act that violates the rights of another, such as assault, battery, false imprisonment, and invasion of privacy. - C: Good Samaritan laws apply to health care workers and sometimes non-medical professionals who attempt to aid a person in an emergency outside of a medical setting. These laws protect the health care worker from liability as long as the scope of practice is not exceeded.
A nurse is tracking the outcomes of clients on the unit who have received postoperative pain management. This activity demonstrates which of the following competencies of the Quality and Safety Education for Nurses (QSEN) initiative? A. Safety B. Informatics C. Patient-centered care D. Quality improvement
D. Quality improvement The QSEN competency involves using data to track outcomes with the goal of devising process to improve clients' outcomes. - A: This QSEN competency involves using national safety guidelines and goals to provide safe client care. - B: This QSEN competency involves navigating clients' electronic health records and using technology effectively to manage client care. - C: This QSEN competency involves determining clients' needs, preferences, and values and providing care that addresses these parameters.
A nurse is reviewing laboratory results for a client who is at 12 weeks gestation. Which of the following findings should the nurse report to the provider? A. Hgb 12 g/dL B. WBC 15,000/mm^3 C. Fasting blood glucose 80 mg/dL D. Serum creatinine 0.4 mg/dL
D. Serum creatinine 0.4 mg/dL This value is below the expected reference range for a client who is pregnant. The nurse should report this value to the provider. - A, B, & C: These values are within the expected reference range for a client who is pregnant.